A lot has happened in the past few days! On my 700th day of ACL recovery, I bucked tradition and didn't do a special outdoor activity. Instead I treated myself to frozen yogurt. I had a hand doctor appointment that day. It looks like surgery is the only way to get this ligament tear fixed. The conservative brace method didn't work, he said I would surely know if it did. Next up is getting an MRI. It's already been approved by insurance, just waiting to get a call from the MRI place to schedule it.
What was a HUGE freak out just a few weeks ago, is a better now. You can say that I am nervous about surgeries (after my knee surgery outcome being less than desirable at day 708). I did a bunch of mind prep to help me face this next challenge: podcasts (I put my faves all into one document that I can access frequently), I signed up for a Positive Psychology: Resilience Skills online course (FREE), watched a bunch of videos on facing adversity, why we need adversity in our lives. Calling it a challenge rather then a set back is a good way to improve the mindset. I Skyped with my DPT and she didn't feel that my existing persistent pain is really an overactive nervous system and suggested to go ahead with the surgery if that is what is recommended. if I do have post surgery wrist pain, I have a great list of tools to help me deal with the pain. She said it was awful luck for me, but I am entitled to have a cry fest about it all, then pick myself back up. She said not to worry if it puts a damper on my rehab, we have a modification for every one of those moves. I am worried about the sweat factor with a cast on too. I told my DPT I was getting my brain ready for another year of rehab weights because I know I still have a ways to go. She said at some point this year we will transition me into performance of my sports. All this hard work means nothing if it doesn't get you back to what you love. Pain is going to come along for the ride, but we use our toolkit for the pain. What the what??!???! Yeah I don't feel ready pain wise. I also asked her about BPTB (bone-patellar tendon-bone) autograft pain complications. It is well documented the BPTB graft is the most painful one due to harvest site morbidity and where it's located on the body. I wanted to know of those that experience pain years after, are they all just not adapting their tissues? Do they all have patellofemoral pain (PFPS)? Or is there a harvest site morbidity pain that is separate from PFPS? It was a loaded question. Basically, there are both types of pain: 1) palpate the knee and there is diffuse/dispersed pain usually more PFPS in nature, 2) then there is histological change at the tendon like after BPTB harvesting. Not all MRI changes are pain that is felt either. If it's subpar tendon adaptation or PFPS, this does take a long time to change. So both kind of. I did something new this weekend - well two new things! I went to our local ski resort to tailgate. I haven't been in the presence of skiing in 2 years. While I'm not yearning to ski - actually I would give it up forever if someone could make me pain free from here on out - I was mostly worried about comments. Comments like, "2 years and you're still not skiing? Most people heal by now." Or "I have pain all the time, I just live with it and I don't let it stop me!" OK, maybe we have different pain then! I even had a text from a good friend who said it was hard to put herself in my shoes because she some kind of pain daily and a high pain tolerance, and just takes ibuprofen for it. That kind of comment does make me feel fragile and I didn't take it well. I shed some tears, and decided I just need to go face it all and get it out of the way. Now it seems less monumental. Yes, we are all different. After the tailgating, I tried out the fat bike for the first time ever. A fat bike is a mountain bike but with super wide tires/rims. These tires are 4.5 inches wide. When set to a super low psi (1-5 psi) you can ride over firm snow without sinking. I was in a wrist brace when we got the bike so this was my chance to try it! Wrist brace actually made my wrist feel more painful, maybe due to the deconditioning. I biked for about a hour up a snowy snowmobile carved road. It felt good, better than walking, but definitely a harder work out. More sweating, figuring out layers is hard, you are still cold on the downhill part, BUT less discomfort on the knee during activity. I did two rides total over the weekend. Due to the strenuous effort, my knee did swell up a bit. I usually don't or cannot exert myself that much on my own feet at the gym. I ended up dong an ice compression with a bandage and flexible ice packs. I want to do it again next weekend (get it all in before surgery), but it does really make the wrist hurt for the rest of the day. I put it back in the brace just so I don't accidentally bump it! Photo from my first fat bike ride.
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I located a patellofemoral pain expert on Twitter and emailed her. She has the best article on why some ACL reconstruction patients may develop patellofemoral pain. I wanted to know if she had any more articles on this combination of ACLR and PFP (she didn't say if she did). Basically it has to do with bone swelling that changes the loading of the knee. Elevated water content levels in the patella may lead to increased pain which further inhibits quads and alters loading after surgery. I also asked if she had A) any case studies for ACLR patients who started a year late but still had good outcomes, B) any case studies on ACL + PFP or know of success stories. She did not unfortunately have any written up (didn't say if she knew of success cases, maybe that was careful wording on her part). She did say 20% of her clients are PFP or fat pad pain post knee surgery, so that shows that it's not that uncommon. She also said it sounded like I was past the worst of the pain - I had never thought about it that way! Yes, I need to remind myself this more often! Things were a lot worse a year ago. She said she would be happy to host my story on her website once I am all better. I will need to be my own success story! She encouraged me to keep going. I love when people write me back. The first week of 2019 was kinda down in the dumps for me. I think knowing how much more rehab I have kind of hit me, while also being happy that I've completed a year of rehab at the same time. I know I'd snap out of it, usually takes a week. I decided to start cataloging and relistening to my favorite podcasts (and find more podcasts) - the kind of podcasts that really turn your attitude around or change your perspective. People who went through pretty hard times but are thriving or at least have a heck of an inspirational story to share. Educational podcasts on injury and recovery. I can tell it's helped too. My wrist follow up appointment is next week for the TFCC tear. They wanted me to come in instead of going 9 weeks in the brace. More on that next week! It also happens to be on my 700th day of ACL recovery. I usually like to celebrate these big 100 dates with something I know I can do. My reason is that physical milestones are much less frequent at this stage but dates come regardless of noticeable progress! Trying to think what that would be right now with snow on the ground. Getting in some good knee rehab sessions. Always hitting at that safe but sore line but not a flare up so far. Below graphic and caption is from Dr. Caleb Burgess DPT, OCS, CSCS. 🔥Pacing & Graded Exposure🔥
. 💥 In most cases, if we "overdo" it during a specific activity, our body will produce pain before any tissue damage occurs in order to alert us to make a change so that it doesn't get to that point! This pain is usually short term and diminishes quickly . 😣 When you've experienced persistent pain with specific activities (> 3 months), many times your pain threshold becomes lower with that task as your body becomes more sensitive in an effort to protect you from what it believes may cause you injury . 🤔 In this case, the process is a little more complicated. As you perform the activity, the body produces pain well before any tissue damage can take place ("Protect by Pain" Line) . ☝️ However, in order to desensitize the body and tolerate more of this activity before pain occurs, you must learn how to find your Baseline, which could be referred to as where you are "SORE BUT SAFE". This is the point where you feel some pain but it decreases following the activity in a predictable and controlled manner. . 🚨 You want to avoid pushing yourself "too far, too fast", however, as this may cause a "FLARE UP". A flare up is a period of intense pain that is more severe than normal, with no set pattern and lasting hours to days. If you have a flare up, it's important not to freak out! A flare up still occurs before "Tissue Tolerance" (the point where tissue injury actually occurs), so just because the pain is intense does not mean that you have injured yourself . 🔥 The goal with Pacing and Graded Exposure is to SLOWLY do a little more of your chosen activity on a daily, weekly, or monthly basis (it's highly individual). YOU know you're body best, so figure out a progression that's right for you, and STICK TO IT! . 💥 An easy phrase to remember is: 👉🏼 "To It, NOT Through It" . 👊🏼 This helps to remember to push yourself TO the "Sore But Safe" line (which should increase over time) without blowing THROUGH to the "Flare Up" line . 💯 The process takes time but if you are patient and positive, you can eventually return to the activities you love and enjoy 😉 . ❤️ SHARE with someone in pain who could benefit from this strategy! I have completed one year of NEW rehab under the guidance of my DPT at a sports and exercise medicine research center!!! Would you believe that we have never met in person? That is right, we are doing this remotely. She's even on a different continent. This is pretty amazing. I remember thinking why she is only giving me 3 rehab moves total? If I don't see improvements, I will thank her for her time and go back to my little 6 week old leg lifts. Six weeks PLUS the rigid knee taping was enough time to notice some changes (keep that in mind when trying something new, try it for 6 weeks first!). Now I'm up to 8 moves. Not all of them have been performed for a full year however, but all of them have been in my routine for the last 6 months. Look closely for the faint quad outline on the outer thigh. I took an old photo then made today's photo transparent on top of it trying to line up the inside of the knee. That is actually muscle growth over one year! Leg on the left is operative leg (my right leg). While the photo may look like decent gains (relatively speaking), I also have a video of clenching my thigh muscles and releasing. While my left side barely budges when I clench my quad, my right side has a very dramatic lift up, caving in, and then jiggling release. Like it's not even attached to my bone. It's as if my thigh were a floppy piece of raw chicken breast (my sister's words). Not sure I'm brave enough to upload it here.
This one year rehab anniversary is both pretty exciting and extremely depressing at the same time. As in, I can be proud of my hard work one second and then crying in the shower the restroom the next second. I think it's the idea that all of this hard work for an entire year and that's all I have to show for it? OMG there is so much work left. How long is this going to take!? When will my knee stop hurting??? So much adapting still left to go! I found out the hard way that the knee is not close to being adapted to the elliptical. I have an elliptical at work so maybe I'll sneak in 2 minutes a day to get things adapting. I went for it and did 30 minutes (SLOWLY) and that was obviously too much. I didn't think it would be that different than walking or biking honestly. TFCC tear. The first 3 weeks of using the wrist brace, I don't think I had it on tight enough. Plus I'd take it off to wash dishes, cook or play mandolin. I've had a few painful twangs in the wrist that made me call the doc's office to ask if I'm theoretically resetting the 4 week clock every time it tweaks. Turns out yes. Ugh. OK start over. I have tightened up the brace and will only take it off for showering and changing my shirt. Plus papers I've read say 6 weeks, so I'll tack on two extra weeks making a total of 9 weeks in all. I really want to give it its best chance of healing - that is if it's the right kind of tear. About a 57% chance that it's the right kind of tear that can heal on its own (according to one paper). So check back early February to see how it went. I think I will know right away if I need surgery. I am pretty sad to have to put the mandolin down. I feel lost in the evenings. It was my perfect coping mechanism for winter and pain. |
AuthorA 45 year old active female who tore her ACL in January 2017 (at the age of 40). Reconstructive surgery in February 2017 with bone-patellar tendon-bone autograft. Archives
November 2022
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