I am getting close to two milestone dates: 1400th recovery day (December) and 4 years post op (February). Snow is already on the ground in my state, and we are getting a big snow storm today. I could be cross country skiing on dirt roads by this weekend! This will be the first yearly anniversary I will be able to ski - barring any more injuries. Same kind of skiing I did earlier this year, not downhill skiing. That big toe joint pain I had in September is still not totally resolved at the time of this post (mid November). My foot did allow me to hike 60 miles in a week during our annual October dessert trip, like just in time literally, the week prior it would not have worked. I didn't intend to hike so many miles, but it just happened and yes, my hip tendon was irritated by the end. So much beautiful desert to see, every bend was different. I had a really hard time making myself turn around! So far, I can do lunges and calf raises with minimal discomfort. It is getting better and I have finally resumed running (only 2 weeks in at the time of this post). It will resolve 100% eventually, whatever it was. I am just happy I have resumed running. Photo from our October trip. It was 80F all week, overnight lows in the 40s. Fantastic last summer hurrah. I had a good Skype session with my physical therapist last weekend. It had been about 5 months since we last Skyped, but there were email updates in there - usually me updating on my newest injury! Ugh. I just hadn't met the goal at hand to discuss the next plan, so I felt we wouldn't have much to talk about honestly. However, this time we discussed how I'm not able to run past 1 minute right now. I shared my month by month "good, bad, ugly" color chart I shared on here previously, which really demonstrates why my tendons are so deconditioned. Mainly my hip tendon is holding me up. I get a lot of residual pain in my lateral hip which really affects my sleep and sleep position. I had been taking a Tylenol PM to help me sleep. From my education, night pain plus pain the next day tells me I'm running too much, so I moved it to 30 seconds of running (8 reps). Not much change.
After Skyping with the PT, he wants to add more! I was a bit surprised! First we're going to add in 10 minutes of skipping 2x a week. This is to be done before my running, which is before my lift sessions. We need to train those tendons to be more spring-like and right now they aren't very springy (foot or hip). I can't skip for 10 min straight right now, so breaks are OK. After 3 weeks of this, we'll add on 5 more minutes. In another 3 weeks, we'll add on another 5, so that by New Year's I'll be up to 20 minutes of skipping 2x a week. After that we may add in a 3rd skipping day. I am running 3x a week. The other change was an external cue. I have been using a lot of internal cues such as land on my forefoot, keep my stance wide, try to keep a quick pace. In reality, it was going about 4.5mph and it was more a shuffle with my feet very low to the ground. Not a lot of knee drive. Instead he wants me to use the analogy "run like you stole something" or "run like you're being chased" which is going to involve a fast pace (over 180 cadence) and a lot more knee drive. This is about 6.6 mph for me right now. Low and behold, my hip pain is a little bit better! I haven't had to take any Tylenol PM at night since we've started this, and I've slept pretty well (but still staying off the hip). The pain has gone down a notch. So perhaps there was something to all of this! This is really a lung workout too, but after 3 weeks that should also improve as well. I definitely have some leg hangover, the good kind. The goal here is still (as has been for like 16 months now), get to 5 minutes of continuous running, 2 minutes of walking, repeat for 30-40 minutes. After that, I can begin agility/plyometrics. This stage is required before sports specific training. After that is real skiing! In reality, I've had TWO instances in the last 16 months where I've actively been trying to increase the time as in weekly time increases. TWO! Once last fall 2019, and once this July 2020. But first things first. Need to get my running capacity up! I am so determined to get over this year long hump!
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I am not sure what happened to my left big toe joint, but it's putting a damper on my rehab! I am now 40 days into this new left big toe joint pain. It just happened one morning when I lunged while barefoot (and half awake). I don't know if the lunge was the incident, or I did something prior and only found out during the lunge. I ended up modifying my activity for 3 weeks - because that is what my PT would suggest I do. In my case, I cut out all walking and running and replaced it with a stationary bike. That did not change anything so I made a podiatry appointment. Two days before my appointment, my toe was finally feeling a tad better, as in I could flex the big toe joint behind me in the classic big toe stretch, but not with weight. That day my gait was near normal too.
I still went to the appointment. He felt I had a sprain of the big toe joint, and/or a bone contusion, maybe from one unlucky lunge perhaps. A sprain of the big toe joint is called "turf toe" and that usually happens with a more significant accident and you know for sure it happened. My PT was not in agreement with this Dx. He thought maybe a big toe joint reaction (they call it first toe joint in Australia) - so either a stress reaction? bone stress reaction? Not quite sure what he meant. He also suggested seasamoiditis which is more a tendon issue on the ball of the foot, regarding the tendons that run through the two small seasmoid bones. The thing is I was more tender on the top of the joint where he squeezed my toe, than I was on the ball of my foot where he palpated the seasmoids. So I am not sure it's that either. Anyway, I'm on day 40 and I can go for short hikes, but not 3 days in a row. I did 2 days this weekend and Monday proved to be quite tender and swollen. I can do short range of motion calf raises, single foot, just can't rise up very high. This is OK because it keeps that calf activated. Full bend with full weight bearing is still not there yet. I am testing the waters as I have a week hiking trip coming up this month! I want to get the foot exposed to some hiking before we depart. Below is a hike I did this weekend. There wasn't a trail most of the time Man, my tendon issues are a bummer! Is this pre-menopause? Is this some hidden genetic issue? Is this due to inflammation in the body? Is this due to all my previous deconditioning and other deconditioning injuries/episodes? I think it really this it's the latter - it all boils down to my awful first year of NO rehab where I deconditioned severely. This kind of wasting away isn't like sitting around on the couch not exercising, this is an athrogenic muscle inhibition type pain reason for deconditioning. The neurological system degenerates too. Really tired of things just not going to plan. I decided to just map out my last 4 years into one of three categories - bad, moderate, going well. Well isn't that telling! 55% of my last 3 years 7 months have had some sort of major issue/injury going on that affects rehab. Only 11% of the time I felt like things were going well and I felt strong (but not normal, full capacity).
So no wonder my tendons aren't up where they should be. They take so much longer to adapt. Your cardio vascular system and muscular system can adapt and grow much faster. Given all these red hiccups in the plan, no wonder my tendons have yet to adapt to my demands. I need to be more patient. On a side note, my chronic 20 years of heartburn at night (which affects my sleep) is finally being focused on. I took PPI medication for <20 years and I felt it never did anything for me, so I stopped it a few years ago. I never was able to "eat well enough" to eliminate my heartburn. Then I started researching more about gut issues, food sensitivities, underlying reasons for heartburn. Basically my conclusion from all my research is maybe this is a lot bigger of an issue than I thought it was, maybe I have an underlying issue that can be treated, and I am completely in over my head! I just thought these food quirks just made me "me," so I accepted it for decades. Now, I found an integrative and functional nutritionist. We've already done the MRT food sensitivity test [https://www.nowleap.com/leap/]. This test uses your own blood to test your immune response to 170 different foods and chemicals with 94% accuracy and 91% specificity. Turns out I am moderately sensitive to foods I have been eating everyday! Bananas, cherries, flaxseed, white potato, sweet potato, apricots, cucumber, tomato, caffeine, corn, cashew, yogurt and more!!!! I have been keeping my gut in a constant state of inflammation. I am getting the guidance of the nutritionist for 4 whole months, and more tests are coming up. We start with a very restrictive diet with only my safest reaction foods and we test and build up from there slowly. I've lost 9 pounds already, but heartburn still needs work. I have lots of healing left in there after decades of scarring and irritation. Food sensitivities can be linked to a plethora of issues. My ultimate goal is to end my heartburn, and not get cancer. My dad died at 58 due to esophageal cancer. Plus sleep would be really good! If this can also help my body/recovery issues that would be so great! Also an inflamed gut is linked to leaky gut syndrome. Bad/wrong bacteria can pass through the intestinal wall and enter the body. This has been linked to turning on certain DNA for auto-immune diseases. My mom and sisters all have different auto-immune diseases. Maybe I can prevent this path. Day 1300 is here and time to add one more "step" to my list!
This 100 day block was hard to keep short, too many things happening. I will say it started out pretty good. June and most of July went pretty well, but then it all fell apart after my week long July hiking trip in Idaho. I clearly pushed my tendons over the boundary and set off multi-week flare ups that I'm still coming out of 6 weeks later. I obviously have to do my week long hiking vacations DIFFERENTLY. There are a few more long trips coming up in October and November. I need a better plan so I can get off this rehab hamster wheel. I feel like my summer was cut short honestly. I am currently in no condition to do hiking trips, not even a weekend trip. Five and a half weeks ago, my PT revamped my programming - basically it included one more run day, one less hiking day. We also set out a running goal (by 8 weeks, run 5 minutes straight, then walk, for overall 30-40 minutes).
Alright well none of that is on schedule! This does not surprise me, but I really was hoping it would work this time! The extra/third of running did need some adapting. I also moved my runs to the sidewalk/road (was running on grass for over a year). Eventually it adapted to that. I was also trying to maintain my 10 run reps, while increasing the time of running. I know that 1 min of running x10 was fine, but when I worked up to 2 min of run x10 (over 2 weeks' time) - the knee started to complain enough that I had to back things down again. Tried a new ramp up plan, kind of OK. Then I decided to take a week off from all rehab (knee, foot, arm) and enjoy my week long vacation. This was a hiking vacation in the mountains. Several nights of camping in our little trailer, then a couple nights were backpacking so sleeping in a tent. I hiked 7 of the 8 days, I put a rest day in there intentionally. My one day max seems to be 8+ miles. One backpacking day was a big off-route day with lots of boulder hopping, huge boulders to step up and down from, scrambling. Probably the biggest knee intensive hike I've ever done; 5 hours of moving. By the end of the trip the knee was pretty toast. The foot handled it mostly, it would start to twang at me and I knew it was time to stop hiking, but no foot flare ups. When I returned home I took 2 days of rest, then resumed my schedule. Soon after running resumed, my lateral hip started to complain again! Ugh. Using activity modification, avoiding crossing legs, and laying on that side at night, putting low level glute moves back into my routine. Running 1 min, x7 worked OK ish - but then I had to stand all day while at my computer or it would certainly get worse while sitting. Then this didn't work anymore so I'm going to put running on hold again and just walk. To top it off, those stabbing pains in my foot I had way back in November 2019 (the mild degenerative changes from the MRI) is currently there. Then sleeping on my side while in the tent plus using my arms a lot with my hiking poles (I had to), really jacked up my arm and neck. That was too much stress for my TFCC arm. I need my right side to keep heartburn pains down when I'm away from my wedge pillow, but that is just hard to do while sleeping in a tent. So my right side is overall not very happy right now. Just trying to stay positive, keep moving in some form, trust this will pass! I don't regret my hiking trip - after all that is the only reason why I'm rehabbing so I can go enjoy the stuff that I love - mountains! But I still wonder, should I have taken a 2nd rest day during that week? Was there just too much elevation gain? Did I need another rest day when I returned? Should I have bumped the running back down first? I just want to find a way to not allow this to keep happening! I have some amazing updates! I have been running 2x a week for 5 weeks now. The knee has responded much better this time around, like the knee can't even tell it ran 24 hours later. Things are going well enough, that we are proceeding with an 8 weeks plan, where I will aim to get up to 5 continuous minutes of running (followed by 2 min walk) for 30-40 minutes by the end of August (hopefully 3x a week). I've already mapped out all my weeks and times. If I can do that, we can proceed to introduction to agility and plyometrics!!!! Only 30% of ACL patients returning to a Level 1 sport actually complete 3 months of an agility program. My PT is requiring it for return to skiing. Also my PT wanted a Biodex reading before any plyometrics start and said if I can get one soon that would be best. This is an isokinetic dynonometer test that measures quad and hamstring strength. My last Biodex test was over 3 years ago on May 2017. I was 12 weeks post op, with an incredibly flared up sore knee. The beginnings of my run away train pain. I actually thought we were going to begin running that day, but the tested me to make sure. I had already had 2 other tests (week 9 and 11?), but they decided to test me again so soon despite how sore I was. This is a rather pain provoking test in general, you are kicking out as hard as you can with your knee strapped in. My pain was so inhibiting that my scores came out LOWER than the other tests. It was this day that they decided to stop all my rehab and send me home to rest. I cried in this same chair, very sad tears. I was devastated they were sending me home (which ended up being for months, until I jumped ship at nearly a year post op). Ugh. Later I learned through my ongoing research, that it's really pointless to do this kind of test on a BPTB anywhere before 12 weeks especially with a patellar tendon autograft. In general, the numbers are going to be pretty low and depressing for most folks. Not a great moral boost. With patellar tendon folks, you're likely going to just tick off the harvest site and not get a true reading and will make things worse. Here they had done the test on me 3x by 12 weeks! Really unfortunate. So you can imagine the nervousness I had going in that day! I had all sorts of numbers swirling through my head. I was also mentally preparing myself should my numbers come out lower than I wanted. I was prepping myself to handle the disappointment too.
My results were shocking! I have not only met the magical mythical 95% LSI quad, I passed it!
I actually cried happy tears in this same chair that gave me sad tears 3 years ago! Get this, my quad improved 189% from 3 years ago. They wanted to frame the pie chart on the wall. I am just blown away. No way did I think I'd get these kind of numbers, and no way did I think it was even remotely possibly given my super uncomfortable knee! I did say to myself at one point well if you're going to have a janky knee for life, then make it the strongest jankiest knee. But on the flip side, I was also telling myself that not until you get as strong as you can be will you really know what your normal knee feels like. I can still get stronger, this isn't it by any means! While I am so elated with this news, I also had higher hopes that the knee would feel a little better at this stage than it does. I'm still pretty sore from the test 2 days later. It will resolve. I'm also not done with all of rehab. Soon up next are the agility portion of rehab and the sports specific training portion. Going by numbers alone, there isn't anything my knee should not do. But of course, it's not all about numbers alone. Other stages of rehab need to be completed. Lots of updates today, but first let me add my 12th step of recovery as I have reached my 1200 day! (Day 1300 will be over Labor Day weekend.)
The last 100 days were better than the 100 days before that thankfully. I have made some progress on my calf strength, currently doing single leg calf raises with a 50 pound backpack on. 4 sets, 8 reps. This will continue to progress and will stay in my rehab plan from now on. I also do nightly foot and arch strengthening moves. The foot can tolerate hiking a bit more. For my birthday we did a 5+ mile hike 1200 vert to see some waterfalls. I was sure I couldn't make it that far with elevation, but I did it! Biked a couple miles to and from the trailhead too. The lateral hip pain took about 6 weeks in all to resolve, with 2 of those weeks being acutely painful. I managed it by myself, reading stuff online, doing low-level glute activation stuff a few ties a day, trying to not cross my legs during the day, staying off the hip (no side lying or prolonged sitting), and what pieces of my ACL rehab I could still do. I told myself to just keep doing something (3 of those days I could do very little). I had to modify things for about 2 weeks before I could resume like normal. Now to the goals! Physio asked me what I want to do this summer. I said return to running and also resume backpacking. My husband and I can do this together and it's a great way to get away from crowds this year, plus we have a long list of places to see! So here is the plan he has for me. Basically hike 2x a week, run and lift 2x a week, and walk 3x a week (I'm sure one could be a bike). The weekend hike will be the day I work up my mileage over the summer. Adding in the midweek hike will hopefully get my foot accustomed to hiking demands, and avoiding the once a week spike in activity. Now the foot and hip just have get with the program! Physio was not too concerned with the hip and foot, we'll just manage it as we go along, and hopefully resilience will improve. Dammit to all hell. I have another flare up situation. This time it's my HIP. My hip has not been an issue at all during ACL recovery. But over 2 weeks ago, I wanted to do some cardio and didn't want to walk and flare up foot and biking wasn't going to work (husband was on a conference call where the bike is set up), so I carefully chose a very low impact ["quiet" was even in the title] YouTube workout. It didn't hurt during, I even did it twice through to get a good sweat. UGH. Hip pain started that night or the next, I don't quite recall. In hindsight, maybe there were just too many lateral side movements that I have not trained to do yet, despite working at hip and glutes stuff for 2 YEARS now, it has been all straight line stuff (forward or backward). Is my 7 week at home version not cutting it? Would this have flare up the same if I were still in my heavy gym based sessions? I don't know. I want to believe I had strong hips and glutes, but I guess they are not there yet. I've done a 10 minute aerobic workout including some lateral stuff as a warm up when I can't get on the bike, that didn't make it worse (maybe the dosage was acceptable?) About 6-8 years ago, I had this same hip issue. It came on after I over did Zumba one night in my basement. Over did it, I mean like 3 hours of hip swiveling, fast paced dancing. I was active at the time, but maybe not as strong as I could be in the glutes and hips. I ended up dealing with this issue for 2 YEARS without improvement despite getting a steroid shots, seeing a sports physician regularly (he was perplexed why it took so long), and 9 months of at home rehab. Now when I Google this pain, it seems like this now has a proper name: Gluteal Tendinopahty or Greater Trochanteric Pain Syndrome which:
I really think is what I had way back when, they were just beginning to call it a tendinopathy instead of tendonitis at that time but the doctor didn't go much beyond that (he even guessed a cortisone shot wouldn't work as there is no "itis"). About a week after the video, the pain was more like "hip aware" in the background. My foot was starting to feel much better so I went on a hike that had some elevation gain. Turns out hills are pain provoking for GTPS especially in the early acute phase. By that evening, I was stretching out my glute/hip doing the pigeon stretch and other stretches. Then next 3 days (including today) I am too sore to walk, sleep comfortably or sit down. Turns out stretching that pulls the hip into adduction is very irrtating. It used to be the treatment, now they know more. I found a great Tom Goom article on what to do in the reactive/early stages of GT or GTPS, they are:
So that is where I am now. I don't know how long this will last. I really hope it's a one time thing. Am I going to be ready to try out skipping in 10 just days? I am a bit worried. Is this going to set me back further? Probably. Is there any knee rehab I can still do that won't make it worse right now? I'll have to find out. I don't believe I am doing more damage, but I certainly don't want to deal with more pain as I don't have many tools that really work in the pain department. It's so nice out as well, I would love to go for a hike in the sunshine, but I don't think that would help with situation right now. Trying to use all my mental toolkit tricks right now because I am not happy about this. At all. I think I've gotten through that foot flare up that started about a month ago! I went on a nice 5 mile hike yesterday. I was very mindful of my footing, making sure not to pronate inward. Every morning upon wakening, that first step on the ground is clear that the foot doesn't feel as normal as the other, but it's a good indicator that it wasn't worse off after the hike. I am 2.5 months into my foot tendon rehab plan. The last 2 weeks being loaded single leg calf raises and heavier single leg seated calf raises. I wear a backpack filled with 30 pounds, then hold another 7 pounds in my hand for the standing calf raises. I have a bunch of smaller hand weights so I can combine all sorts of weights to gradually increase the load. Seated calf raises - I use my cheap-o gym rack which has a leg extension machine, and just scoot far to the edge of the bench so the extension is right on top of my knee. It works pretty well! I've also decided to add more foot strengthening work in:
It is pretty clear the foot is still weaker than the other, so hopefully these will be a good addition. Two more weeks and I can reintroduce SKIPPING!!! In wrist news, I finally am able to take off my WristWidget! After one year of wearing it, my weight bearing numbers are equal with and without the WW on. That is an indicator of healing. However, I'm not totally done. I have new exercises added such as dynamic loading shoulder work. I am not pain free, but I've managed to get out on a bike (pavement only). Kind of testing what distance is OK on the arm/wrist. Technically I'm not cleared to bike until I can plank for 2 minutes on my hands, but I'm getting there. Knee really wants to hike and bike. I think it feels better when it can do more. Right now it's a bit annoyed. Maybe from all the deep squatting from yard work and the foot not moving normal. One year ago was my 800th recovery day. I did a big steep hike that I had not done in years and the next day I danced for 3 hours at a reggae show. I can't say I can do that right now. It almost feels like I went backwards a bit. I kind of did, given all the injury setbacks. However, in the past year I did have some pretty big milestones which I will list as a reminder to myself:
Almost 2 months into my posterior tibial tendonitis rehab, I had my first flare up. It wasn't from the rehab exercises; it was from me doing something I should not have. I was out on a my daily walk last week and I sprinted nearly a block to say hi to a friend who was pulling into her driveway. I wanted to catch her outside, rather than known on her door. I guess I was desparate for a little conversation! That created a very swollen tender painful spot on my inner arch. Then a few days later, I went on a short hike with the husband and the trail ended up being quite covered in snow and lead to some post-holing. My tendon was very unhappy about that. I was ready to rip off my shoe and throw it. I turned around and was able to hike out at least, but it really hasn't settled down from those two cases. Even regular walking irritates it right now.
Today I am starting the 3rd month of foot tendon rehab. The plan is to do single leg calf raises - seated and standing - but now I'm going to do progressive loading. I'm assuming my foot needs to be much more calm before I start my first day. I found a great article on tendonitis and tendinopathies by Dr. Howard Luks and how avoiding training errors in runners helps with injury prevention. Tendon issues are the most common injuries in runners. It has a lot to do with load management. The 4 stages of tendinopathy: Onset through the healing Once you have developed an overuse tendon injury or tendinopathy, your tendon will go through a predictable process towards resolution. It’s important to understand this process because it will help explain why it takes so long to recover from some common overuse tendon injuries.
This was very educational and comforting to know that the tendon rehab goes through a predictable process! Bummer to hear it can take 9-12 months in total, and pain can last 7 months. I believe I am out of the first phase, but I also feel like I may have set it off again, or maybe this is part of the trial and error portion of phase two? I think I am about to enter phase three because we will be adding load on this next phase. |
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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