Day 50

Here’s a bit of recovery wisdom that I've recently derived: One of the main reasons that you want to rehab as soon as possible after ACL (or any other immobilizing) surgery is that the longer you remain bio-mechanically altered, the more likely you are to injure something else.

Last week’s diagnosis of my recently instigated knee pain:
Sciatic nerve damage.

The determination was based on a quick exam and a few physical tests administered by Thor, comic book legend and trusted PT guru. I know nerve damage sounds nasty but given the alternatives the nerve is by far the best choice. If not the nerve, then the source of pain would have probably been one of the repaired elements of my knee (the ACL graft or sutured meniscus). If either of those had been compromised, it would be highly unlikely for the situation to somehow self-resolve. As such, I was more than happy to buy the nerve damage story. In general, you know things are a bit desperate when you are rooting for nerve damage.

It's now just ten days later and while the pain is not gone, it is already quite a lot better. The relatively quick improvement matches the initial diagnosis and is a good indication that the source was not the graft or the meniscus. Definitely good news.

So how did this happen? Well in my case the theory goes like this:

3 Easy Steps to Sciatic Nerve Damage
1.) Do not straighten or fully use the knee for a few months. This will help to make the nerve shorter and less flexible.
2.) Ice the knee into a deep freeze.
3.) Stand up and fully straighten the knee into hyper-extension – be sure to bend forward at the waist to induce maximum stress on the nerve.

Although it was enough to force me back onto crutches, I’m off them again now and as mentioned, the pain is definitely better. This is especially promising given the fact that I recently gave up Advil, the last of my pain medications.

I had been taking 200 mg of ibuprophin (via Advil) every 4 hours for nearly 5 weeks (beginning the day my supply of Toradol ran out). For the first few days after the nerve diagnosis, however, I doubled the doses to 400 mg every 4 hours. Into the third day of elevated doses I was opening my mail when my eyes suddenly obtained free-agency status. Within seconds my left eye was looking at the ceiling and my right was angled toward the floor. I stumbled to the couch and squeezed my forehead between my hands trying to correct the internal corkscrew effect until it finally subsided after a few very long minutes. By then I had sworn off everything from Advil to fast-food, squinting, nail-biting, illegal u-turns, littering, loitering, loud music, internet porn, new episodes of LOST, and anything else I could think of that might have caused the disorientation. I haven't touched the Advil since.

Going off pain medication is a bit like jumping into a mountain lake. It might be ok or it might be bone-chillingly cold. But you won’t really know until it’s too late to undo what you’ve done to find out. Thankfully, the post-Advil period has so far been quite tolerable. I just have to keep reminding myself that the newly identified aches and pains at this point are not likely an indication of lost progress, but rather the result of once again accurately feeling everything as it really is.

Yesterday I was back on a Stone Clinic PT table where I confessed to Thor that my lower back was still not entirely right. He worked my back a bit and then targeted a new area, the Psoas, a hip flexor muscle that you never even knew you had. Thor calls it the “Filet Mignon of the human body” and in accordance with what is apparently a strict personal policy of full-disclosure, he said that if we were ever stranded after a plane crash in the Andes, that’s the part he would take first. A distracting bit of information I now wish I could manage to forget. In any case, digging into my abdomen to “relieve” the tension in the psoas was a none too pleasant endeavor in itself but it definitely did seem to help afterwards.

The PT session focused primarily on the sciatic, the aforementioned filet, and on obtaining full extension (the latter of which I had been successfully getting to at home for the past couple of days with the help of my wife who is understandably somewhat hesitant to push on my knee). Afterwards I asked Thor about the sports brace that he had previously suggested. The bottom line was that he highly recommends one if I am going to engage in sports during the first year post-op. A quick internet search when I got home led me to this excerpt from about.com regarding ACL knee braces…
“The problem with knee braces? While they may help support the knee when low forces are applied, these forces would not be expected to cause injury to the reconstructed ACL. However, a force that is high enough to disrupt the reconstructed ACL would not be effectively stabilized by the knee brace.”
Similar comments can be found here on the ACL Solutions website: http://www.aclsolutions.com/faq_07.php

Given the opposing opinions, the fact that I already have the bulky post-surgery issued brace, and my general lack of intention to join a pro sports team this year, I think I may have a difficult time justifying a sports brace.

Left: Lightweight state of the art custom fitted brace available in a dozen colors.
Right: Brace worn by Joe Namath in the 1968 season prior to Superbowl III.

At this point I’ve abandoned the regularly scheduled formal PT sessions, although I’m working daily at home and will continue to follow up at the Stone Clinic as needed over the rest of the year. I’m spinning 30 minutes every night on the bike (mounted in a trainer, and at a blazing 40 rpm, but hey, it’s something). I’m still not getting to full extension when I walk but I am getting closer. Overall, I’m quite thankful and pleased to report that despite the recent setbacks, things do seem to be back on track once again.