Nine months post op ACL reconstruction yesterday! I had my nine month post op visit with the physician assistant on Monday. He wants me to try something new, something I was not expecting at all.
It's no doubt I've been hyper-focused on my knee. Reading about it, reading journal articles, searching for others like me online, doing exercises everyday, trying to advance to single leg exercises (I have major atrophy still). It's on my brain every waking moment. Maybe, just maybe, thinking about it too much is getting me stuck or contributing to lingering pain? Luckily, I came across articles over the weekend that supported this idea that constant (sometimes negative) ruminating can be a hurdle to recovery or exasperate pain. I read some articles on chronic pain and pain catastrophizing that really rang true. So this was quite handy that I already was mentally prepping myself for this topic, and low and behold my surgical team wants me to try this! For the next 6 weeks, this is what I am to try with the goal of taking focus off of the knee:
He made the analogy of women who have trouble getting pregnant can only think about getting pregnant. The family will choose adoption, life is all great, then bam! they get pregnant (this was his analogy, obviously this doesn't happen in every case). So maybe the stress of getting better is having something to do with the pain, or having it on my brain all the time, like I am modifying my central nervous system. So combine this with my positive thinking post to change my overall attitude, I'm ready to try something new. I'll report back before Christmas to talk about how the experiment went. (Blogging will be halted for 6 weeks as well.) The very next day after my post op visit, I went up one of my go-to canyons, a canyon I would frequent during the week because it was so close to home. Felt awesome to be up here. 299 days since my last visit!
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I'm going to try something. I'm going to train my brain to think happier healing thoughts! These last few months my biggest daily worry is about not getting better, as in I'm going to be in pain for several years or longer. It's pretty clear not many folks are still in this much pain 9 months out or longer. The doctors say that I picked the most painful graft and anterior knee pain is a common complaint as if my pain was to be expected. Yes, but life hindering pain? Can I really use my mind to think anterior knee pain away (or not make it worse)? In general, I think I'm a pretty positive person who doesn't take things for granted and feels pretty dang lucky and appreciative of the life I have. During this journey, I've been tested. REEALLLY tested. I have never experienced such lows. Everyday, I worry what is my future going to be like. I heard a podcast on Neuroplasticity from The ACL Club on how you can rewire your brain because it has the capability to create new pathways. For this post, I'm thinking of it in the positive attitude/mindset sense (there is neuroplasticity in the physical and neurological sense). Basically I want to cut down on these negative thoughts that occupy my head space because it and the pain are affecting my life. Some research suggests that you can think yourself healed, as if you have the power in your mind to heal yourself, which I'm researching further out of curiosity (if that worked then everyone could beat cancer and we know that is not true). Link to podcast below: https://soundcloud.com/showyourscars/031-the-power-of-neuroplasticity It was the first time I heard the term, so I looked into it for attitude adjustments reasons and overall positive thinking. Any ACL recovery is a very long tough journey, but you can ether make the most of it and enjoy the process as best you can, or you can be miserable and feel sorry for yourself. I was really enjoying the process in the beginning actually. Whether or not it affects your actual recovery outcome or recovery duration, you can be a much more enjoyable person to be around by enjoying the process more. I don't want to be consumed with doom and gloom thoughts. It's exahusting. I want to have a better outlook, to be a better person. Let's be honest, there can very well be much more difficult things to face in life and this ACL recovery is just one way to really test your strength to get through it all. Here are a few things based on some articles I've read:
I will probably add to this as I get more ideas, but it's a good start for now.
I was on day 7 of doing the new exercises until I pushed it a little too hard yesterday (wore my Ace bandage wrap to help me squat deeper). I'm pretty sore in the tendon today so I will only do light indoor biking, stretching, and try a short walk later just to enjoy the sunshine and nice temperature outside. After Halloween, I had pain for 3 days and I did not do any rehab, just some stretching. I have mentioned before, when I am in pain like that, it is so so depressing. I feel like I'm never going to get better. I tried heat this time, because ice doesn't really do much. I can't say anything makes it feel better, except not moving and just waiting it out.
When I am able to complete my rehab and continue with my day as planned, there is a major improvement in my general happiness. It's like it was dark and now it's light again. Such a roller coaster! I was able to resume my rehab routine on Saturday and far so good (today is Monday). Sunday is the day I start my weeks over. I know I said I was going to keep doing the same routine after having that horrible week on the couch, but I added some new things to my routine. So far after two sessions, nothing has backfired! I'm so elated!! Here is what I did at 8.7 months post op:
I thought of another way to occupy my winter - hot spring touring. We have several hot springs that would make a good day trip. I visited one yesterday. One would think it would be great for the knee, but I was surprised that my knee got super stiff and tight, plus it was clicking inside quite a bit. I don't normally experience these thing. I will ask my surgeon if this is OK. Speaking of which, in one week I will see my physician assistant for my 9 month post op visit. I am getting a list of questions ready. Photo: stationary bike is set up in the basement. It's my mountain bike on a trainer. Clipless pedals have been removed for platforms. Yes, I bike in my slippers right now. Day 260 is 8.5 months post op. I had a fun Halloween weekend/day. Saturday was an 80s dance party. I managed to stand around and socialize, plus dance a little (I LOVE dancing but tried to limit it to upper body movement mostly, haha). I called it a night at 10pm. I had some knee pain the next day, but I managed to go for a 2 mile SLOW hike on flat trails later in the afternoon and had to use two hiking poles. It was one of our last sunny warmish days and I had to be outside. Last night on Halloween, I visited 3 open houses and walked around on sidewalks, probably about a mile total? I am MUCH more sore today than after the Saturday night "dancing." Why did that leave me more sore? I was out 3 hours versus 2.5 hours the other night. Sometimes it feels like there is no consistent pattern. I do have a very prominent limp today and am walking very slowly wishing I could get my crutch. This time the pain is not solely at the harvest site but over my numb patch to the right of my incision. Knee is wrapped in an Ace bandage for comfort too. Tried my TENS unit midday and it did not help with pain. Anyway, I read lots of journal articles on BPTB (bone - patellar tendon - bone) autograft, long term follow ups, tendonitis issues, 40+ years of age patients, etc. basically to see what kind of future this may hold for me. Lots of papers mention "knee scores" to gauge the knee's function. I don't have a good way to gauge my progress right now (I say my biggest accomplishment in 5 months is getting out of a chair with two feet normally), so maybe if I record various knee scores at intervals I can see progress. Knowing my own knee score numbers I can understand these journal articles better too. The Lysholm Knee Score was developed in 1982 and used to evaluate outcomes in knee ligament surgeries. My Lysholm Knee Score is 32 out of 100 (I technically made this on Monday, but it's still the same for months on end). The scary part is in most of the articles, there is always one or two stragglers, people still quite abnormal years out from surgery. In one paper at 9 to 12 year follow ups, I read there is a couple people still rating 35-44 in the Lysholm Knee Score. That would be just devastating at 9+ years post op! That's like a smidge better than I am now. What will be good to me? The Tenger Activity Level is another scoring system to standardize activity pre- and post-ligament surgery and often compliments the Lysholm Knee Score. Before my injury, I was a Level 6: Recreational Sports - (many sports listed ) about 5x a week. That was me. I did do some ski mountaineer (skimo) racing, but really as a recreational person not a honed elite skier or anything, so I didn't go for the next level up. Currently at day 260, I am a Level 2: Work - light labor, walking on uneven ground possible, but impossible to backpack or hike. I'd say that is me, and some days I am Level 1: sedentary. I would like to reach Level 6 again, but if Level 5 is all I can get then that would be better than not ever being active. We will see! International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form is another scoring system to detect improvement or deterioration in symptoms, function, and sports activities due to knee impairment from ligament injury or surgery. Highest level is 100.
My IKDC score is a 24. This handy PDF I found tallies up the score for you. Before I even completed the Lysholm or IKDC knee tests, I would tell people I'm 35% of normal as a way to quantify things. So I guess I wasn't too far off considering the two knee scores (24 and 32). |
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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