2nd anniversary/Things I ponder, Part III

Back in late summer, I began to think about what I would post on the second anniversary of my new knees.  At the time, I was riding my bicycle, and I thought about videotaping my ride and narrating some of the highlights of my rehab in relation to the different landmarks along the way.  At the end of that ride, I noticed that the ride had taken me longer than usual, but I figured it was because I was lost in my thoughts and not concentrating on pedaling in a consistent manner.

A few days later, I was using The Stick on my quads prior to my ride (a necessary part of every ride, before and after), and I accidentally went below my knee and felt exquisite tenderness.  I recognized that tenderness immediately as tendinitis like I had had before in my quads.  So with punchy fingers, I discovered that I had tendinitis on both lower legs from the knees to the tops of my feet on both sides of my shins! This finding explained why I had been noticing some increased stiffness in my knees.  Once again, I had developed a problem while trying to do something good for my knees and muscles. I immediately began doing what I had done for the IT band tendinitis some months before--5 days of rest, using The Stick 4x/day, icing 4x/day, stretches for these specific areas found on the internet, and NSAIDS.  It has been 8 or 9 weeks already, and there is improvement, but not complete healing.  I'm guessing that the healing would have been quicker if I had had the different modalities used at physical therapy.

So here I am at my 2 year anniversary slowly building back up to my previous mileage.  When I developed the IT band tendinitis earlier, my doctor said that this should not be a recurrent problem if I would stretch good both before and after a ride.  So far that has held true for my quads, so hopefully once I get my lower legs taken care of, stretching before and after a ride will keep further tendinitis at bay.

So now, I will answer questions from 2 previous posts at 5 months and 9 months post surgery that may be helpful to someone looking to have a knee replacement or recovering from one.  The answers in blue are from 9 months post surgery, and this point in time will be in red.


1.  I wonder if my knees should still be this stiff?  It's a different kind of stiffness than I had before surgery, but I sure would like to come out of this with none. (I am doing some serious flexion and extension stretching exercises.  I have to do them every day, but I tend to have tight muscles anyway, so time will tell if I will just end up with my normal muscle tone that's a bit tight . I have minimal complaints about my right knee, but the left one still requires a good deal of work.) Stiffness, for the most part, is a thing of the past.  Flexion and extension pose no or very little problem for me.  I am very pleased at how much I can bend and extend my knees.  Now, if I sit for longer than 20 minutes or so, I still have some stiffness when I first stand up.  That will keep me from getting up and leaving during the middle of some group activity, like church, where I would be a distraction waiting for my knees to cooperate as I stumble away!



2.  I wonder if there will always be some movements that will cause me pain.  There are times when I move around in bed that I am very aware of my knees. ( These painful movements are fewer and certainly less noticeable than the first time I asked this.  I have noticed that I no longer require a pillow between my knees to cushion those sore knees.  All in all, things are looking up!) It is a rarity for some movement to cause me pain.  Occasionally I might make some quick movement that is uncomfortable, but I would not attach the label of pain to it.


3.  Will I be able to kneel?  Will I be able to squat?  Am I expecting too much? (I am amazed at the progress I have made with my yoga routine as far as getting on my hands and knees.  When I first started, I had to put pillows under my knees and it was very uncomfortable.  Now, I only use the yoga mat on the hard floor.  I can't say that it is total comfort, but it is certainly manageable. Kneeling and squatting will come much later, if at all.) I can kneel with minimal discomfort.  Getting there is not a pretty sight though.  I cannot just kneel down with fluid movements that require no thought!  But once I'm down, it's not too bad.  Probably wouldn't want to kneel down and dig in flower beds for prolonged periods like I used to do, but I have not given up that that day will come.  I will not even attempt to squat; I'm pretty sure I could not get up from that position.  Maybe after a significant weight loss.


4.  When will I be able to descend stairs without pain?  Going up isn't always a lot of fun, but going down is definitely not without pain in one knee. (Definite progress in this area, but I am still mindful of steps, and the left knee still hurts some.  Probably cannot do steps without a rail to hold.) Steps that are 4 inches or less are not a problem, but more than that is not totally comfortable.  Once my tendinitis in my lower legs is healed, I hope to give more attention to stairs.  Again, a significant weight loss will certainly help this issue, too.


5.  When will I be able to walk without listing to one side?  I really want to have a normal kind of walk. (7 1/2 months, but I'm thinking much of that was due to the problem I was having with my feet.) I no longer list to one side, but I have become painfully aware of balance problems in the past couple of months.  I have started going to a seniors exercise class at my church where I am very much the youngest person there.  I was shocked at the problem I was having with balance with some of the exercises they were doing.  I now spend more time with my Wii Fit working on those balance activities.  I know that after surgery, balance was a definite issue, and I worked on it for months, but I did not know that it was still a problem for me.  My leg strength has really increased in the past couple of weeks and that cannot but help.


6.  My left knee does not extend as well.  Will this always be the case or can I expect both knees to be more similar? (8 months--I notice that when standing this is much less noticeable to me.) I would say that both knees are pretty equal now.  My left knee is obviously the more problematic knee and is the reason that I continue to do stretches every day.  I am aware that my progress and my current state is linked to mindful stretching every day.


7.  Are most of my knee problems going to resolve with increased strength? ( This seems implausible, but before getting the injection in my foot, I wondered about why I bothered to get new knees if walking first thing in the morning was still really difficult.  Once my feet were not hurting, I could really feel the benefits of having knee replacements.) Yes.


8.  When will I have more stamina and be able to walk more than 6 laps on the track without paying for it later? (7 1/2 months--again the problem was more related to my feet) I cannot really answer this question because I still have issues with my feet.  Walking does not excite me, but I can go shopping in Target or Costco without having to come home and rest like once before.  Again losing 300 lbs. would probably help. (Yes, that is an exaggeration but indicates a significant problem.)


9.  When will I be able to get up out of a chair and immediately start walking without having to wait for my joints to lubricate first? (8 months--the feet had much to do with this) As mentioned earlier, this is still a problem although not as significant as before. It varies, too, from day to day.  It is definitely less of a problem when I am strong.


Another interesting discovery I made this fall.  After my surgery, I got rid of all my shoes since they were worn in a particular way related to my bone on bone knees.  Those shoes were no longer compatible with my new knees which now had space in between the bones. (check out the before and after X-rays)  Right before my surgery, I had bought a pair of dress flats that I had worn only 4 or 5 times for short periods so I figured they were ok to keep.  Since I wore running shoes even to church for the first year, those flats did not get any wear.  After the first year, I wore the flats 4 or 5 months on Sundays, put them up for the summer, and brought them back out a couple of months ago.  This time they were TOO BIG--would not stay on my feet, flopped up and down when I walked.  I'm guessing all the swelling in my knees was shared with the whole lower leg via gravity.  Obviously the edema problem is gone, and I now have shoes that are too big!

 
Now you may feel like I am insulting myself by using this animated cartoon, but I totally identify with it.  As I have been riding along, I many times wonder what I look like from behind and wonder if someone is making fun of me.  I must say, I no longer sway from side to side, but I know I did for a long time!  I had even considered having my husband video me from behind at different intervals as a visual diary to look for change over the ensuing months.  It seems like every time I get going good with a consistent exercise regimen, I get waylaid by an injury.  Anyway, if you are timid about exercising in public, please read this.  After reading this guy's blog post, I have chosen to think that others admire the way I haul myself through space and are quietly saying, "Atta girl!" 


Happy Anniversary to my new knees which have changed my life for the better! It was a scary decision, but one I am so glad I made.

In Case You're Wondering... (19 months)

Today is an anniversary of sorts, and I am reflecting on how close to normal my life is.  There is really not much to report.  I continue to do some form of exercise every day to maintain the motion in my knees and do my knee stretches. I am eager to keep my knees in their "abnormal" state. I still marvel every day at the little things I can do which in and of themselves are not that significant, but when all the little insignificant movements get added up, the summation is very noticeable to me.

Barring a setback or major advance, I'm guessing my postings will be fewer and farther apart.  Life is just so ordinary now!

Major Milestone (17 months)

A couple of days ago, I was going to class and had a book tote in one hand and a giant Tervis tumbler in the other hand.  Without even thinking, I went down some stairs step over step WITHOUT using a handrail! I was astounded when it dawned on me what I had done.


In light of this accomplishment, I am declaring myself healed.  In an earlier post, I mentioned that I was giving myself until 18 months to finish healing since I was not completely happy with my progress. I feel certain that my unhappiness is related to the IT band problem  that I must have been developing at that time and which made itself known a few weeks later as it insidiously progressed.


I will still have to continue my strengthening exercises and stretches, and I still hope to putter in my yard with a shovel someday, but these new knees are giving me a continued new lease on life.

Who Knew? Gonna Brag a Bit...

I'm in my 7th week since I realized I had developed a problem that needed attending.  That's 7 weeks of rest, ice, stretching, ultrasound, stimulation, The Stick, pressure on trigger points, lying every day for 20 minutes with my legs tied together below the knees, slowly increasing rpms and time on the stationary bicycle, and so on.  In the past week, the stiffness in my left knee is so incredibly much better.  Over the weekend, I did my yoga routine for the first time in years the way it is supposed to be done.  I had had to adapt it to my needs, so I would do all the positions on the floor before standing up to do the standing ones.  If I were doing the routine in the correct order, I would be up and down off the floor, but that just did not fly with me.  Today, I amazed myself at how quickly I moved around on the floor compared to just a couple of weeks ago.  When I do this position

with my left leg in front, it was comfortable and the legs really looked tight like this.  When I changed legs and put the left leg in the back (like this picture), there was an uncomfortable stretch and my legs were awkwardly loose.  I decided I would show my physical therapist this position today and see if he had any suggestions.


After the physical therapist had done his magic on me today, he had me turn to one side to stretch my leg backwards to stretch the quads.  He was working with my right leg and had temporarily forgotten that I had a replacement in that knee.  He was amazed at how far back he could bend my leg and stated that he had never seen a knee replacement that could bend that much!  I reminded him that my right knee has never been much of a problem.  So then I changed sides, and again he was surprised.  His exact words were, "it's abnormal!"  Keep in mind I was more limber than usual after his treatment, but nonetheless, I was delightfully "abnormal."


Next I showed him my yoga position, and he assured me that it would improve as I continued my stretching.  Then he told me to resume that position and left the room.  He brought back another physical therapist to show her that what I was doing was "abnormal" for knee replacements.  Which leads me to think, are most patients just grateful that the knee pain is gone and they can sleep at night and that's all?  Granted, those are very big gains, but maybe we could all achieve more if we only knew it.  If I don't gain any more ground, I will still be incredibly thankful and glad that I had surgery, but what if I can get back to digging in my yard?


I will have to admit that I have more time to devote to this than most.  One of the great frustrations for me during the last 6 months is that I don't seem to make any progress in my house.  Over the past several years, my house has suffered from benign neglect and consequent clutter.  First it was from pain prior to surgery, then intense pain and rehab, then from my own rehab program.  Recently when I was bemoaning the fact that even though I was so much more active and feeling better, I did not seem to be able to anything more that laundry every week. My husband then suggested that I add up the time I spend every day, including travel time, doing stretches, going to the gym and/or riding my bike, and more recently icing, physical therapy, doctor appointment, and so on.  It turns out that I have a part time job of about 30 hours/week just attending to my rehab!!  And I just thought I was a slouch.

A Bump in the Road (16 months)

Picture from http://www.realbodywork.com/learn/knee/vastlat.htm

Well, I was right.  I have iliotibial (IT) band tendinitis in both legs. (The white band going from the hip to the knee in the picture is the IT band.) We are going to try physical therapy first, and if that alone doesn't work, I'll need some cortisone.  I have been in physical therapy for 8 days, and I can already see significant progress. As sad as I am about this step backwards, I'm pretty sure that I am going to be better off when it is resolved.  The stiffness I have had all along in my left knee is WAY better.  It has improved so much just from using The Stick (see previous post) that I feel encouraged that I may actually return to working in my yard again some day or getting up and down off the floor with future grandkids. 

Leg extension

In discussing this with my doctor, this IT band problem should not be a recurring problem, but one that I will be proactive with with stretching to prevent it from happening.  Looking back on it, because this problem developed so insidiously, it has probably been going on for months and I just thought my healing process was slow.  Guess I'll never know if that's true, but I really do think I will come out better on the other side.  When asking my doctor about the machines I do for strength, he said he didn't think anyone should do the leg extension. So I've scratched it off my list.

I'm back on the stationary bicycle, but building up has been slow.  I rode for 6 minutes the first day, and every minute hurt.  Tried 10 minutes next, and the first 6 minutes hurt.  Slowly built up to 30 minutes and I hurt the rest of the evening, so 30 minutes at one time was too much.  Two sets of 15 minutes was tolerable, and so it goes. I am currently at 25 minutes and the RPMs are steadily increasing to my former ability.  It is frustrating to know how much strength and endurance I am losing, but I am trying to stay positive. It grosses me out to think that by the time I get back on my bike, it will be hot and humid and I will require huge motivation to get going! As I have titled this post, I am optimistic that this is just another bump in the road.

If it's not one thing, it's another.... (15 months)

Catch 22.  Idiomatic usage meaning a no win or double bind situation.


That's how I have felt the past week.  I have been riding my bicycle since last September and bragging about my increased muscle strength and my serious excitement over my increased ability to walk.  Being the cautious person that I am, I have slowly built up my time and distance to be rewarded with increased strength, endurance, range of motion, and looseness of joints.  I have had a perverse enjoyment of listening to my heavy breathing while pumping away with reckless abandon. (I have also been able to eat Girl Scout cookies and still lose weight, but I probably shouldn't admit to that.)


Then... after 6 to 8 weeks of noticing that my left knee (the one I have given 6 more months to fully heal) has been whispering to me that there is some stiffness and soreness and now, actual discomfort with flexion and extension, I begin to pay attention.  When the right knee is also a little stiff, I'm thinking seriously that maybe something isn't right.  Then last week, I was "bicycling" in the pool, and it  actually hurt for probably 7 to 8  minutes.  I'm thinking,  "the pool, REALLY?  I am hurting in the POOL?"  I hardly hurt in the pool right after surgery.  Now I know something is amiss, and it is time to make an appointment with my doctor.


It will be 2 weeks before I can see him.  I get on the internet and start studying the anatomy of the knee to see if I can figure out where the problem is.  I localize the spots, and start looking for information for problems in that area and come up with the iliotibial (IT) band.  Runners and cyclists tend to have problems with the IT band.  Great.  After watching a video for diagnosing it, I perform the maneuver on myself, and as far as I am concerned, it is positive.  There is another diagnostic maneuver that I cannot do on myself, so I will have to wait on the doctor.  So after reading about treatments for said condition, I with great regret, lay off all activity related to my lower extremities, ice my knees frequently, and take NSAIDS.  Physical therapy will have to wait until I see the doctor.  The suggested time for complete rest was 5 days. This is really making me nervous.  I have worked so hard, and now it looks like I have caused this malady to myself.  That is not fair.  How am I supposed to know what is too much when I have been so careful to slowly build up? To have the one thing that has exponentially boosted my rehab to now be a problem is aggravating.  To say I am frustrated is an understatement.  


So I call my physical therapist to ask him what I can be doing before my appointment with my doctor in now 10 days.  I love my physical therapist.  He's going to see me today unofficially because he says I am probably 90% correct in my diagnosis, and we really need to get those quads relaxed.  He also told me that the treatment is very painful. Joy. If he's telling that to someone who rehabbed two knees at the same time, it must be REALLY bad.

2 hours later-- it was pretty painful, but not anything I can't handle.  It is the IT band.  The simple explanation is that this band goes all the way from the hip area to the knee over the quads.  As my quads have gotten bigger, this band has been irritated and pulled tightly over my muscle.  The muscle is all lumpy and thus very tender, and it must be stretched.  So I had to go buy a rolling pin to roll up and down over the IT band until I get this from Amazon.

I also ordered one of those dense foam rollers to use for my stretches.  And then there is this low tech exercise, where I could in no way grab my foot, but would rest the shin on top of a chair seat.

According to my physical therapist, I can still ride, but I need to stretch before and after my ride.  He also said that if I'm not much improved when I see the doctor, a little cortisone may be in my future. 

It won't be long before I will be well equipped to open my own PT gym!

A Word to the Wise... (almost 15 months)

I bought my bicycle last September. At that time the salesman told me I should bring it back in a month for an adjustment, but he and I both knew I wouldn't get that much mileage on it in a month.  So, he gave me 6 months.  Today I took it in for said adjustment, and WOW!  The gears were adjusted, the brakes, too, a cable was stretched so it was tightened, blah, blah, blah. I just got back from my first ride, and I absolutely cannot believe the difference.  The hardest part of my ride is getting to the Greenline and getting back home once I get off.  I could not believe the ease with which I climbed the first incline that almost always brings me to a standstill!  Once I was on the Greenline, I was pumping away like the guys with the fancy gears.  Most of the inclines on the Greenline were barely noticeable today.  For Memphians, the fartherest I have been before today is a little past Highland and the  Chickasaw Country Club.  A couple of nights ago my husband and I went to a restaurant that is off the Tillman exit.  I mentioned that it was still so far from Highland, and I looked forward to getting that far some day.  However, today I rode all the way to Tillman before I knew it!!

Getting home was still hard, but I was not hating every minute like I usually do.  Amazing what a fine tuned instrument can do.

Those Small Bits of Progress are Adding Up! ( 14 months)

Yesterday I noticed that I am finally walking faster -- not up to normal speed, but faster than I've walked in the past few years. I was beginning to think that I would never walk fast again.


Today I carried in some significant weight in groceries-- 2- 1 gallon containers of milk, a bag of oranges, 3 lbs. of rice, and more.  I carried all of this in at once, and it did not hurt my knees in the least.

I get more encouraged every day.

It's Time for a New Ribbon! (almost 14 months)

Today I ran various errands for 4 hours which necessitated getting in and out of the car and walking into establishments.  For the first time since my surgery, I got out of the car and just started walking.  Usually I have to stand there for 20 seconds or so, or if I take off walking sooner, I look like someone who has had knee surgery or is in dire need of it!!  I cannot tell you how BIG this is.  I have not walked like this in almost 4 years!


To what do I attribute this great advance?  Diligence. Diligence in my rehab, and more recently, spending more time on my outdoor bike even when I don't want to do so. Riding outdoors is much more difficult than a stationary bicycle, and even though my sister laughs when I talk about the hills I have to climb (she is from East Tennessee), those little inclines are very difficult for me.  I know I am hysterical to watch because I almost come to a standstill trying to get up those little slopes in a seated position.  That, or I am veering back and forth like a child learning to ride a bike and keep his balance.


To all in the throes of rehab, DILIGENCE.

What I have learned

I cannot go long without doing my exercises.  Two days prior to leaving for our trip, I did not go to the gym for various reasons.  Add to that 7 days of not riding a bike, and I came back home with very stiff knees, in spite of the fact that I was doing stretching exercises every day.  Granted, when I came back I was hurting, but it took me a full 10 days to get over that trip.  The first day on the bike, my left knee was so tight that it took a full eight minutes of revolutions before my knee quit hurting.  It was 10 days before I did not have to do some warm ups of going around halfway on the pedals to work out the kinks before going all the way around the first time.  I also had to scale back on my time and intensity level on the bike and scale back on weights and repetitions on the leg machines.  Just short of a month of my return, I am just now regaining my previous level of strength.


I don't think this will always be my life, but it is right now, and I am more determined to stick with my rehab for the near future.  A man at the gym where I go had 2 knee replacements 4 years ago, and he told me that he has to exercise 3 days/week.  I could live with that--I could give up these 3 extra days!