Day 175

Fifty days since my last post. That’s how long it has taken to notice any improvement in my knee. Change is frustratingly subtle at this point. I have a follow-up with Dr. Stone ten days from now at which time I had planned to ask for another MRI to find out what had halted my recovery. That still may be a reasonable request but as I look back at previous posts it is clear that rather than halted, my progress has just shifted into super slow-mo.

By mid-July I had dropped another 10 pounds, thinning down nearly 15% in 3 months and frighteningly close to the weight listed on my high school driver’s license. I’ve since bounced back up a bit to settle in right around 155 - a good lean weight for my 5’10” frame and 20 pounds lighter than I was at my heaviest after surgery. Thankfully with my increased activity levels and a little focus on diet, the shedding of surplus weight has not been difficult for me - and it has undoubtedly helped my knee.

I’ve not been to physical therapy for quite a while, and whatever you do don’t tell them this, but I don’t miss it. Not even a little. It’s true they did get me through some rough sections (the Stone PT crew in particular) for which I will be forever grateful. But at this point I’m quite confident that I can use the information obtained in a single session for many weeks without the joy of regular PT visits. Over the past couple of months I’ve been exercising and pushing and testing my knee every day on my own anyway. I am plenty motivated.

A few weeks ago I went out to play 18 holes of golf, not knowing if I would even be able to swing a club and secretly afraid to death that I might do some sort of damage to my healing knee. I did have to change my swing a bit to rely less on my right leg but I didn’t think it would make much difference in my game. Tiger had just won the US Open a week or two earlier with a torn ACL – and it’s not as if he’s a significantly better golfer than I am, so I figured I’d give it a shot. I did take a cart, which is not legal at the Open, but with the high degree of random accuracy in my game there was still quite a lot of walking involved. I managed two glorious pars on the day and was quickly reminded of my knee on the few occasions that I thoughtlessly started into a jog across the fairway in search of a wayward (and thus, I reasoned, likely defective) ball. In the end I got my money’s worth by getting to take well over a hundred shots, a dozen or so that actually went in the intended direction, and I walked much farther than I had on any other day since the Christmas “incident”. Most importantly, I didn’t hurt myself in the process. I was quite pleased with the results.

I’ve also recently been going out on my scooter. Ok, let’s get past this, yes, I have a scooter. And no, not one of those implicitly gay Vespa mini-motorcycle type scooters that you see gleefully scootering down cobbled European streets piloted by young artistes heading to the nearest picturesque Euro café for a latte and a scone. I’m talking about a simple old-school two-wheeled you push it with your own legs or it goes nowhere type scooter. And if you think you can push a scooter without bending your knee, well think again, Scooter. Although I’m right footed, I push with my left leg – a childhood leftover from my goofy-footed skateboarding days. This leaves my right foot, assuming all goes well, firmly planted on the scooter platform. The right leg must bend forward at the ankle and down at the knee, support the body through the push, and then straighten again, lifting the entire weight of my body back up in preparation for the next push. It has never seemed like an unusually challenging or heroic movement. Until now. Scootering puts my right knee in exactly the role it wants so desperately to avoid – moderately bent full body weight bearing. It is agonizing. At peak scooter output I am grunting and grinding my teeth through every push and my seven year old daughter on in-line skates still leaves me in the dust. She’s a good kid though and she always waits for me after she’s proven her superior abilities. The scooter has convinced me that my problem is not only the pain. Although it hurts plenty, I’m also still considerably challenged by the weakness in and around the knee joint. If I can survive another month of outings on the scooter with the roller-blading kid, that will surely change.

I’ve also been riding my bike at least once every week, heading out for increasingly longer rides on tougher routes, and pushing for more speed and better pedaling form. My times on set routes continue to improve and this past weekend I was able to stand and pedal up a hill - a very steep but reasonably short hill at about 50 pedal rotations long - for the first time since the injury. The pain was there but easily dismissed by the overwhelming feeling of power and strength and the imaginary fanfare that awaited me at the top as if I was cresting the famed Alpe d’Huez itself. Of course when I did reach the top there was no one there except for a single jogger who appeared genuinely concerned by what I realized in hindsight was the deep hurling growl, not unlike that of a sick dog, that came echoing from my lungs during those final few yards.

Despite the challenge (or maybe in part because of it) the bike has been my main vehicle for regaining movement and strength and sanity. My knee still suffers on long climbs, but it is certainly improving, and the specific discomfort in my knee is often lost in the flurry of pain signals as the rest of my body suffers right along with it. Misery loves company and there is no surer path to self-inflicted misery than pointing up a long climb and willing yourself to the top as fast as you can possibly manage. It is difficult, and distressing, and desperately rewarding.

A few months ago in a fleeting moment of blind optimism I signed up for the 2008 Tour de Tahoe. It’s just like the Tour de France except that it’s not a race and it’s not in France. It’s actually an annual ride around Lake Tahoe with about 1300 other cyclists. I did the ride for the first time a couple of years ago and the support staff and the riders were wonderful. I prepared meticulously and spread my effort perfectly across the 4 ½ hour ride. A walk in the park for serious roadies, the route sits at an average elevation of about 7000 feet and covers 72 miles with about 3000 vertical feet of climbing. It was and still is most difficult road ride I have ever completed. When I signed up earlier this year, I could barely walk around the block. A ride around the lake seemed like an impossible goal. But at the same time, September 7th seemed like a lifetime away. Now it’s less than six weeks. My longest ride so far this year was 32 miles, mostly flat, at about 300 feet above sea level, two days ago. Typically I do 25 miles with a couple of small climbs and I’m done for the week. I have a lot of work to do. I need some longer rides and more time at the gym. But I also really need this ride. For some reason, a significant contributor to my sense of who I was and who I am and who I will be is strangely bound to my ability to push myself around that lake. This time it holds more meaning than ever. If I’m ready by September, it will be just barely.

Day 125

Where were we…? - ah yes, the knee thing. I know it’s been over a month since I last posted, a complaint I’m sure my legions of regular readers would have if they had ever existed in the first place. Fact is, I just needed to escape from the whole challenge of the ACL project for a while. I stopped posting on the blog, stopped reading the ACL stories of others on the internet. I began to limit the details in my answers to the many thoughtful questions about the status of my recovery and I cleared a dresser drawer to stow my impressive collection of knee braces and compression wraps. I even temporarily stashed away the pile of medical bills and statements and purposefully difficult insurance forms. I started riding – on the trainer every night and outside whenever possible. I started a simple daily exercise program that included knee strengthening work but didn’t focus on it. And I started eating better – staying well hydrated, eating smaller, more frequent meals, with more nutrient dense foods, and I simply stopped eating after 6pm every night.

Over the last month or so I’ve managed to drop the 15 extra pounds and the majority of the convincing second trimester pregnancy profile that I had cultivated during my post-op immobility and at the same time I’ve gotten stronger – both mentally and physically. In short, I’ve taken a more holistic approach to my knee rehab. The initial improvements in my knee have finally allowed it to become another working part of my daily life rather than the center of my every waking thought.

That said, there are things that I still cannot do. Simple things that are made all the more frustrating and concerning when I recall the published rehab schedules that I long ago made a conscious effort to ignore. I still have some degree of pain with every step and most of my shin feels oddly like it’s under the lingering effects of a low dose of Novocain. My physical limitations now all seem to center around an inability to put any significant amount of pressure through the knee, especially when it is bent past about 20 degrees. I still cannot quite walk down stairs. I cannot quite stand and pedal my bike. And I absolutely cannot run, jog, or otherwise motivate myself any faster than a normal walking pace. Attempting any of these activities results in an immediate line of pain up the front of my kneecap. Overall, the pain is improving somewhat, but only so slowly at this point that my progress in that particular area is not even noticeable unless I recall my condition over the course of the past few months.

My range of motion is now reasonably good. In flexion I can typically get to within an inch or so of heel-butt contact. I’ve not worked on this post-op so what I have gained is just the natural result of the reduction in swelling and the improved flexibility of the muscles and connective tissues involved. Extension, on the other hand, was a long and painful struggle – one I took very seriously. Thankfully, my knee eventually conceded that particular battle and I now have essentially full (hyper-) extension nearly equal to the “good” leg.

“If you do too much, you’ll know it.” This simple excerpt from the book of wisdom was given to me at some point so early in the recovery process that I can’t even remember who said it. Regardless, credit to someone is well deserved as this bit of information turns out to be entirely true.

On Day 95 I went out on the bike again. I’d done my first short ride on Day 90, and I’d been riding 30 minutes every night on the trainer for a few weeks so I figured it was time to try a slightly longer route. 18 miles this time, with a few mild hills thrown in. The ride was a success. In fact I felt so good afterwards that the next day I welcomed the chance at a short family walk through Mill Valley. We were a few blocks out when my 3-year old wore through a blister inside one of her shoes. No problem, I simply carried her piggy-back style on the return trip like any caring and physically capable father would do. Later that day a small group of extended family prepared for a hike up one of the many trails of Mt. Tam. Clearly it was expected that I would sit that trip out as I was given instructions on staying behind alone – “the TV is downstairs”, “help yourself to the kitchen”, that sort of thing. I surveyed the expedition team - a handful of healthy adults, a few young kids, including my wounded 3-year old, and one of the grandparents. I could certainly keep up with this group. And so I did, and with only a handful of sharply painful missteps and ill-executed strides. It felt so good to be out and active. I was becoming normal once again.

But as I woke the next morning I quickly realized that I had slightly overestimated my return to normalcy. I had trouble just putting enough pressure through my knee to stand. The new swelling was quite apparent and my range of motion was reduced by many degrees on both ends. Eventually I became stable on my feet again but for the next couple of days I walked with a renewed limp and pain levels that I had nearly forgotten ever existed. I had done too much and as I was promised, I knew it.

Since then I have been much more careful, and I’ve pretty well limited my knee-related physical rehab to bike riding and slow, controlled strength developing movements like the ones that can be had on a high quality leg press sled. Every Saturday morning I ride semi-leisurely for a couple of hours and then on Sunday mornings I hammer with everything I have through a 25.1 mile loop that includes a 3 mile out and back climb into a local canyon. I race against myself, against my own ability, and against the clock. And my average speeds have been steadily increasing every week at every checkpoint along the route. A few sections of the canyon road are as steep as I can possibly climb at this point and if I push hard enough in the return downhill I can sometimes hear the announcer voice of Bob Roll in my head as I slice through the French countryside ahead of the furiously chasing peloton. With an all out effort, my speed is limited at different points on the ride by either my knee or the conditioning of my cardio-vascular system. On my most recent ride the limiting factor was often the cardio – which in terms of my knee is a strange victory in itself.

Day 90

Ask your doctor if knee surgery is right for you. Side effects may include short-term discomfort and a slight limp. The direct effects of having your knee cut open and holes drilled through your leg bones are reasonably obvious and have panned out for me more or less as expected. But as I continue through this experience I am beginning to take note of the ever growing list of additional effects caused by the resultant lack of mobility, symmetry, and balance.

Of course the initial crutching and lingering hobble has caused minor alignment issues with my lower back, hips, ankles, feet, etc. And the temporary immobility has managed to transfer a good bit of body mass away from my legs and toward my mid-section. But now we begin to get into the less obvious. For example, last month I stopped shaving my legs (I began shaving both because as my wife’s sharp fashion sense noted, shaving only one looked rather strange). Now the hair on my injured leg is growing back at about twice the rate and density as the uninjured leg, leaving me to assume that there is so much regenerative biological activity going on in my recovering knee that it’s actually causing an increase in hair growth. I’ve also been sleeping on my left side almost exclusively for the vast majority of the last 130 days. Occasionally I'm on my back but never on my right side where my injured knee would be in direct contact with the bed. Could this consistent lack of sleep side symmetry cause a misalignment of my jaw? Possibly coincidental I realize but now whenever I yawn, my mouth gets momentarily stuck open and then abruptly pops back into place. Good times.

My three month checkup was today. Doctor Stone took a quick look at my knee and then did that now very familiar lift and tug maneuver with my lower leg, after which he commented, “That’s a perfect ACL.” Certainly there is a potential bias in his assessment but the fact is I gave up second guessing him long ago. If he says it’s perfect, that’s what I’m going with.

PT, however, well that was another story. Thor wasn’t in so I met with his female counterpart. Let’s call her Xena.

As this was my three-month visit, a sports-fitness test was on the agenda. After scribbling out a half dozen or so exercises on her clipboard, Xena had me start with "The Plank" – lie face down, feet together, hold the body off the floor, resting on the toes and the forearms with the elbows directly under the shoulders while keeping the body straight (like a plank of course). I lasted in that position just 1 minute, 26 seconds. Average at best.

Second was a timed 25 rep bench squat. I had been doing these at home for a couple of weeks so I went through these pretty quickly with only a bit of pain through my knee.

Third was a timed 15 rep bench squat holding a 45-lb straight bar. Forget it. I could not do a single rep. As soon as my leg was bent more than about 20 degrees the vertical pain through my patella was instant and sharp and the message was clear – “Go any further and your next stop will be on your ass with a 45-lb bar stuck to your forehead.” Scratch that test.

Fourth was a step test – step up onto about a 12-inch block and back down. Here too my knee was useless. I could not step up with my right nor step down with my left. Again, it was the pain through the patella that would not allow me to complete the movement. At that point the entire test suite was cancelled and we went onto some reasonably aggressive and uncomfortable patellar mobilization and quad and IT band grinding and mashing.

I knew I was behind the standard recovery schedules, but still, I honestly thought I was doing pretty well. I was exercising and getting around without much trouble, and if I took just a bit off my normal pace I could finally walk without a noticeable limp. But my PT session left me soaking in a newly formed puddle of defeat and frustration. I had come to accept my struggling recovery but despite my efforts to dismiss it, the fitness testing at PT was a real confidence killer. There was only one possible cure.


When I got home I decided to that I would ride across town to a friend’s house to pick up some random articles left by my kids the last time we were there. The truth is that the idea of getting out on the bike had been rolling around in my head for weeks and the stated purpose of the errand was entirely irrelevant. The real reason to go was to see if I could actually make the 9.5 mile round trip at all. I needed another data point on my progress. I needed to assess my condition on my own terms. It would be my first time outside on a bike in nearly five months. My mind worked through various reasons to postpone the outing - too windy, too close to dark, too risky, and the like. But as part of my brain ground through the list of excuses, the rest of it continued to prepare to ride as if I had no actual choice in the matter. I checked everything on the bike twice – tire pressures, brakes, quick releases. Finally I rolled down the driveway and headed off.

Riding was initially somewhat awkward but within a few blocks I had pedaled myself into a slow rhythm. I quickly learned that pushing too hard through the downstroke on the injured side produced the same pain that I had experienced earlier in PT and that standing to pedal was entirely impossible for the same reason. With these limitations regretfully acknowledged I rode on. It was 7pm, slightly cool, with the light of the sunset just beginning to sneak into the trees on the ridgeline. The afternoon breeze had stopped entirely. Conditions were perfect. And even though I was unable to accelerate with any force, rather like a car with something stuck underneath the gas pedal, the riding itself was still amazingly empowering. Random people waved to me as if somehow they knew. There were too many of them to simply discount their unexplainable awareness of my endeavor. I waved back as if to thank them for noticing. I focused intently on every turn, on every minor change in the pavement. And I pedalled with as much force as my knee would allow. I made the trip out at a 14.4 mph average. On the return trip I pushed even harder and heaved and wheezed my way to a one-way average of 16.4 mph. Not exactly new speed records for certain, but at last some positive results. A personal victory of sorts. Of course it was a small and meaningless accomplishment in the big picture, but still, for today it was a small and meaningless accomplishment that was very much needed. My heart and soul and even my body thanked me afterward. And I quietly basked in the glory of the ride for the rest of the evening.

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.

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.

Day 41

Something has gone wrong. And it has done so rather suddenly and severely.

As of yesterday I was doing reasonably well, albeit behind relative to the published recovery schedules. Over the past week I had been seeing improvements with strength and flexion. Last night, I wrapped, elevated, and iced my knee. Afterwards I slowly pressed it into full extension and as I stood, partially supported by the edge of the couch, I was pleased to see that the slightly hyper-extended angle of my left leg was finally matched by my right. I carefully felt for and found the solid stop of the new ACL. Encouraging progress to say the least.

But early today the light at the end of the tunnel quickly faded as sharp pains began shooting through my leg. The origin was difficult to determine although it seemed to be firing from a nerve running across the back of my hip and landing somewhere inside my knee. I took a hot shower, which helped some, and an hour later I was back at the chiropractor. The adjustments helped with the upper element of the pain but left me with a new awareness of the problem in my knee. I had to stop six times over the 30-yard walk through the parking lot back to my truck. When I got home I was on my way from the driveway to the front door when I finally summoned for my recently retired crutches as my wife and 3-year old by chance saw me standing outside on the sidewalk.

I ran through yesterday's events in my head in search of some possible indication of cause as I surfed the internet for "ACL reconstruction failure". Over the course of the next few hours, filled with intermittent, sharp pains shooting from within my knee, I began to suspect that the more likely source was not the ACL, but rather the newly sutured meniscus. I tore the meniscus in my other knee a few years ago, the result of an unscheduled road bike dismount. That tear thankfully healed without surgery but I still have some well seared memories of the pain. It was very much like this now feels - sharp, specific, and plenty severe enough to stop me in my tracks.

Obviously I don't yet know what this all means. My recovery is at the very least on hold. Tomorrow I head back to the Stone Clinic for previously scheduled physical therapy. Hopefully I can find some answers there. I suspect that they will tell me to just wait this out for a while to see if it somehow begins to resolve on its own. If it doesn't, there will probably be another MRI in my future.

To suggest that I was not emotionally prepared for this recovery detour would be a tremendous understatement. I realize that I have an excess of what would in smaller doses be a healthy paranoia about this injury and I am trying to maintain an accurate perspective here. Still, I find that I am becoming somewhat overwhelmed with the uncertainty of this entire ordeal once again.

Day 34

An update on my rehab situation…

I've been diligently heading off to physical therapy three times per week since early January. Stone has a PT room in his facility but since he's an hour away and out of my insurance network, the vast majority of my pre and post op therapy has been at an in-network clinic closer to my house. They are all very nice there, have all the necessary equipment, and they seem reasonably competent. The therapists at Stone on the other hand are some of the best in the business and today I had PT with one of them in conjunction with a post surgery check up appointment. Given the Stone motto (Fitter, Faster, Stronger) and the undeniable fact that I was nearing the start of week 5 but still only barely meeting week 2 recovery expectations, I knew full well that I was stepping into a possible shit storm by seeing a Stone therapist but I also knew it had to be done. When I arrived, Dr. Stone gave me a quick once over and said he was pleased with how solid my new ACL was. He smiled in a way that made it clear that he was genuinely proud of his work, like a kid admiring his recently completed model airplane. He also pointed out that my range of motion was lacking and he told me to check with him on my way out after therapy.

The Stone therapist that I saw today has no shortage of size and muscle to adequately deliver “therapy” and as all good physical therapists do, he probably harbors some well developed sadistic tendencies beneath his pleasant and professional exterior.

As an aside, while I realize that those in the PT trade may be meeting the clinical definition of “therapy”, until the start of this whole experience I always thought the word had a wonderfully serene and peaceful feel to it. Like aqua therapy or aroma therapy. It is supposed to be after all, therapeutic. Turns out though, physical therapy is much more closely related to electro-shock therapy. And perhaps a close cousin to running-naked-through-a-hail-storm therapy.

In any case, my therapist today, let’s call him Thor, is clearly dedicated to his craft and is a fountain of catch phrases. He asked how things were going on the bike. I explained that I had tried a few days ago but still could not get over the top of the pedal stroke. “Well, we’ll fix that”, he said, as if he was talking about squirting some 3-in-1 on a stuck hinge. “Motion is lotion you know and you should be on the bike by now. You’re a bit behind the curve.” “Yes, I know”, I replied. Thor went on to explain that a big part of the reason for my limited range of motion was the swelling around the kneecap. When the leg is straight and the quads are flexed, the patella should move toward the hip. Mine, as he pointed out, looked like it was set in cement. Thor said that the swelling in my knee was “old and cold” and that it never should have gotten to this point. “But don’t worry”, he said with a quick grin, “we’ll fix that too”.

As the therapeutic part of the session began, Thor hit me with another catch phrase that had something to do with eating shit and essentially was meant to explain that in physical therapy, if you don’t pay frequently with a little pain each time, then you have to make a few larger payments of pain to catch up. Today, he warned me, would probably get expensive.

All of my physical therapy sessions have had some associated pain. I mean, my knee has already been hurt, so to do anything to it or with it just hurts more. Sometimes a little, sometimes quite a lot. But today was an entirely new level of demandingly ferocious pain. It started with what seemed like days of increasingly hostile, insistent gouging and squeezing and digging around the patella. Thor used his fully double jointed muscle-bound thumbs to “get the junk out” from within the tissues around my knee. This attack nearly sent me diving off the table numerous times for the relative safety of the floor. I was told to verbally refer to my leg as someone else’s, as though we were both observing this violent work being done to some other poor sap. But this only served to confuse me – why the hell does that guy’s knee hurt me so much? Between each attempt to force the knee beyond its recently self-imposed limits, there was more targeted grinding and smashing of the tissues. Lying on my back I desperately focused on random holes in the ceiling tiles. To gain extension, my knee was firmly held down to the table while my foot was pulled upward. To force flexion my leg was bent farther and farther in short pain filled bursts. Eventually I just gave up on trying to achieve the requisite Zen master concentration and I resorted to yelling my way through the previous limits. By the end of the session I had pushed into nearly 5 degrees of hyper-extension and gained an extra 17 degrees of flexion. Significant and exhausting progress.

Afterwards my knee was iced for 20 minutes or so and I actually felt pretty good, my euphoria fueled by a combination of lingering endorphins and the relief that the session was over. Thor said it was time to burn the crutches and the brace - metaphorically, I assumed. Then he gave me a neoprene sleeve to wear to help keep the swelling down and told me not to panic if by tomorrow my knee turns a little purple. “It’s just temporary”, he assured me.

On the way home I thought about how reserved and cautious my usual PT clinic had been and although I really like the people there I tried to honestly assess their value in my recovery going forward. I wondered how much of today’s “make-up” work should have been done in their facility, the easier way – a little at a time. Later I stopped at my local clinic, paid off my existing co-pay tab (3 sessions at $25 each) and cancelled my future appointments. I have an evaluation session with another local clinic this Thursday. It’s time for a change of PT scenery.

Day 30

The corner, the one that they told me I would turn at some point during my recovery, the one that would be the start of easier rehab and accelerated improvement, the one that I had been looking forward to for weeks, yes that corner, it turns out, is a myth.

Like any good myth, it sounds plausible enough, maybe even likely. But the truth is, there is no corner to turn. It just doesn’t exist. Recovery, if it must be described in comparative terms, is like hiking up a long, tedious trail. Progress sometimes comes easily and other times it is very difficult. Overall, ground is gained only gradually. Those who have been through ACL injury, surgery, and recovery often refer to the experience as a journey. It's now more clear than ever that the vast majority of time and dedicated effort required over the course of that journey is spent in recovery.

Typically when people ask me how I am doing, I invariably say, “I'm better”. And then, as if accuracy was an important element in responses to polite, largely rhetorical questions, I sometimes clarify that I don’t mean ‘all better’, just better than I was last week. And that last week I was better than I was the week before. And so on. For the most part, as long as I can keep giving that answer, I don’t really need the mythical corner after all.

The reality is that I have made some significant improvements over the past few weeks, the most dramatic of which is a welcome reduction in pain levels. In fact, overall the pain has steadily decreased every week since surgery, with the exception of a few days in week 3 wherein I began to get the disturbingly consistent sensation that that someone was pouring acid down my shin as the nerves began to regrow. But now, just beyond week 4, other than a random twinge or ache, my knee really only hurts when I am engaging it – trying to extend the leg or plant my heel when I walk, trying to extend or flex beyond my still limited range of motion, or doing something stupid that results in banging, bumping, or otherwise annoying the area.

The swelling hasn’t gone down at all in the last few weeks, partly, I suppose, because as my symptoms improve I am increasing my activity level. It’s not dramatic, but compared to the other knee, the swelling it is very obvious. "Oh, it's supposed to look like that one.", I frequently get from people when they see how thin my healthy knee is. Based on my previous thoughts on the two types of inflammation it’s pretty clear that I’m down to the more stable type of tissue swelling that will not be going away any time soon.

Range of motion has not increased by any significant measure and I have to admit that it is beginning to concern me. I am now a full two weeks behind any published recovery schedule I have found. On a really good day I can push through the pain and eventually force the knee down near or even at a full zero degree extension – still a far cry from my natural range which has nearly ten degrees of hyper-extension. Then again, it’s been pointed out to me that there is no functional advantage to achieving hyper-extension, so maybe zero will be enough. In flexion I can now get to 100 degrees, but I'm hopeful that with another day or two of consistent icing, pulling, and stretching, and a few R rated outbursts of profanity I will be able to achieve the additional ten degrees I need to spin bike cranks again. Getting there will be my goal for this weekend.

In general things are definitely getting “better”. Last week I spent a day at work, in the brace and on crutches for the most part, but by the end of the day there was little question that it was just too much too soon. The next day I was back down to about 30 degrees of total motion and I could barely stand. But this week I spent two consecutive days at work offsites, again in the brace and with the crutches, and I did much better. If nothing else, it feels good to be able to leave the house and be out like an ordinary, healthy person again.

Also contributing to my renewed sense of normalcy, I packed up the airbed a couple of weeks ago and I’m back to a more normal existence - sleeping in my own bed (although with a large flat pillow between my legs to keep my knees from banging into each other), showering standing up, working at a desk, and eating at the dinner table again. Small things individually, but in aggregate, they make up a large part of why I now feel like a healthy person recovering from an injury rather than a helpless immobile invalid. Although having the perception of health does not in itself make you healthy, I do believe that getting trapped in the perspective of pain and disability can definitely delay recovery.

As I go back and look through my earlier posts, I run across the bits of well-intentioned, Hallmark-ready recovery advice I had about staying strong and maintaining a positive outlook and continuing to focus on improvement. I’ve now come to realize that this advice is much easier to give than to follow. I’ve also realized recently that although I had previously seen plenty of people recovering from injury either on crutches, or in knee braces, or casts, or slings, or the like, I had always considered only the practical effects of the physical limitations they were faced with. No riding for twelve weeks, or no stairs for six months, no mosh pits for a year, or some similar consequence. Never, not once did it cross my mind that these people were almost certainly in the middle of a lengthy excursion into physical discomfort that at times was likely quite physically and emotionally demanding. The bottom line is that until you actually go through it there is no way to fully understand what it takes to remain diligently positive and strong throughout an extended period of even moderate pain and disability. Those who can do it, and I am not one of them, have an inner strength that the rest of us will never truly know.

Certainly, my knee injury is not catastrophic. But as I have said before, neither is it at all insignificant. It lies somewhere in the middle. And thankfully, I have a bit of a short memory for personal details. So when I look back on this a year from now, I will have only a vague recollection of how uncomfortable and difficult it really was. I will have gladly forgotten the true extent of the trauma. I may even have forgotten about the myth of the corner that was promised to me. What I will know by then is only that despite a few very long days, various confidence draining setbacks, and countless hours spent pleading with my knee to heal itself, eventually, I still made it through.

Day 17

I’m told that somewhere along my journey back to health there will be a corner. And that this metaphorical corner, once turned, will mark the start of better days. Rehab will become easier. Pain will be minimized. Recovery will be accelerated. It is a belief in the existence of this corner that helps to motivate me, especially on those days when my own improvements are not readily evident.

As for my physical status, my resting pain is basically under control at this point but I am behind schedule on recovery. My range of motion was supposed to be 0-90 by the end of week 2. Now, well into week 3, I can barely reach zero in extension and I’m still max'd out at about 80 degrees of flexion. The unassisted walking (in reality, gross limping) that I had done late in the 1st week proved to be too much too early and actually ended up causing more pain and swelling. It turns out, the general rule in recovery is that walking is exclusively about form, not function. The goal is to walk with focused and exacting mechanics, even if accuracy requires crutches or other assistance. Hobbling awkwardly across the room without crutches may be emotionally rewarding but it's not physically beneficial.

It seems that there are two key interrelated elements involved in ACL surgery recovery – swelling and movement. The way they work together is that deliberate, controlled movement helps reduce swelling, and reduced swelling allows for more range of movement. Of course the converse is true as well. Swelling prevents range of movement and lack of movement prolongs swelling.

With regard to swelling, here’s another entirely unconfirmed medical theory based solely on my observation: it seems that there may be two types of swelling. The first is an immediate, fluid inflammation that is quite visible and increases when the knee is abused and held below the heart. This swelling can be greatly reduced by ice, elevation, and light, directional massage. The other category of swelling is a more solid, unyielding swelling of the bones and tissues. This swelling has a greater effect on stiffness and on limiting range of motion. It is this type of inflammation that seems to be somewhat improved by anti-inflammatory drugs and movement. And time. Lots of time.

This is our family room.

And, for now, my bedroom.

And my dining room.

And my rehab area.

And my office.

This is essentially where I have spent at least 20 hours of every day since I returned home after surgery. If I’m not in this very spot, I’m either at physical therapy, in the kitchen, or in the bathroom. These four locales have quite nearly made up the total of my existence over the past few weeks. I have been considering taking down the air-bed and getting back to real life – sleeping in the bedroom, eating at the dining table, working at a desk. But I don’t want to be wrong and then have to ask to have it all set up again. I guess the fact that I am even considering giving up my comfort zone is a promising sign.

I’ve been in physical therapy three days a week since surgery. For the most part it has been a steady struggle, but today I had a small breakthrough. With my leg very nearly reaching full extension, I stood up without crutches and slowly transferred my weight from my left side to equally balance myself over both feet. I could feel my right knee gradually settle into the type of centered, stable support that allows us to stand upright with relatively little effort. I slowly straightened my posture and looked directly ahead of me. I felt eight feet tall. I drifted into a vision of myself comfortably standing on the sidelines watching my daughter at her next soccer game. Standing solid like that on both feet was a minor, although much needed achievement. Shortly thereafter a man came into the PT clinic, his head held well forward on his rigid neck. He held a plastic cup into which he spit the accumulated saliva that he was apparently unable to swallow. His voice strained as he explained to the staff that he had been sitting up at home for nearly ten minutes at a time. By their responses it was clear that they were as pleased with his progress as they were impressed by his determination. And I was once again left with an adjusted perspective and a renewed appreciation for my own condition.

After physical therapy I returned home, cinched down the straps on my hinged leg brace, and with the prior approval of my physical therapist, I set off on a partial weight bearing walk around the block with my crutches and my two kids. There are ten houses on the inside of my block. The round trip took about 25 minutes. It was an exhausting trek but it was not unreasonably painful and I actually felt strong right up to the end. If I have a few more days like this one, I suspect I may be turning that corner I've been told about very soon.

Recovery Tips

Following are a few thoughts in case you or someone you know is about to have ACL surgery. I'm not a doctor and I don't play one on TV so clearly none of the following is intended to supersede any advice or direction provided by a medical professional. These are just a few things that I learned as I went through the initial post-op phase so I thought I'd include them here.

Get help
This is critical. Find someone who is willing to be at your beck and call 24/7 for at least the first few days. Talk to this person (or people) ahead of time and explain to them what will be required. Be explicit in your expectations so there are no misunderstandings. If you’re married, now would be a good time to tactfully remind your spouse of the “in sickness and in health” line that you both agreed to during the ceremony. Also, get creative and find a few tricks to help yourself. I wore a robe with big pockets so I could transport things while on crutches. I also hooked the foot of my good leg under the injured leg as necessary to help lift myself onto the couch or into bed.

Get comfortable
To suggest that the first week or so after surgery will be uncomfortable would be understating the situation by more than a little. Make an effort to help balance out the discomfort by increasing comfort in other areas. Get a stack of comfortable clothes. Get some nice socks or some fleece underwear. Whatever does it for you. I cut one leg off at the knee from a pair of sweats so I could stay warm while icing. Cook a meal or two ahead of time. Get some comfort foods at the ready. Keep them to a minimum, but an occasional fudge brownie or three might just be what you need to keep your heart in it.

Get situated
The first week is going to be a long one so get prepared. Create a space for your post-op experience well ahead of time. The space should have some method for leg elevation, and be somewhere that you can safely and easily sleep. Make sure all critical items are located within reach – food, water, crutches and meds in particular. I also had my laptop, tv remote, phone, magazines, ice pump, and a guitar all no more than 30 inches away once I got home.

Manage pain
This is the primary objective of the first few days. It seems like an obvious goal but for me, if the pain is severe enough for long enough I can actually begin to loose focus on trying to manage it. Certainly pain is subjective and post-op there is definitely going to be some of it but if things drift too far beyond your tolerance it will get miserable very quickly.

Transition slowly
The worst pain that I experienced came with the transition and aftermath of moving from a leg elevated position to standing up. The blood that rushed to my lower leg brought with it the most agonizing pain and teeth clenching pressure of the first week. I quickly learned that the key to limiting this pain was to transition in stages. Move the leg from elevated to flat, wait. Move the foot to the floor, wait some more. Slowly stand with crutches, then go on the move.

Do drugs
Understand how the different meds work, especially those that affect pain. I was given a narcotic (Percocet) and an NSAID (Toradol). The narcotics (at least for me) are primarily what I would consider “disassociative” drugs. They only reduce my association with the pain. It's still there but I don’t feel as connected to it. The NSAIDs are Non-Steroidal Anti-Inflammatory Drugs. These actually reduce pain by reducing the inflammation that is, in part, the cause of the pain. I was also taking an antacid and plenty of fiber to avoid any digestive issues caused by the surgery trauma and the various IV and post-op drugs. Last, if you end up on a course of anti-biotics like I did, consider following it with a probiotic of some sort to get your gut back in order.

Make a schedule
For your meds, make a written schedule of some sort that allows you to check off or otherwise record when you have taken something. You cannot afford to wonder if you just took a Percocet ten minutes ago. Missing a dose might make for an unnecessarily rough day and doubling up could be worse.

Feed the body
Eat eat eat. But try to eat as healthy as possible. Your body will be trying to recover from a major assault. This is not the time to fill it with pepsi and cheetos. Make sure you keep your digestive system as happy as possible by regularly tossing good food down the hatch. You can burn off the extra calories in a few months but if you go hungry and your stomach turns on you in the first few days, it will make things far more difficult and uncomfortable than they’re already going to be.

Be the potty
Females can skip this trick because honestly I don’t know how to help you here, but for guys, consider keeping a large empty plastic bottle handy. You really do need to stay well hydrated, but at least for me in the first two or three days, getting up just to get to the bathroom was by far the most painful part of the whole ordeal. Consider at least giving yourself the option of shortening those trips down to just a simple roll onto your side. Maybe getting up to go won’t be an issue for you, but a simple plastic bottle is cheap insurance in case it is.

Keep clean
As a guy I am genetically able to go for many days without bathing but doing so can eventually drive away anyone who had previously committed to provide post-op help. ACL surgery makes bathing difficult in part because of the pain and immobility and in part because the sutures cannot get wet for at least the first few days. Here are a couple of ideas –
1.) Face it. Skip the shower and just wash your face. Or even easier, go with a swipe of witch-hazel. You’ll feel cleaner even if the rest of you has begun to smell like the inside of a city dumpster.
2.) Sit down. Get a chair that can go in the shower. I used a milk crate but it was not very comfortable and eventually I got tired of the waffle marks on my butt.
3.) Hose off. Get a removable shower head with a hose. If you have to sit down to shower, this is a must have feature.
4.) Wrap up. I used saran wrap to keep my sutures dry. This method is not waterproof by any stretch but it's plenty splash proof enough. You can also get a shower bag from most medical supply stores.

Take off
Obviously you’ll be off work for some period of time but I’ve talked to some people who tried to go back to work the week after surgery. While this might be physically possible, depending on the severity of the procedure and the physical demands of your job, 2 weeks to a month may be more reasonable. For my surgery (ACL BPB allograft and meniscus repair) I had difficulty even working from home during the second week because I couldn’t sit in a chair for any length of time without my knee blowing up like a balloon.

Keep smiling
Even if you have to fake it, and you probably will, smile as much as possible. It's a simple and powerfully self-fulfilling gesture. Make a list of all the things you can do while you’re temporarily stuck with a bum leg. Find a project, learn a language, read a novel. Most importantly, be positive, be strong. And remember that the worst of the recovery is short and it will all soon enough be behind you.

Day 7

Today was quite uneventful. This was a much needed development – or lack thereof. It has been a very long week. The idea that surgery was just seven days ago is incomprehendible. It feels like nothing short of a month at least.

I am actually getting good at being injured again. Surprisingly it takes some practice, some time to adapt. But I am also ready to be over the steep initial section of this recovery and back into the more incremental stuff – like doing fifteen mini-squats instead of just twelve. For now, I suppose the keys to success are patience and diligence. I cannot rush my progress and I cannot get overly anxious for improvement. And I have to keep doing all of the things that help. Now residing amongst the normal daily requirements of work and family are the elevating, the icing, the medications, the stretches, the exercises, and the regular pushing well into the pain in order to improve and maintain range of motion. Already there have been days, I assure you, when I have felt like just skipping it all. People typically talk about physical therapy in terms of the number of days of scheduled PT per week. But recovery requires a daily engagement. When I first met with Dr. Stone I told him I understood that PT would be a substantial commitment of 3 days per week for 3 months. He laughed through a single breath and said, “Oh no. I want you doing physical therapy every day for the rest of your life.”

Of course I was talking about actually going to the PT clinic and although I have pretty good insurance there is no way in hell they are going to help cover that schedule. But he was talking about life. And in alignment with at least one other doctor I talked to, he was essentially saying that once the ACL is torn, the luxury of being able to neglect the health of the knee is lost forever.

I took a shower today. The second one since surgery. For the first shower I just sat outside the tub and leaned into it, resulting in an only half satisfying rinse of my upper body. This time I got a plastic milk crate from the garage and set it upside down in the tub on a non-slip pad. Safety first. Then I went a couple of times around my leg with plastic wrap from the kitchen to keep the sutured areas of my knee dry. It looked a bit like a leftover ham. Our shower head is removable and attached to a long hose – a nice feature in general when you want to direct some focused shower action to specific areas and critical for any sit down affair such as this when one leg is propped up on the side of the tub. My seated posture on the crate made me feel like a geriatric patient and had the unfortunate side effect of accentuating the developing roll around my midsection. Getting rid of that will surely be my next project after this ACL business is sorted out. When I was finished I carefully removed the protective plastic wrap. A strange feeling came over me as I studied my badly beaten bare knee which has been typically covered by a compression sock. Disturbingly swollen and stitched up, it didn’t look familiar at all. The size, the shape, the color, it was entirely all wrong. It was as though it belonged to someone else. At that point I even began to get a bit uncomfortable as I became more aware of my own nakedness in the company of this stranger’s knee. It was quite an odd experience. And no, it wasn't the result of a mild Percocet overdose.

In fact, since I mentioned it, I haven’t taken more than one Percocet in any of the last three days. Today I didn’t even take any. Personally, I don’t feel like it does me much good. It certainly has little or no therapeutic effect unlike the Toradol, which actually contains an anti-inflammatory. Percocet (and all of the morphine derivative drugs for that matter) seem to be good not for reducing pain, but only for reducing my desire to care about pain.

In general though, my knee is getting better. It's taking its sweet time about it but it is getting better. Every day I can stand up a little longer. Every day I can take a few more unaided steps. And although there were hours today when I was certain that the pain would spike into new agonizing territory, eventually it eased up and overall I’d say it was still a bit better than yesterday.

From here I will probably post weekly or monthly as I think of additional things to include. I’ve been considering a consolidated list of recovery tips for others headed for ACL surgery, so I’ll start working on that.

In the meantime, I know I only have a few dedicated current readers (hi mom), but this blog has already helped me to this point by giving me an outlet for my thoughts. As such I give my sincere thanks to those of you who encouraged me to start it in the first place. You know who you are.

And so it ends. My first week in the ACL reconstruction club. I’d like to ride off into the sunset now, but I’m still about 30 degrees short of being able to pedal so I’ll just keep my leg propped up here on the couch. I’ll post with more details as they occur…

Day 6

Baby steps. That’s what I’m back to in a very literal sense. Yesterday I took my first unaided post-op steps. About forty in total, in three separate events. At one point I just got up off the air-bed and forgot my crutches. I took a step toward the kitchen and realized “Hey, I’m walkin’ here” (sans New York accent). It was definitely painful but rather than any sharp pains there was just an overall pressure that actually seemed to counterbalance the strain caused by standing upright in the first place. So I took a few more steps, very slow, very calculated, and very ready to bail over if I felt anything bad. A dozen or so steps later and I was back to the family room. No crutches needed.

It occurred to me later that if you spent a week elevating, icing, and avoiding putting any pressure on even a completely healthy leg, those first few steps would be damn uncomfortable. With that in mind, I wonder which aspects of my current discomfort are due to a complete lack of use and which are from the injury and surgery. Regardless, the knee actually feels better when I put weight on it now. For sake of accurate record, ok, the term "walking" may be just a bit on the exaggerative side. Let’s call it “maintaining balance while awkwardly moving forward”. In any case, at this point it's as close to walking as I’ve been since last Tuesday morning and it does feel unreasonably satisfying.

Unfortunately, with the primal joy of my recent walking accomplishment still fresh in my consciousness, I was reminded of my most fundamental limitation. As if some bitter, buzz killing part of the universe felt the need to provide some balance to my newly developed sense of optimism and achievement, my 7-year old ran toward me in the family room hysterically screaming that her 3-year old sister had just hit her head “real bad”. With my wife just out of reach in the front yard I started heading toward the bedrooms and the sound of the crying when I realized that had left the starting line with no brace and without my crutches. Do I take the six steps back to the crutches or just push for sixteen more in the direction of the 3-year old? I slammed my teeth together as I chose the latter without ever really considering going back. “HURRY!”, my 7-year old pleaded, urging me down the hallway as she realized how long it was taking me to travel the last 25 feet. I was already going as fast as I could and it was clearly not fast enough for either of us. A wave of helplessness had turned to anger for my condition by the time I made the last few steps into the bedroom. She had fallen while standing on the bed and had hit a bookshelf on the way down. Her body was still lying where it landed. She is unusually prone to this type of random accident but thankfully she is also somehow nearly immune from real injury. Within a few minutes the tears finally ran dry and she was fine.

Helpless, inadequate, incapable... Just a few of the things as a parent that I absolutely cannot tolerate feeling. Another good time to remind myself that the current situation is temporary and improving every day.


Today I had my first local physical therapy appointment. It was nice to be back but the session was terrible. After all of the walking yesterday I woke up with some renewed levels of pain and pressure in the knee and down the shin – which has now begun to display dull shades of purple and yellow. I took a single dose of Toradol with breakfast but then I got caught up in work related issues as the day wore on (working from my air-bed) and I forgot to take the afternoon dose. I didn’t ice during the day and I never had a chance to get my leg elevated. All noteworthy mistakes. Everything I did at the PT session was more painful and thoroughly distressing than it should have been. Range of motion was back down to 10-60 degrees. Just a day and a half prior I was achieving 0-85. I’m not sure what the unit of measure is (µA I suppose), but for the electrical current testing my left quad sets showed a 126 average, the average on my right side was just less than 5. By the time I got home I had concluded that the session was my worst to date, and that quite possibly I should have gotten a ride to the appointment rather than driven myself.

Next PT session is Wednesday. Two days to ice and elevate and prepare.

Next time will be better.

Day 5

Everything happens for a reason. Things have a way of working out. What you truly need will somehow be provided for you. None of these generalized well-wishing statements hold much value in my beliefs about the way life works. I do believe strongly in the mind-body connection and I believe that the events of our lives can to some extent be affected by a positive and welcoming approach. But I also know that bad things quite often happen to good people and vice-versa and typically no amount of focused spiritual karmic voodoo makes any difference.

That said, as if she were somehow listening in on my self-generated psychosis last night regarding the strength of the graft attachments, Dr. Stone’s assistant surgeon called at about 1pm today “just to check up on me”. Yep, on Sunday afternoon. She is a wonderfully positive and engaging person and based on the things she has said is also a strong believer in the interaction between mind and body. I explained to her what had happened but to my relief she did not at all share my concerns. She assured me that the graft and its attachments are strong and that at this point it would basically require a force similar to that which caused the original injury in order to create new damage. The same was true of the repaired meniscus. Apparently re-injury fear, even heaping irrational levels of the stuff, is very common in recovery. “Stay positive” was the closing bit of advice she left me.

At 4pm, perhaps, I wondered, at the request of the assistant surgeon, Dr. Stone himself called. He too assured me that the ACL was fine. “It’s locked in there”, he said. Well alrighty then.

I’m really not one to question good news, but I have to say that for the most part this “ACL is safe” theory does not make sense to me. To make matters worse, I naively believe that there are few physical concepts that I cannot comprehend if they are just explained to me. Surely, everything is relative and with enough force, anything can and will fail eventually. But given that I applied very little force to my knee and given that my two doctors believe the reconstructed ACL is reasonably difficult to harm, eventually I have to abandon my own terribly underinformed, logic-based thought processes and just go with what I am told.

It is at this point that I also have to begin to admit that I am carrying around a rather generous load of ignorance. Despite my research efforts on the ACL over the past two months and my typical lack of difficulty understanding the basics of bio-mechanics, I still cannot quite get my arms around the function of the ACL. I can almost get a general feel for its hyperextension support by studying the ACL in diagrams, but I don’t at all see how it provides rotational stability. I also have nearly no awareness of how to protect or even favor the meniscus or any of the other major components. In fact there is only one thing about the knee that I have determined for certain. As simple as it looks from the outside, the internal elements make up one exceptionally complicated system.

A quick update on pain levels. My digestive system has finally registered an official complaint over the working conditions of the past week. I’m not nauseous but everything I’ve eaten since this morning has been in a rather big hurry to leave the building. It could be the antibiotics (which are now finished) or the pain meds, or just something I ate. Regardless, the result is that I decided to skip my 2pm feeding of Toradol and now, nearly four hours later, pains that have been gone for days have begun to reappear with renewed intensity. The most severe ache is coming from the upper two-thirds of my shin, likely inflammation of the periosteum (the thin outer layer of the bone). Nothing catastrophic, thankfully, but overall it is considerably worse than yesterday. If nothing else, it's a good measure of where I really am in terms of unfiltered pain. Apparently there is still plenty to go around.

Day 4

Pain levels toward the end of last night and this morning continued to improve. The swelling does not seem to have decreased but another change of the dressing shows that the stitched wounds – and now that I take closer note I see that there are at least eight of them – are mostly dry under the protective pieces of first-aid tape. With the reduced pain levels I began today to work on range of motion.

When I woke up this morning I had an approximate range of motion of about 10-25 degrees, or about 15 degrees total. I iced around 10am and again at 1pm and at 2pm I took my scheduled dose of Toradol and added a Percocet, the latter of which I have been skipping on at least half of the available 6 hour doses. At that point I started sliding my foot back and forth on a ramped piece of melamine. I can push my foot up toward the top of the board and toward full extension and then I use a piece of rope looped around the bottom of my heel to gently coax my foot back down the ramp towards flexion. I did this for a couple of hours and eventually worked my way to nearly full extension and about 60 degrees in flexion. I was quite pleased with the progress.

Afterwards, to minimize any resultant swelling, I iced again, this time for nearly an hour. During that time the heel of my foot was resting toward the top of the ramp, my butt on the bed, and my knee, unbraced for the ice wraps, was just barely off the ramp and therefore essentially unsupported in the middle. As I removed the ice wrap I saw that my knee had settled to about zero degrees. Or was it farther? I suddenly worried if the swelling in my knee was causing it to appear more bent than it really was. My stomach turned and I could sense my lunch beginning to reappear in the back of my throat. I tried desperately to determine if I had fallen into hyperextension. Although I have been told that my knee is “solid” and that I should not worry about re-injury, my own mechanical perspective suggests to me that I do not want to be pulling on the ACL at all at this point. The soft tissue of the graft is strong, I understand, but the bone plugs at the ends of the graft have surely not had time to heal into my bones and so are still relying entirely on the interference screws for their attachment. I sat flat on the floor and fully extended both of my legs. The right leg is tight in extension but it gets there far too easily for my taste. I am now nauseous and disgustingly unnerved.

According to the Stone Clinic guidelines my range of motion goal within the first phase of recovery (1-2 weeks) is as such:

"Passive range of motion should be 0 degrees or hyperextension to 90 degrees flexion, minimal pain and edema, unassisted good quality gait before moving onto Phase II."

Certainly my right leg was not far into hyperextension, if at all, and obviously there was very little downward force on the joint but the fact that I even potentially endangered the new graft (or even just the intended tension of the graft) is absolutely sickening me. It is mentally devastating. What is apparent at this point is that since Christmas this ordeal has generated plenty enough pain and emotional disturbance for me to develop an exceptional level of obsessive paranoia around anything that threatens a successful recovery. I may have a difficult time getting to sleep tonight.

Day 3

I am now on a blow-up bed in the middle of the family room, resting ironically at the precise location of the original injury. My leg is constantly elevated as it has been every day since surgery and I'm icing for twenty minutes every other hour or so. Last night I slept without the brace for the first time and thankfully I kept reasonably still. I have been sleeping with a brace for most nights since Christmas because if I happen to have a dream that causes me to flinch or stir, I am quickly and violently reminded that my knee is not available for such random movement.

Here are some of the movements that I am engaged in at this point (in case any of my PT friends are reading along)…

Foot Pumps – This is a repeated forward and backward motion of the foot moving at the ankle. It doesn’t sound like much, but it stretches and pulls on areas of the knee that I never knew existed.
Circles – Big ones and then little ones, to the right, to the left. Another ankle exercise to help the lower leg remain engaged.
Alphabet – The final foot related feat, drawing the alphabet in the air with the big toe using the available movement of the foot and ankle.
Quad Sets – Isometric contraction of the quads. I’m not quite there yet so I’m doing “flicks”, which is a repeated instantaneous firing of the quads.
Glute Sets – Isometric contraction of the glutes. This also tends to work some of the upper hamstring.
Range of Motion – Extension and flexion. Honestly, I haven’t done any of this work yet because it's been too painful and as a result I am down from about 30 degrees on the day after surgery to now less than 5 degrees of available motion. Will need to get started on this soon.

The pain is actually a lot better today, right on schedule. As long as my leg is up, the discomfort is completely tolerable. And, when moving from “leg elevated” to “leg down” to crutch my way around the house, the redirected flow and pressure in the knee, although still very apparent, is far from the excruciating levels of the past few days. This is a particularly welcomed development, I assure you.

For some reason it just occurred to me last night that this injury (likely to be known from this point forward as "The Christmas Day Incident") was the most severe injury I had ever experienced of any kind. Ever. I've had plenty of bike crashes, car accidents, and I even once opened up three of the fingers on my right hand in a mishap with a viciously sharp wood chisel. The misguided chisel assult resulted in an impressive distribution of blood across the garage and a few bits of unfinished pine lost forever in the fleshy parts of the fingers. But after a couple packages of gauze and a few feet of first-aid tape, the injury was under control and everything healed within a month or so. The knee though, this was different. This was a new degree of injury. And then I realized that this new “worst ever” injury honor had been quickly reassigned to the surgery itself, which although immensely more controlled, was far more damaging than the event that caused it to be necessary in the first place. I've noticed that in the language of physical therapy, the cleverly designed reference to this operative induced injury is “physical insult”.


One aspect of this journey that I somehow did not anticipate is the underlying disappointment of the surgical re-injury. For every one of the forty-two days between Christmas and surgery I worked hard at improving mobility and function and healing and although I was never 100% I was quite able to get around on my own with limited discomfort by the time I stepped into the OR. Now I am debilitatingly injured once again. And to some degree, even more so than before. I never used the crutches pre-surgery, and now I am absolutely dependant on them. I never needed pain medication pre-surgery, but for the past few days it has been critical. Alone in the house I just now spent twenty minutes getting myself into the kitchen to make something for lunch. As my stomach has begun to tire of the medication schedule, I have needed to be even more diligent about keeping myself regularly fed. Turns out, although I was able to empty the contents of the can and heat it up, there is just no good way to get a bowl of soup from the microwave to the table while relying entirely on crutches for your own movement. Even if I could somehow manage to get the soup to the table, I would still not be able to sit in a chair for long enough to eat it.

Obviously the reconstruction surgery was not unplanned nor the consequences entirely unforeseen, and I am still quite optimistic about my recovery. But I must admit it is still far more frustrating than I had expected to be so “physically insulted” and so very dependant once again.

When Dr. Stone asked, “Are you ready?”, clearly this is the challenge to which he was actually referring.