I mentioned to someone yesterday that the unknown length of time I'll be on this journey "looms over me like a dark cloud." He joked, "Wow, that's some positive thinking!" OK, maybe that was my reminder that I really do need to work at my positive thoughts. I need to make it a daily habit. I admit I fell off the "affirmation wagon" a while back when I was chanting phrases of gratitude to myself. I will go back to reciting affirmations and writing them down as well. Because I felt it was helpful back then, just need to keep at it. The graphic below came from Smiling Mind a free mindfulness app which popped up in my Instagram feed the same day I got that joking comment! This also reminds me I need to get back into the habit of mindfulness. Learning to control and calm your thoughts through mindfulness can help with the negative thoughts.
OK there's my self pep talk for the day! I can do this better.
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I recently got in two decent weeks of rehab finally! Looking back at my spreadsheet, I really haven't had two decent consecutive weeks since early June (I'm talking ~6-7 sessions with a rest day every other day). Lots of reasons why: LIFE. I don't think I've ever said, "I don't feel like going, I'll just stay home tonight and drink wine." If I can't go there is usually a good reason like I'm not home or I'm very sore!
Things are busy this week, and I'm trying to not let it derail my rehab plans. We have 5 house guests coming, house cleaning (house is always a mess) and cooking (despite keeping it simple). Fri/Sat my husband will be competing in a 100 mile mountain trail race and I'll be his crew. I hope I can rehab Sunday but that may depend on the sleep factor. House guests are all here for the same race. It's pretty exciting! Last weekend I had a pretty functional weekend. Note: not the same as a "good" knee weekend. Still waiting for that. Functional as in I hiked downhill for the first time without poles! I previously used poles like mini crutches taking a bit of my body weight off on that downhill step. I did two hikes without poles and a decent downhill descent! One involved trail work, so I am pleased that I held up for that much activity (like 4.5 hours). I had a normal gait, so it appeared I was walking normally! This is pretty big news for me! My friend asked, "So did it feel good?" I'm like no it hurt the whole time! Hahaha! But the point is I could do it, and I couldn't before, and there was enough strength to walk an even gait down hills. Taping the knee was essential. Baby steps... Another big update besides walking downhill - I did my longest mountain bike ride (maybe ever???)! There are 5 potential weekends left before the White Rim trip where I can get in some long rides. I wanted to try a "big" ride but with not a ton of climbing, but also on trail or dirt roads. I managed a 27 mile mountain bike ride, 3300 feet of climbing, in about 4 hours - almost all on single track. I was quite tuckered by the end! The pedaling was pretty moderate, not a ton of steep sections, some places I did hike the uphill. I decided to cut it short (original plan was more like 30 miles) because the last hour my knee cap felt like it was lined with sandpaper. Very irritating and annoying despite the fairly moderate spinning. However, no major joint swelling and no flare ups! That was a big three day knee weekend! Despite some of these recent improvements, I REALLY have so much further to go. *SIGH* It looms over me everyday like a dark cloud. Need to stay in the moment, focus on the now. Otherwise, one can go crazy. No one likes to guess times for me, but if I had pain for 11 months, one very rough guesstimate I heard is 11 months at a minimum of proximal muscle rehabilitation to get some normalcy. 11 months would be like another 2+ months. Hmm, I don't think anything magical is going to happen in the next two months honestly. Gauging by how consistent my pain is and how slowly this is going, maybe I should guess another 8-10 months on top of what I've done so far. Just a guess. Whenever the pain and swell fests go down, and I'm stronger, then I can start running/jumping/agility. At least I know the order of how things will go! Summary: 19+ months post op, <9 months into new rehab. Some photos from my 27 mile ride. I started from the front door! I revisited this wonderful little info nugget called "Recovery Strategies Pain Workbook" by Greg Lehman. It's described as a workbook "designed to help therapists and patients deal with injuries and persistent pain. The book can be used alone or can be used with a therapist." I actually found this several months ago, but when I started to read it I kind of wrote it off. I don't remember why. Maybe I was in a bad mood, or maybe I thought it was hog-wash. Ha! I reread it recently and it really improved my outlook! Much of the advice is exactly what my Australian DPT has told me, just really spelled out in detail. I find it very applicable to my case, but of course it's not supposed to be right for every single person or situation. I also like how it's called "persistent pain" and not "chronic pain." Makes it sound like pain is only temporary! Here is the FREE download link: CLICK It doesn't into go into the neuroscience behind pain, but breaks pain down in an easy to understand manner with key take home messages. Here are just a few of the blurbs I've copied and pasted from the PDF that resonate with me. The body is designed to respond to the physical stresses we place on it and get stronger and more resilient. Physical stress (exercise, gardening, lifting weights) all cause slow changes in people to allow them to do more. One of the amazing things about people is how we can tolerate and adapt. Habituation means that the same input over time leads to a smaller output. With finding your contributors to pain you want to reflect and consider if you are doing too much too soon for what you are currently ready for. There are three things to look at or consider changing: 1. How much you are doing 2. How quickly you progressed 3. What are you currently ready for We try to find the balance of doing enough to make us adapt and not doing so much that we overload our system, get sensitized and pain or injured. First, understand your beliefs about your pain and try to get some insight if those are contributing to your movement habits. Then, start exploring movements. Usually, nothing is off limits its just our tolerance initially. Your body is built to move in a number of different ways. Try those out. (NOTE: except of course stuff where you need rigorous ACL return to sport testing) Avoiding meaningful activities, like hobbies or time with friends, can increase your sensitivity by increasing social withdrawal, a depressed mood or sense of hyper-vigilance. Meaning, you just don’t trust your body anymore to be strong and robust and you feel it needs protecting and safe guarding. And remember what pain is all about...its about the perceived need for protection. AVOIDANCE COPING: If you are worried that raising your arm over your head or going on long hikes will cause damage or more pain then you might avoid these things. But because of the way the body and you adapt if you continue to avoid those things you might actually become fearful of them and sensitized to them. Your fear and avoidance end up “triggering” your pain response even if you are no longer damaging yourself. Biographical Suspension is when you aren’t "you". It's putting your life on hold. Ask yourself, "what would you be doing if your pain was less of a problem for you?" Poking into mild discomfort and doing the things that are meaningful helps to turn down the sensitivity of that alarm. In general it is a good idea to start with just poking into pain for a few movements or minutes. A success is that you don’t have a massive next day flare-up and your pain remains stable that day too. Because you can poke into pain too much. Like many things it's finding the balance of how much to persist and how much to avoid. And that balance will change over time. You stop doing things that are meaningful and important to you. Avoiding activity, social withdrawal, time off work and loss of contact with family and friends can sensitize you. Consider what it is that you are missing. Consider how this can affect your physical and mental well being. We also recognize that you might have flare-ups with pain. This is normal and part of recovery and living well again. We should not expect to always avoid flare-ups. Rather you can manage them and keep doing what is important. Section 4 of the workbook are the strategies and questions to ask yourself so you can help gauge and regulate beliefs and thoughts. I haven't written anything out yet, but it is thought provoking. I started thinking back to all the situations where I cancelled or backed out of because I was worried it was going to hurt me more, or I would pay for it for days! Yes, there were probably some things I wouldn't have been ready for, but sometimes it was just dinner with girlfriends where I'd be sitting. I certainly have isolated myself during this recovery.
What is also surprising - and it comes from my DPT as well - that the goal is to NOT avoid flare-ups all together. Say what???!?! This is really shocking to hear honestly. I feel like it's to mission to not flare-up mainly because it's so hard to handle the lows. But the advice is that it's OK, the body/knee will forgive you and you will adapt. So far it has been true in every single flare-up. Gotta use those tactics. Then also - doubly shocking - keep moving when in a flare-up! That seems pretty hard honestly, but next time I'm going to try my best not to let it stop my life. Two days ago I did a bike ride after work. I set off without my knee wrapped. For about 20 minutes I constantly debated, "Should I go back and get it?," because every stroke of the pedal I felt the front of my knee hurting. I wondered if I was going to make it worse especially on the uphills. Thinking back to the workbook, I decided to stay with the feeling, let a little bit of stress get applied (obviously it wasn't stopping me from biking, just distracting). Well by the end of the 1.5 hour ride, I can say it felt much better! Maybe the whole "exercise is an analgesic" thing came true for that ride? Maybe I was habituating things as well? Anyway I'm on day three of not wearing the Ace bandage on my knee. I still tape for weights. I would like to stop relying on this bandage for functionality. Maybe I just need to start habituating that feeling. Side note: I would like to do more midweek aerobic stuff - I just rehab during the week and bike on weekends. I need more movement, need to get endurance/fitness, lose some pounds! That bike trip is in 46 days, still unsure of it all! Phew!! Finally off that 18 day pain train! What did I do? I just did a little too much back in mid August. Dancing, biking, rehabbing - I cannot pinpoint one exact thing, but everything just kind of caught up to me. Also during this big week I had that weird pain experience at the gym too.
Now back to my normal everyday pain! I can be functional with this daily pain. I can still have progress in this state. Tonight I plan to tape up the knee and resume rehab at the gym. I will decrease my leg extension and leg press weights, but keep all my hip, glute, hammy weights the same. Perhaps I added to the "overdoneness" by adding on too quickly. I recall feeling even sore in the other knee because weights were pretty heavy. This flare up was particularly bad because the joint was so swollen and tender. It felt harder mentally too. I didn't handle the low points very well. One day I must have cried 30 times. I reached out to my PT asking how do I know if I did something wrong? How long is too long to be this swollen? She suggested products such as lectric soda crystals to draw out the swelling (never heard of these but YouTube explains everything), Zostrix which is a topical analgesic made from chili peppers, Tubigrip which is like a compression sleeve elastic. She also suggested I do some type of gym rehab even when super sore; i.e. just working the non-operative side, or just doing the minimal load I can tolerate, some load is still OK. Well some of those days I just plain hurt simply walking so I opt to move as little as possible. Next time I will try to go regardless and try some of these new products too. She suggested 2 days on with load and 1 day off. I think we can all agree that this heavy loading, then periods of unloading due to pain are probably not the best plan of action! To add to my "mental tricks" bag, I bought the book True, Grit and Grace by Amberly Lago. She endured a horrific moto accident and has had 34 operations to save her leg. She now lives with CRPS and lives a happy life despite the pain while redefining what life means for her. I find that amazing and inspirational, not to mention humbling. I need to learn her tricks! I wish I could limit these episodes. Then again if I didn't have any, I may be so frustrated that things were going too slowly. PT said that she likes how I decide when to up my weights. Basically if I feel I can do more than 8 reps, then I will up 5 pounds. There are formulas out there like the Acute to Chronic Workload Ratio where you increase weights or effort only 0.8-1.3 times your rolling aka "chronic" workload. Would that help guide me more? Not sure, I am not progressing like normal people and this isn't like training for a race where you can build upon each week. I don't think it's singular events that tick it off, but probably a combination of things that vary with certain intensity, duration and how they were grouped together. PT said that it is OK, I am allowed to live my life and have fun, in fact she said it's essential that I do things like this. The knee will forgive me! She did not make me feel like I needed to try and avoid these flare ups, they are just part of the process. Use the tools we have for pain, swelling and mental health, and HANG IN THERE. We were able to get away for this weekend in our little trailer. Thursday prior, I was unsure if I'd be able to bike or not. I said let's just go anyway, the change of scenery will be good. Come Friday it was still kind of tender but I managed a very slow ride right from camp. Then Saturday I did an 11.9 mile ride and Sunday a 9.4 mile ride! I think I'm off the pain train! Wahoo! These trails were somewhat mellow all staying under 2000' vert which was very pleasant overall. This was Idaho, not far from home. Non-motorized single track trails are the best. |
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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