Dr. Visit

I had to go to Chapel Hill to see my Dentist, and since my knee was sore I thought I’d swing by the surgeon’s office to discuss it. I showed him where I’m sore on the medial inferior facet of the knee, and explained how the patella tendon area has felt tender recently (“squishy” while running).

He poked and proded and in the end thinks that this is just a normal part of my recovery. There’s still some inflamation in the trochlear grove that the patella is rubbing, and it will take some time to go away. He said continue to listen to my body and back off when necessary. If running seems to be the major cause, to back off running and conentrate on biking. He again suggested swimming and water running, but I don’t live close enough to a pool to make that possible on a regular basis.

I also expressed my concern to him that the patella now seems less mobile than before surgery, and he also said that was natural. After surgery the retinaculum fibers tend to tighten, and that I just need to continue to work on my mobilizations.

And finally he suggested iontophorsis for the two “nodules” that have grown at the portals. These seem to be tough fibrous tissues, almost like calcium deposits, but he just said they are scare tissue. Sometimes they have to go in surgically to remove them but he thinks mine will benefit from iontophorsis, which is when cortizone is massaged in electronically. So I’ll talk to my PT about that.

/Sean

Progress

I haven’t written in a while so here’s an update. Something I should have written about but did not was that I fell on Saturday 10/29. I was being silly and jumped on a vine hanging from a tree in our backyard, and down it came. My knees were flexed, so I landed hard on both legs, and the R leg flexed much more than it has since surgery. It was extremely painful – so much so that I got a little nauseous. But it seemed to recover relatively quickly after that.

I’ve been sore the last few days (weeks?) under the patella tendon, just a bit medially. I thought it may have been from some agressive stool vaults my PT had me try or the fall, or maybe a combination of the two. Looking back at my exercise log, my fall was on 10/29 but I ran 20 minutes straight on 11/1. But ever since that 20 minute run, I’ve been too tender to add to it. In fact, I’ve stopped running after 5 or 6 minutes a couple of times. Just last night I did 2 minutes running 1 minute walking 5 times for a total of 10 minutes running.

I have been biking w/o discomfort both on the trainer and on the roads. I’ve done just over 30 minutes so far. I’m about 1 minute per mile slower than before surgery on my 6 mile assesment ride to the boat ramp and back, but that is w/o pushing it at all and no standing while pedalling.

When we were in the hospital for a few days when Reece was born, I actually got sore by not doing anything! I was not icing there, so maybe that was part of it.

I am disappointed and frustrated with where I am. The patella tendon pain seems to be subsiding after a couple of weeks so that is good. The patella does not move very much — even less so than before surgery. My PT worked really hard on it today and it did loosen up.

Quick Update

A quick update on my progress:

  • I actually ran for 5 minutes out of a 30 minute treadmill walk on Monday. I ran 1 minute on the 5, 10, 15, 20, and 25 minute marks. I was a bit sore later, but not much.
  • On Wednesday the fitness center at the hotel I was at was closed, so I tired the run walk routine outside. But it didn’t feel good at all running so I stopped at 2 minutes.
  • On Thursday the fitness center was back and I ran 2 minutes 4 times with 3 minute walks between. Knee was a bit tender so I did not do the 5th one which was my original intent.
  • I’m up to 30 minutes on the stationary bike and that feels good.
  • My PT had me start adding plyometrics — basically a “stool vault” where I bound from one leg to another over a stool, some straddling movements, crossover side running, etc.
  • And I’ve added wall squats, mostly single leg with the right leg, and hamstring curls, to my leg lift exercises to work on the right leg’s strength.
  • Finally, lots of stretching of the IT band and the lateral posterior hamstring. Well, the lower outside part that feels like a tendon.

I’d like to be doing more but overall I am happy with my progress. My knee is still tight but I recently reached 137 degree flex, so only a little more to go to be normal. But that is not very comfortable yet!! And it does get a bit sore here and there and is still somewhat inflammed. But again I had more than just a simple scope and recovery will take some time. And of course I won’t know if this solved the long term problem of patellofemoral syndrome until I can really start pushing it.

Rolfing

In my continuing attempt to document all of the things I tried before surgery, here’s some info on Rolfing….

A local rolfer writes for a local endurance magazine, and I saw her articles and liked what she had to say. She has a good background in physical activity, yoga, and Rolfing, and I like the integrated approach. She is the same person that gave me the bioprint, and so we also incorporated that information into the Rolfing program.

It’s somewhat hard to describe the process. It’s like a deep tissue massage, combined with body movements or certain positions, all used to facilitate proper alignment. I’m into proper alignment from all the yoga I once did. (I started yoga because of the knee problem!) In addition, there are certain exercises my Rolfer gave me to do at home to add to the effect.

Typically there are 10 sessions in traditional Rofling. I can’t recall the exact order or the specific goals for each session, but they all are aimed at integrating the body into proper alignment. Overall I think that something like Rofling, where someone physically manipulates the body with the goal of proper alignment, is good. But I question whether that can be done in 10 sessions. I would think soft tissue manipulation would need to be an on-going, continuous process, over a long period of time, to have any real lasting effects.

My Rolfer tailored each session more to me than the traditional sequence, though we didn’t abandon that altogether. But the bulk of time was spent trying to get my right knee to stop rubbing the femur. We found issues in my lower back, foot, ITB, etc. In the last session, we agreed that my problem was beyond just soft tissue manipulation. 😦 I had already decided I would go for surgery, but this was just one more “nail in the coffin.”

I think the person doing the Rolfing is very important. Someone that understands your goals, takes the time to really understand your problem, and works with you towards that goal, using Rolfing and any additional knowledge they have. I guess that holds true for the doctors and physical therapists and anyone else you may work with.

So would I recommend Rolfing? I think giving a few sessions a shot is certainly worth it. If you can get your insurance to pay for it, typically under “neuromuscular retraining,” it would definitely be worth the try. Otherwise it can get to be a bit expensive at $100 per session. My insurance company doesn’t cover Rolfing unless you claim it as neuromuscular retraining, but then the practionar has to be a certified physical therapist (not a certification in rolfing alone).

Update

Well it’s been over a week again, so here’s a quick update on where I am:

– still doing about 30 minute walks on the treadmill, or this week in Boston
have been walking around the city
– 20 minutes on an elliptical, which felt pretty good
– up to 20 minutes on the stationary bike
– finally getting my heart rate up a bit — to 110-120 — and sweating a little
– lots of knee flex stretches and straightenings — need to get full range of
motion back!
– I’d really like to run! I tried a running motion at 4.2mph about 5 or 6 days
ago and it didn’t feel quite right. A bit tight above the knee area and I
could feel tenderness on the inside. But I think I will try again in the next
day or two.
– I’ve been doing some leg lifts with ankle weights and bands but not enough

Update

It’s been a while since I’ve posted so here’s a quick update just about 1 month after surgery:

– I’m up to 30 minutes walking on the treadmill, with a high speed of 4.0 mph
– Just added some inclines up to 5%
– 10 minutes on stationary bike with almost 0 resistence
– lots of leg lifts (vmo/quad, hip abduction, hip adduction)
– still icing a few times a day
– knee flex stretches still hurt, and last measurement was at 133 degrees
– still doing patella mobilization stretches

The knee is still a bit swollen, but overall progress is good. Well, I see folks running after a scope in 2 to 3 weeks, and that makes me feel like I’m not progressing that much. But I know I had a fair amount done — more than just simple cartlidge clean up. So I have to keep it in perspective. I have good days and bad days with that, but more good than bad recenlty.

I would like to start running in the next few days, even if it’s just for 2 or 3 minutes. I see my PT tomorrow and the Dr. on Monday, so we’ll see what they say. Knee flexes are still somewhat painful when I get to 130 degrees or so, and I need to get back to 140.

Also, I’ve just noticed in the last day or two that the knee seems a bit unstable on non smooth ground. It seems to give or “buckle” very slightly here and there. Things change so much that hopefully this is just a passing phase. With the limited use of the past month, and the use it has had being all very controled, maybe this is expected.

/Sean

BioPrint

In my continuing effort to document things I tried before surgery, here’s a post on bioprinting.

I can’t recall exactly where I saw the information on bioprinting, but at any rate, it led me to a local rolfer who does it. I eventually did 10 rolfing sessions with her as well as the bioprint, and I’ll post on rolfing at some point.

The official web page for bioprints is www.biotronix.com.

After reading about it, I thought I’d give it a shot. Basically a bunch of sensors are placed on your body, several digital photos are taken, and then those photos are uploaded to biotronix, and a report is sent back. The report contains an analysis of where you are “off” and exercises you can do to try to correct some of those problems. By where you are off, I mean structural imbalances, such as a pelvis that tilts too much, a center of gravity that is off, etc.

You can view my report here.

Overall it’s a quick process and I thought the analysis was pretty accurate. It also (mostly) matched up with the analysis my PT had given. Since I had done yoga for a long time, I already knew several of my problem areas, and the bioprint found all of those, plus a few. The major area that it was off compared to what my PT said was my anterior pelvic tilt. My PT had me working on that extensively, while the bioprint said I was within range. However, I was just barely within their 10% guideline, so this was not really that far off from showing up as a problem on the bioprint.

The bioprint gives you a 10 week program of exercises to follow, and I don’t think anything other than very minor issues would actually change in such a short time. But I am a big believer in the power of yoga to fix alignment issues and strength imbalances over time, and the bioprint’s combinations of stretching one muscle while strengthening its opposite, is really not that different. Yoga of course is a whole body approach, although I think there are times when a yoga teacher will have you concentrate on one set of poses to solve a particular problem. But bioprints are very specific to the problems they find.

While I did the majority of the exercises in the program, and either combined them with or added them to, my PT exercises, I didn’t see the changes I had hoped for. I probably didn’t do them quite enough, because at times I was overwhelmed with the number of PT + bioprint exercises, while still wanting to get back to running and riding. However, I will start to do several of them again, once my knee heals enough from surgery.

I would like to see bioprint include a follow-up visit at the end of the exercise program, to re-evaluate your body and see if any changes have occured. You can always spend $150 for another print and report, of course, but it would be nice if they included that up front for an extra $50 or so.

If you are a person who does not know where your potential problem areas are, I don’t think the $150 would be a waste of money. It will show you some biomechanical issues that may be contributing to your knee (or other) problems.

My “bubble” burst!

Saturday I was at our annual home owners meeting, in someone elses house, and was flexing my knee a bit just standing there, when my bubble burst! Ok, so my bubble is the “pone” above the lateral portal. (The portal is where an arthoscopic insertion point is made.) This pone had been quite large and had been growing — I should have taken a picture of it — and my PT and Dr. had both commented on it as one of the larger ones they had seen. Both said that it would eventually go away, but neither said it would burst!

I literally heard some kind of pop and splat sound. I looked down and saw what appeared to be the inside of a cherry tomato, minus the seeds, lying on the floor. It took me a minute to realize there was liquid running down my leg too, and then I finally figured out what had happened. It was a bit embarassing to say the least! Thankfully, it had happened on hardwood rather than white carpet, so it was easy to clean.

I taped it with some gauze, but it continued to drain the rest of the day. And I kind of forced some drainage later that night by flexing it a lot and massaging the liquid out. I figured while it was open, I might as well let it flow. That way there’d definitely be no need to drain it later. The liquid was clear with a very slight red/pink tint, and odorless, so it wasn’t infected inside. I then taped it pretty good and it seemed sealed the next day.

Today (Monday), I called the Dr. to let him know what happened, and he wanted to see me to make sure all was ok. So he took a look and seems happy with the knee overall. Swelling way down, the fluid seemed benign, etc. He said I should limit knee flex the next few days — so no more cycling and knee flex stretches. This is in order to allow the portal to fully heal. He explained that he had to put the portal a bit further up than normal, in order to remove a “mass of tissue” as he called it today (plica) that was where the portal would normally be. So the portal is just above a bony protrusion, and its getting rubbed from the inside.

I also explained that I had a bit of a “catching” or “grating” feeling in the medial inferior patella area. I had actually gotten a bit sore here last week so had limited some of my PT. It got worse after the fluid drain. Some of that may be due to the taping — I think the tape limited the patella movement, so there was a bit more rubbing. Or it could just be that there’s less fluid in there cushinioning it now. He didn’t seem to concerned and said to just watch in the next few days to see if that dissipates.

After the doctor appointment, I had PT, and we just did some quad sets with electro stim and leg raises with 2 lbs ankle weights and electro stim. This was somewhat more limited of what we had originally planned in light of the fluid draining and Dr.’s orders to limit flexing the knee for a few days.

PT appointment

I met with S. again today, and she did patella mobilizations, knee flex stretches, and electro stim for 30 minutes. The 1st few minutes I did quad presses when the ES was activated, and then after that I did leg raises while contracting the quad when the ES was activated.

As far as knee flexion, she measured me at 132 degrees, which is much better than just 1 week ago. It’s still tender if you go that far but it is certainly getting better. Overall she seems pretty happy with my progress — she was very surprised that I’ve been using the R leg now going up and down stairs. (Down is a bit harder.)

She wants me to add a couple more leg raises to my work now — one lying on my R side, L leg drapped over the right, and lift the R leg; and the other lying on my L side and just raising the R leg.. I’ll see if I can find some pictures of these.

I’ve been pretty good about my workouts 2X / day:

– 6 min walk on treadmill @ ~ 3.4 pmh
– 5 min stationary bike
– 30 x 5 sec hold quad press
– 30 x 5 sec hold hamstring press
– 30 straight leg lifts
– 10 X knee flexions with an isometric push out b/w flexions
– a few down dogs thrown in here and there

I will start to increase the time on the treadmill and bike tomorrow.

2nd PT appointment

I had my 2nd PT appointment yesterday. My regular PT, B., is gone, so I met with S. She did some patella mobilizations, assisted knee flexion stretches, and then hooked me up to the electro stim for 25 minutes. This time ES was for strengthening, not reducing the swelling, and I did “quad presses” whenever the ES was sending stim to my leg and making the muscle contract. Normally with quad presses I don’t feel like I’m getting much done, but with the ES, there was some definite feelings of tiredness at the end. We also did a few straight leg raises while lying flat on my back, and I can start incorporating these into my home PT.

I’ve also upped my treadmill walk from 5 minutes to 6 minutes. I’ve left my cycling at 5 minutes as this is still a touch more difficult due to the amount of knee flexion needed, but this morning it did feel better so in the next day or two I’ll increase that as well.