It's been a month, and it hasn't been easy, but I finally feel I'm seeing real progress. The mental toll that this has taken was unexpected. I had a pretty good attitude about it for the first couple of weeks, but as the third week pressed on, I found my mood was taking a turn, perhaps because it was sinking in that this would be months of recovery and not just a few weeks. However, in week four, I turned a bit of a corner. Here is what I learned!
It's important to note that I began physical therapy on the 7th day of post-op, and I have been going steadily three times a week but doing my exercises every day at home.
WEEK 2: I was pretty sick of laying about on the couch and was thrilled that my physical therapist cleared me for modified exercise. Up until this point, I had been weight training twice a week for YEARS and on week 2 was able to resume -- again with modifications and with my leg braced.
Week 2 also brought a false sense of stability in my knee, to the extent that I was hobbling around a bit without my brace (not recommended). This is because all of that soft tissue is very stiff due to surgery, and stiffness feels like stability, but it's not. I slept well and figured out how to carefully side-sleep with my leg propped on a pillow.
My PT put me on the stationary bike, where I was peddling backward and forward in half circles. I couldn't make complete rotations because I could only bend my knee to about 40 degrees or so. This is because of the quadricep graft, and I still had quite a bit of swelling. If you had a patella graft, you'd likely achieve full 90-degree flexion at this point. Keeping my knee wrapped in an ace bandage eventually helped bring the swelling down (in addition to icing regularly). By the end of week two, I was getting around my house and other controlled environments without my crutches.
I also had my stitches removed and was trying to carefully remove dried blood with a warm washcloth but gave up at a certain point. "It will come off eventually!" I figured. If this is your experience, whatever you do, DON'T pick the dried blood or scabs! I know. Ewe!
WEEK 3: I stopped using crutches outside, and I also started driving because, luckily, I injured my left knee and not my right. I was only going to and from physical therapy, so there wasn't much risk. As the soft tissue around the knee begins to mobilize, it brings back instability because the muscle becomes supple. This was when I ensured I had my brace on whenever I wasn't sitting. Most importantly, I realized that for two weeks I hadn't been really activating my quad fully. With some helpful feedback from my PT, I finally connected to the area where they had taken the graft and was able to do (what I would call) a lift of the muscle above my knee.
Additionally, because the graft is very tight (it's meant to be that way so that you can eventually stretch it), we found that my femur and tibia heads weren't articulating correctly in the joint. I had to work to push the femur back into place by laying an ankle weight on my quad for about 5 minutes a day. Otherwise, there was a feeling of my knee catching every time I'd go to bend it. That said, I achieved 90-degree flexion by the end of week 3.
WEEK 4: I turned a corner. I accomplished a pretty normal gait getting up and down the stairs. I'm making complete rotations on the bike, but what feels like a real win is that I'm getting much closer to a normal heel-to-toe gait while walking - instead of kinda limping around. At this point, I just want to walk normally! I also returned to walking my dogs, but only once daily. I'm slow, but they don't seem to care, and I certainly don't. I've been able to dress a bit easier, especially when getting pants and shoes on. I find I can't have my knee bent for too long or straight for too long, so I'm back to having issues when I sleep, BUT --all in all, a little bit of normalcy has returned.
MAJOR TAKEAWAYS: PT (especially in the first three weeks) is physically draining but also mentally taxing. Listening to your therapist and your body and working through pain is exhausting. With that, I'd recommend scheduling your sessions at the end of the day because (at least for me) I just wanted to crash after. However, when doing your exercises on days when you're not seeing your physical therapist, I think it's more helpful to do them in the morning to get your knee warmed up for the day ahead.
Also, if you still have a lot of pain at night and need to pop a Percocet, you're probably overdoing it. I learned this the hard way; trust me, it's not worth it. However, Motrin with Tylenol has become my best friend, and you might want to consider picking some up.
Back to the mentally taxing part, it's nice to talk to someone who has been through this specifically or something similar (knee or shoulder surgery) because it's really hard, and many folks don't get it. It's difficult not to get depressed, but talking to someone who understands is helpful. That being said, give yourself grace if you're not up to socializing or talking to folks. All of these things are okay. Most importantly, remember this is not forever; it's just for now. It's a marathon, and slow and steady wins the race.
But also. It's not a race.
Lastly, I am VERY grateful I've been weight training for years. I don't know how I might have gotten around without my quads and triceps strength, especially in the early days after surgery. I thank my lucky stars for my dear friend and personal trainer Cheri Page Fogleman. Being able to continue my workouts, despite my limitations has kept me SANE.
**She also has beginner group classes over zoom and is great with modifications. If you're interested, you can learn more about her here. **
4- 10 WEEK GOALS: This is the stage when you will start to see a significant amount of improvement. Although the repair is still healing, it is important to progress the activity gradually and under the supervision of your physical therapist. Your physical therapist will ensure you are walking normally with proper alignment. Normalizing your walking pattern early in the recovery process is important. You may need to use an assistive device, such as crutches or a brace, to help you walk without compensation.
You’ll continue to have manual therapy as well as an exercise-based treatment program. The ACL graft tissue continues to heal and goes through a remodeling process, which is WILD to me. It structurally becomes ligament tissue. Truly amazing, but this is important because a ligament is what you need to get that knee moving again. Not a grafted tendon.
Lastly (fingers crossed), during this time period, you should transition to walking without assistance. Inflammation should be low, so you should start to see your mobility improve substantially.