Category Archives: Physical Therapy

Uppin’ the ante in PT

Rehabilitation in physical therapy is going better than
expected so far. I am amazed at all that I can do, and I even feel like my
right quad is getting stronger by the day. My therapist even gave me more
exercises to do. Now, I also do the leg press, leg extension, hamstring curl,
and butt kick machines at therapy each visit. When those are combined with my dead
lifts, calf raises, squats, bird dips, and leg lifts, and 20 minute bike ride
warm up (that I really push myself on), physical therapy is more of an actual
gym session. I love it! I’ve even upped some of the weight resistance on those
machines since I started doing them last week.

While I said that I am feeling stronger, my right leg is
still noticeably smaller than my left leg and does not have as much muscle
definition, but that is more than a year of atrophy, so it will take some time
to get back to normal.

In the meantime, I have been looking at some bike tours in
the area. I am cleared to ride my road bike and I really miss the race
atmosphere that accompanied marathon running. I found one bike tour in San Diego in August that
looks especially promising. It is a 26 mile bike ride and it looks fabulous. I
really want to do it, and I hope it is my future. Eventually, I would love to
do a century ride, but just like with running, I’ve got to start small.

Physical therapy

Today was my first day of physical therapy. It took quite a
while for it to be approved through insurance and of course there were a couple
snags throughout the approval process, but I am glad to be in PT and
rehabilitating my knee.

As usual, my first therapy session began with an assessment
by the therapist. He was impressed with my range of motion and knowledge of the
medical terminology regarding my knee’s history. However, I do not believe he
was impressed with the strength of my right leg. To be honest, atrophy took a
pretty big toll on my right quad, hamstring, and calf. My right leg must be at
least an inch and a half or two inches smaller than my left leg.

My first physical therapy session of 2011 started off with
the anticipated warm-up on the bike, but this exercise bike was like no other
one I had ever ridden before. This bike had a monitor in front of it that
displayed a bike path in scenic ocean bluff setting. The handle bars on this
bike turned and it was like a simulation game. After the warm-up, I was
pleasantly surprised with some exercises that I did not think I would be ready
for. I did half squats on discs,
these things called bird dips (oh those really did a number on my glutes and
hamstrings), dead lifts with a 20lb bar,
an exercise called the clam, and lateral leg lifts. I was not anticipating the
squats or the dead lifts and it was pretty exciting to jump right into those
exercises this soon after surgery. Hopefully it won’t take too long to get my
right leg’s strength back to where it needs to be.

Progress!

Progress with knee surgery is coming along pretty well. Last week I did the test on the Biodex Machine to measure my muscle strength. So far, I have regained 85.5 percent strength in my quad and 81 percent strength in my hamstring. Once I reach 90 percent or better, I won’t need physical therapy anymore. I will keep working out on this machine and testing on it with therapy.

Also, my doctor told me that I could start jogging at around the 4 month mark. That is in only a little more than a month! It does not seem even feasible yet though, because just walking around all day at school makes my knee stiff and sore. I think I will wait until my knee feels more normal to start running because it does not feel anywhere near normal yet. It still feels slightly foreign.

Good news in PT…and a possible setback

I am back in physical therapy this week, which is such a relief after missing a week because I had to wait for insurance authorization. To date, I am a little more than 10 weeks past my surgery. My therapist told me that at about this time after surgery, the ACL graft is stronger and there is more blood flow and circulation to the area. This means that I can now start doing open-chain exercises in addition to the closed-chain exercises I am already doing. Currently, the closed kinetic chain exercises I am doing in physical therapy require that I always have my foot planted on a firm surface (leg press), however, now that I am okay to do open chain kinetic exercises, my leg is free to move and my knee is bending (leg extension). This is a big improvement for me because now I can work out my quad muscles more.

 My first and only open kinetic exercise I did today was the leg extension with 5lbs of free weight. It was tough, but I was able to complete my 5 sets of 10 reps. In addition to the leg extension exercise, I also did two different lunges. I did full walking lunges (still without any weight) and I also did stationary lunges with my front leg on an inflated disk. That one was a challenge.

 Next week will be a very big week for me in physical therapy. On Thursday, I am going to get hooked up to the biodex machine to test the strength of my right leg compared to my left leg. The Biodex machine is an isolated joint isokinetic system used for neuromuscular evaluation and therapeutic exercise to measure the amount of strength produced at different velocities. The machine will conduct this test by measuring the strength I produce in a series of hamstring curls and leg extensions. I will first have my left leg tested as a base measure, and then my right leg will be tested. The therapist told me that he is hoping I will test in the 70 percent range fore strength, which would be a good measure because that would indicate that I have regained about 70 percent of my strength back in my right leg. This test is critical because depending on how I do will determine if I can start with agility and jumping exercises, and eventually running. If I do really well on this test, I may be jogging in about a month. I really hope that I will be back to running soon, but I am not going to push it. Also, my knee is continuing to “pop,” which has me slightly concerned, but it isn’t painful yet, so I am hoping that this is just temporary.

Second week of physical therapy complete

Happy Fourth of July!

This week I completed my second week of physical therapy and it went very well. In addition to the new exercises I am doing, I was also cleared to drive! This is very exciting because I no longer am “trapped” at the house when Zac has to work his 24 or 48 hour shifts. Plus, now I no longer require my husband to chauffeur me around to my doctor’s appointments, physical therapy, and any other place I need to go.

As previously mentioned in an earlier post, my sets have increased from six sets of 10 repetitions to eight sets of 10 reps. Also, my four pound weight I strap on above my knee for the straight leg raises, straight leg raises on side, inside leg lifts, and my straight leg raises on my stomach has been increased to a five pound weight. I am definitely feeling the extra two sets and the extra pound.

 One of my new exercises is one of my favorites that I recall from previous ALC surgeries. I really look forward to doing this exercise at physical therapy because it is so much fun. On just my right leg, stand and balance on the straight and level side of a foam roller cut in half. My therapist says that this really engages all of the muscles in my leg because I am concentrating on keeping my balance. Once I have my balance, I take a small, weighted ball and throw it at a square trampoline (called a plyoback rebounder) that is about six feel away from me. It is like a game. I always try to beat my high score in the number of times I can consecutively throw the ball and catch it without putting my foot down. I do this exercise two ways. First, I stand on the half foam roller and it is directly underneath my foot so that every part of my shoe is touching the roller. Then, I turn the foam roller so that it is perpendicular to my foot and my toes and heal are not touching the roller. My other new exercises include riding the bike with just my right leg and wall sits. I ride the bike with just my right leg for the last two minutes of my biking session and I do wall sits in intervals of 30 seconds for a total of five minutes. Physical therapy is beginning to be a real workout for me and I love how it seems as though each visit I get to do new things. I feel that I am making great progress, even though it is slower than usual.

 Sometimes I wonder if it is safe for me to be working out my leg this much. I am doing 80 weighted sets of exercises everyday. On Thursday I noticed that my right calf was killing me. It felt like a tight, painful muscle cramp every time I moved my calf muscle. This worried me so I told my therapist and he said to give my calf 72 hours to rest. I know that this is a good thing because from experience I know that you can overwork your muscles, and when you do that it is extremely painful. In high school I thought that by doing 1,000 crunches every night I would have a great stomach. Instead, I just had injured abdominal muscles that hurt like nobody’s business every time I took a breath. But I digress… And, even though I am also supposed to do these exercises everyday, I decided to let yesterday be a rest day. I still worked on range of motion though because that does not involve any weighted exercise. I will continue with all of my exercises today to round out my second full week of physical therapy.

Week 1 of Therapy Complete

I completed my first week of physical therapy this week. While I have made great progress in this week alone, I still have a lot of work to do until I am fully healed. Right now, I am five weeks and five days out of surgery and I am entering a time where my new ACL graft is going to be at its weakest point. Weeks 6-9 usually are when the ACL graft is at its weakest point. I’m not really sure why this is, but I know it has something to do with blood circulation…or something like that.

It still won't straighten all the way. UUuugh!

In therapy this week, I was given a list of exercises to do. I am supposed to do them while I am at therapy and also when I am at home on days I do not go to therapy. This week, I went to therapy on Monday, Tuesday, and Thursday and each day I felt that I made substantial improvements. On my second visit on Tuesday, I did the hamstring curl with five pounds. At my third visit on Thursday, I did all of my mat exercises with four pounds strapped to my quad. (The reason why it was on my quad and not my ankle is because my graft is still not strong and extra weight around my ankle can cause it to stretch or pull the graft). Right now there are two key areas I am working on, my range of motion and strengthening my leg. Currently, I still do not have full range of motion. By this time with my previous surgeries I had full range of motion, but seeing as how this is a revision surgery the recovery process is slower and not even guaranteed. Yikes! I am pretty upset that my leg won’t straighten all the way yet. I am still missing several degrees when I sit on the floor, and I am missing even more when I try to walk on it. I am worried that it will be perpetually bent. As far as my strength is concerned, unfortunately, those first four weeks after surgery did a number on my right leg. I loss so much muscle mass in such a short time.

On my days off from therapy, I either do my exercises at the gym or in the pool. At the gym I make sure that I do at least 30 minutes of cardio on the bike first. And now I can finally push myself on the bike and add resistance. It is such a relief to finally be able to get in a real workout and break a sweat now. It really is amazing how quickly you get out of shape. I am able to do eight miles on the bike in 30 minutes and it is exhausting! Slowly, I am going to get back to where I was at in cardiovascular shape. Hopefully then once I start running it won’t be too difficult to start all over again.

There still is quite a bit swelling in my right knee, but as you can see it is starting to go down. I can faintly see the outline of my patella now, especially at the top of the knee, which is a pretty big improvement because before I had this large mass of swelling on the top of my knee. Also, in this picture you can see the atrophy continue. My right calf and thigh are substancially smaller than my left ones. To help the swelling I am doing heat and cold therapy multiple times a day plus taking an anti-inflammatory. For the heat and cold therapy, I heat for 15 minutes, followed by ice for 15 minutes and I repeat this about 2-3 times per sitting. Hopefully the swelling is gone in a few weeks because once it is gone I know that my range of motion will improve.

Finally, I am being proactive about my scars. Daily, I am applying Neosporin and vitamin E oil to the incision points. Also, when I go outside to the pool area, I make sure that I liberally apply sunscreen to my knee. Seeing as how these are new scars, too much time in the sun will cause them to turn a dark purple red color, and I won’t let this happen.

 WEEKLY REHAB

  • Monday – Physical therapy
  • Tuesday – Physical therapy
  • Wednesday – Pool exercises
  • Thursday – Physical therapy, upper body weights
  • Friday – 7 miles on the bike, exercises at the gym
  • Saturday – 8 miles on the bike, exercises at the gym
  • Sunday – Pool exercises and upper body weights.

Adding weight in therapy!

I am five weeks and two days out of surgery so far and I keep making progress at physical therapy. Today was my third day of therapy so far and I feel stronger and more capable with each and every visit. The therapist strapped a four pound weight onto my leg today as I did my straight leg raises, straight leg raised on my side, inside leg lifts, and the straight leg raises on my stomach. The weight made the exercises much more difficult, and my muscles were burning, but I know that the additional weight is helping me rehabilitate my leg. The weight had to be strapped on my thigh though because my new ACL graft isn’t strong enough yet to have the additional weight on my ankle. With that said though, it had only been three visits and I keep doing new things at therapy. I am pretty satisfied with how quickly things are coming along now.