As mentioned in the post officially unveiling ‘the news’, with so little evidence out there re the impact of pregnancy on ACL issues, I’d have loved to have been able to compile some data before, during and after the pregnancy that added to the resources available. However, that’s not possible so, even if it’s of no clinical use in terms of scale/repeatability etc, I’m hoping that the notes I compile may at least be useful/interesting to anyone else in a similar boat and looking to use other peoples' experiences to inform their own decisions.
Unfortunately I’m not able to assess laxity myself so I’ve been looking at other ways to monitor how the knee holds up: during the pregnancy itself; while I’m feeding; and for six months afterwards.
The two obvious first ports of call, which you may have come across, are the Oxford Knee Score* and the Cincinnati Knee Score**. Both of these are questionnaire based and subjective but, rather than trying to reinvent the wheel, they seem as good a place to start as any.
So, I’ve filled out both and will repeat on a monthly basis (unless something changes noticeably in that time, in which case I’ll do an interim score too). It will be interesting to see if they reveal any trends over the next 12-18 months or so and, even if they don’t, that in itself is a result.
Ideally I'll devise some way of monitoring flexion too, as my perception is that that improves for me during pregnancy, but short of getting out an old, school protractor or relying on trying to measure how many fingers I can fit between my heel and backside when kneeling down (without twisting and affecting the result anyway), I'm still working on that one. Answers on a postcard...
Oh, and those interested in the array of different knee evaluation criteria available, may also be interested in this link
*Devised to assess extent of likely knee osteoarthritis and resultant recommended clinical treatment (not the most relevant to this but an interesting measure in its own right, particularly given the night-time knee pain)
** Devised by Noyes FR (If you've spent any time online looking for information re ACL injuries, you'll almost certainly have come across Frank Noyes and the Noyes Knee Institute in Cincinatti . Whether he is genuinely a leader in the field or very good at marketing for his place of work, there is a lot of peer-reviewed research that's worth a read and referenced on other trusted site e.g. KneeGuru, so that's good enough for the purposes of this 'study'!)
18 February 2018
OKS – 36 (May indicate mild to moderate knee arthritis. Consider seeing your family physician for an assessment and possible x-ray. You may benefit from non-surgical treatment, such as exercise, weight loss, and/or anti-inflammtory medication)
Cincinatti – 45 (<30 = Poor, 30-54 = Fair, 55-79 = Good, >80 = Excellent)
21 March 2018
OKS - 38
Cincinatti - 65
Notes - That was an interesting experience, I wasn't expecting to find the questionnaires relatively difficult to fill in this time round but perhaps this illustrates why obtaining data in pregnancy is quite such a fallacy: both questionnaires ask specific questions re physical activities such as walking, stairs etc and those are actually being impacted by the pregnancy at the moment so it's not straight forward to assess the knee's response. I can't quite believe how much I'm slowing down already (33 weeks) when I was still 'flying' at this stage first time around!
Walking - difficult to assess as SPD, running out of room to breathe properly and too much exercise triggering Braxton Hicks are all impacting how far I can walk before I can pass any judgement on knees.
Running - as above so not happening!
Jumping - as above so not happening!
Stairs - only problems have been SPD related, which varies in severity from hanging onto the bannisters to haul myself up/down some days to no problem at all on others.
Pain - sometimes at night but SPD pain is more prominent - nothing quite like waking up every hour due to hip pain and then feeling your SI joint shift each time you attempt to roll over. The glamour!
Pain/swelling - low level pain and swelling in back of knee whenever I've been out in the ice and snow. I'm being hyper-careful though after the ice incident in January last year (very sensible shoes, being very careful where I put my feet, not going out in it as much as possible etc.). Interesting that there is a small reaction though: lack of practice on slippery surfaces/supporting muscles not used to it or symptomatic/legacy issue?
Range of Motion - I haven't figured out a way to objectively assess this yet, and have been conscious about not pushing it after last time so nothing really to report. PROBABLY no increase in flexion. The only time I've noticed flexion as an issue has been when doing some antenatal yoga a few weeks ago, much of which was focussed on deep squat poses to build strength for birth. Not a chance of squatting down that far!!
Stability - knee shifts a bit but hasn't gone fully out of joint.
19 April 2018
OKS - 33
Cincinatti - 60
Notes - 37 weeks and the relaxin is well and truly kicking in now in my elbows, shoulders, hips, lower back and knees. Having to be careful of over-extension in knees and elbows particularly.
Walking - the knee is definitely looser than it was and I've had to guard it a few times when it feels like it's going to slip (catching myself with leg too straight or when turning). It also gets sore more easily. Wonder how much of this is relaxin, how much down to the additional weight it's carrying and inevitable posture changes, and how much is chain reaction from walking differently when hips and back are playing up.
Running - ha ha!
Jumping - ha ha!
Stairs - don't do enough of them to judge.
Pain - More day-to-day soreness in the knee itself, particularly if I've been walking for a while (a mile is about the limit for a variety of reasons at the moment although, bizarrely, MummyFit class is still okay. Go figure!) but I wouldn't say it's 'bad'.
Swelling - difficult to assess. By the end of the day, everything is swollen.
Range of Motion - definitely feels more prone to hyperextending now. Conversely, the flexion is worse, based on doing quad stretches at the end of MummyFit class. Today I couldn't grab my foot far enough up to really pull it back and, as I've said before, I'm not going to push it.
Stability - knee shifts a bit more frequently than previously but hasn't gone fully out of joint.
Update 27/4/18
Just a quick update as, after yesterday’s MummyFIT session, I’ve take the decision to call it a day on that front, actually knee driven more than anything else. I mentioned in my last post that it feels as though the relaxin is well and truly kicking in now (38 weeks today) and yesterday’s session was the first where I’ve really felt my knees complaining. Each interval (all no impact lunges, squats etc) was interrupted not by muscle fatigue but stinging or soreness in the reconstructed knee - to the point it wasn’t happy with me fully weight bearing between sets, so I’m taking that as my signal to call it a day. I’m hoping to continue with some swimming until bump arrives, and will keep up the monthly updates, but I’m not interested in pushing it now to see what happens. I may do another OKS/CKS this weekend to get some new figures for comparison but, until that point, it’s over and out for now.
Update 14 May 2018
A little delayed but updated OKS/CKS scores done today are below (40+4 weeks at time of completion). Looks like this bump is going to follow in its sister's footsteps and be properly overdue after all. Anything less than 40+13 will be an improvement. Pah!
OKS - 32
Cincinatti - 45
Notes - Looking back at the figures (subjective, of course), there is a steady decline but a little startled how much lower the Cincinatti score has become over the last three-ish weeks!
Aside from the relaxin issue, the other obvious change I haven't really touched on previously is, of course, how much additional weight I'm carrying now (14kg up on pre-pregnancy weight, which itself was a bit higher than I'd have liked it to start with). I suspect this has a lot to do with the increased knee soreness (particularly vs other joints also affected by relaxin) and ties in with all the evidence about carrying excess weight and increased incidence/severity of osteoarthritis. Hopefully this will settle down once bump is here and the weight 'falls' off. Another one to monitor...
Walking - not doing a lot of this, beyond pottering around the house, as just too generally uncomfortable. At the point now where if I venture the 1/4 mile to the corner shop, I'll have problems getting back and continuously run the risk of being picked up by the RSPCA as the walk increasingly resembles an escaped penguin rather than a human being
Running - ha ha!
Jumping - I would have said 'ha ha' but I did actually try a couple of nights ago in attempt to begin bump's eviction proceedings. PGP/SPD mean I'm not getting on with sitting on the birthing ball to encourage things along (well, it's okay while I'm on it but causes more problems than are worth it when I get off again) so, in the spirit of 'I'm sick of being pregnant', I decided to have a go on my rebounder trampoline while watching the Eurovision scores come in. I lasted around a minute before the bump was complaining so called it a day. The ACL knee (anterior medial) and hamstring were particularly sore the next day and I couldn't work out why. Then I remembered.
Stairs - don't do enough of them to judge.
Pain - Day-to-day soreness with general activity e.g. walking around. Also sore when kneeling down, draped over my birthing ball rocking forwards and backwards to keep bump in the best position (first baby went back-to-back during labour so will try (almost) anything to avoid that again). Note to self - when it eventually all kicks off, take a pillow with me to birth centre to stick under my knees.
Swelling - N/A
Range of Motion - anecdotally, the flexion seems to be coming back but I don't have any solid evidence to back that up.
Stability - can feel knee shifting when moving between squatting/standing up but feels more like knee cap tracking than inside the joint.
7 March 2019
OKS - 29
CKS - 50
IKDC - 47.1