Day 72

I do realize that much of the content of this blog is rather self-absorbed in nature. It is after all my blog about my knee so it seems there is little sense in writing everything in terms of random third person fictional references. Still, I find there is a somewhat uncomfortable level of implied self-importance involved with being the topic of most of these posts. A few people have said that rather than reading a blog when they want to know how I'm doing, they would rather just talk to me directly. This is certainly more personal, maybe even more meaningful. But somehow, verbally recounting status details even for just those blog-opposed few is strangely draining for me. I don't really mind discussions about the mechanics of it all (the surgery itself is rather fascinating if you can stomach the details) and I do appreciate the fact that anyone even cares enough to want to know how I'm doing. But honestly I'd rather write about my physical and emotional status once every few days than talk about it at all ever. I guess I just don't want to make this whole situation any more a part of my daily existence than it already is. Writing also forces me to provide a more thoughtfully considered evaluation of my condition and, perhaps just as important, how well I am (or am not) dealing with it.

The other main reason for these posts is that I hope to provide someone else who has an ACL injury (and what would necessarily be a lot of reading time on their hands) with key information and an insider perspective on the experience. The doctors will tell you what will happen after surgery. And they might even tell you that it’s going to hurt (“This will likely be the single most painful event of your life”, I was told by one surgeon). But what they won’t discuss with you is how all of this might make you feel at any given point during the journey. If you do happen to have an ACL injury, or know someone who does, one of the most important things to keep in mind is that every injury is distinct. Every recovery is unique.

Your mileage may vary.

The day before surgery, Doctor Stone pointed to a woman hopping on a small trampoline as we walked through his PT facility. “Three weeks”, he said with a hint of pride in his voice. She did appear to be a little hesitant about the safety of the trampoline therapy, but still, there she was, three weeks post-op with the same surgery I was going to have and she was hopping around like part of a circus act. Sure, I could get on the trampoline now, in the middle of week 10, but at week 3 I was still rocking back and forth in a corner, sucking my thumb and incoherently muttering something about my “boo boo”. It has since occurred to me that the term “ACL reconstruction” is not nearly definitive enough to make accurate predictions about recovery. There are two other significant factors to consider:

1.) How much collateral damage was done in the process of tearing the ACL?
2.) How does your body respond to injury, and especially that of surgery?

With respect to damage, if you are somehow able to tear the ACL with minimal additional strain on the knee (and it is possible if you hit it just right) then you will probably fair much better in recovery. I regularly hear or read about people who have torn their ACL and then finished the karate class, or played the rest of the game, or walked around for weeks before finally going to see a doctor. The moment I was injured I was instantly and dramatically debilitated. It felt like a bomb had gone off inside my knee. There was no opportunity to "play through the pain". In the midst of my pre-op investigation phase I talked to a local guy who tore his ACL playing indoor soccer, but then put off the surgery so he could hike part of the John Muir trail first. “Well, I wore a brace”, he noted as if that explanation was going to be nearly enough to get my head to stop spinning at the thought of it. I was three weeks into pre-op PT at that point and brace or no brace I was still barely able to walk through the neighborhood grocery store. Over the mountains and through the woods was definitely out of the question for me. Clearly, although the general diagnosis was the same, we did not have the same injury.

The other element of recovery has to do with the body’s unique response to the trauma - of the initial injury and then later of the surgery itself. I had the same surgeon, and exactly the same surgical method and materials as trampoline woman, so it was as close to a controlled study as I was likely to get without some research funding. But somehow the function of my knee did not recover at all the way hers did. Ten weeks, dozens of fully committed PT sessions, and countless compression wraps and ice packs since surgery and although the entry wounds are now well healed scars, my knee still retains hints of a freshly insulted joint - still somewhat awkwardly swollen and distorted. When I broke my collar bone at twelve years old (sliding off the top bunk in my sleep if you must know) it began healing itself within days, surrounding the break with an aggressive accumulation of bone tissue the size of a golf ball. I realize now that while this may be a preferable bodily response to a broken bone, it’s probably not ideal for joint injury.

With all of this in mind, I’ve found it helpful – to some extent even necessary – to consider the published rehab schedules and other people’s stories of recovery for what they are – single data points (just like this one) that make up a small part of the bigger picture. I’m beginning to accept that my recovery is uniquely and entirely my own. The successes, failures, and schedules of others, while interesting, are not mine in any real sense. As I wrap my head around this concept, the stress of comparison is removed from the equation. And only then am I able to successfully focus on what really matters.

Day 67

“Where have you been?”, you’re probably not really asking. Well if you hypothetically must know, I’ve been waiting. Waiting for some significant event to occur on this project. Surely, one would think, there would eventually be some clear indication of progress or sudden improvement in my condition - an event transpired, a milestone reached. In short, something worth writing about. Right?

But as seventeen days have gone by since my last post, I am now beginning to realize that I have officially entered the slow burn part of this process where progress cannot be measured on a daily basis – maybe not even weekly. It’s not that I’m not improving, it’s just that I am now doing so at the same hypnotizing pace as my insurance company’s claim processing effort. My progress has been so slow in fact that phrases like “probably permanent” and “as good as it’s going to get” are beginning to creep into my subconscious.

In general things are going well, although when I walk my knee now sometimes snaps and cracks like a mouthful of pop-rocks and occasionally when I bump it just right I involuntarily drive my fingernails deep into the nearest solid object. I’m still regularly reminded of the sciatic nerve but even when I do feel it, the pain is mostly mild. In fact, my knee is almost pain free at this point unless I run it up against either end of the range of motion where things quickly turn excruciating. Before the injury my range was about minus 7 to 150 degrees - essentially, from slightly hyper-extended to a full heel to butt bend. Typically I now have about 5-125 degrees available, but with a generous bit of teeth grinding and profanity I can push it to about 0-140. In PT it can be pushed adequately into hyper-extension. But if I’m not regularly moving it to the limits, even the typical range rapidly tightens up.

Functionally, the last few weeks have actually been excellent. I’m still doing thirty minutes every day on the bike, now at 60 rpm and with moderate resistance – enough to make me sweat for the first time in well over a hundred days. Last weekend I strolled around for hours with my family and a couple thousand other fish fans at the Monterey Bay Aquarium. And I voluntarily hiked to the car afterwards, which turned out to be a mere eight or ten blocks away, the natural result of my resourceful father’s determined search for free parking. The next day I went swimming. We’re not talking laps or anything but just the act of aimlessly swimming around was amazingly fulfilling. It was the first time since Christmas day that I had felt almost uninjured, almost normal again. And yesterday I walked my oldest daughter home from first grade. There are no words that would nearly begin to describe what it means to me to once again be able to make that little trip.


I also had another session at the Stone Clinic PT facility yesterday. The new trick on the rehab agenda: Squats. Sensing my need for reassurance of progress, Thor, the maharishi of PT, pointed out that this is the first time I have been even close to physically ready for the squat. He suggested that we are all born with an innate sense of perfect squat form. (A premise you’d be inclined to agree with if you’ve ever seen the common squat stance of a two year old, feet firmly planted on the floor, butt hovering within an inch of the ground.) But somehow as we age we begin to lose our form – as well as our natural ability to cry our eyes out and laugh uncontrollably in the same five minutes, but that’s getting a bit off topic. If you were somehow able to convince an average adult to perform a squat, you would undoubtedly see their knees immediately start forward as they initiated the descent. Their butt would remain centered under the torso until the bottom of the movement where they would begin to resemble the lesser known yoga stance, “pooping dog”. Giving equal time to the other popular domesticated pooper, Thor also refers to this as “cat box-ing”.

With this in mind I called on my inner toddler as I retrained myself in proper squat form. And I tried to stay focused on Thor’s squat form rules:
1.) Feet comfortably shoulder width apart, angled out 30 degrees.
2.) Knees over ankles throughout the movement.
3.) Send the butt out first. – This is really the key to the squat. As soon as the butt goes backward the head moves forward to balance compensate. This gets things going in the right direction and allows the descent to occur while the lower half of the legs remain reasonably vertical, thereby minimizing the potentially damaging sheer forces experienced by the knees.

After a few trial runs I was able to get very close to a full squat (butt lower than the knees) before shooting pain across the front of my kneecap sent me tumbling to the floor. I’ve still got plenty of work to do, but my newly found squatting abilities were both surprising and encouraging.

I guess the short of it all is that my knee is slowly getting better. Even if too slowly. I am both tremendously tired of being injured and also quite confident that things will be much better next month, and even better still the month after that. And as it's been from the beginning, that belief alone is still plenty enough to keep me going.