Another weird and rambling blog update. I’ve been holding off writing this one for a while as I’m very up and down at the moment and not sure what I think one day to the next. I was kind of hoping I’d settle on a thought process and then it would write itself but, alas no, so here goes…
(I should also say before I start that any frustration is directed at the situation and circumstances, not individuals!!)
Physio
Having waited for my planned physio session in May, it wasn’t the greatest and basically summed up that I haven’t actually made much progress over the last two months. This is frustrating to say the least, particularly given I’ve been in the gym for over an hour, six days a week (unless the pain levels have driven a day off). General comments were that the HTO is fine (I know!) and that we need to stop the ACL wobbliness (you think?!)
I can’t remember how it came up now (appointment was almost a month ago at time of writing) but the phrases “It’s still pretty early days” and “Don’t underestimate the challenge of walking downhill” came up and I just despair. It was 8 months out from the surgery then, 9 months now, and, no, I haven’t underestimated the challenge of walking down hill… for years. This is not a place nor a perspective I wish to be stuck in.
My physio identified that loading seems to be a key issue (hence the heels problem at the Royal visit last month) and there was acknowledgement that the hopping hadn’t got any better over the last two months so now we’ve taken that even further back to ‘non impact hopping prep’ - so basically, shallow single leg squat - up into releve - and back down again 🤦🏻♀️
I think it was meant to be reassuring when they said that they’d get me hopping again before discharge but all I take from that is ‘Wow, is that the sum of our ambition now?’ because it’s certainly not the level of activity I was aspiring to.
So this month’s exercises:
Jogging / cycling - as before
Weights (leg extensions, leg press, hamstring curls, adductors, abductors) - as before
Squats at front of bosu for increased knee loading
‘Static’ lunges with front foot on bosu (3 count down, 1 count up)
Reverse lunge from bosu, then power up with high knee
Step downs from low box (keeping knee over second toe and hips level)
Hop preps
There’s a lot of commentary on social media about the importance of having physio tailored to your own situation - and that is what I have - not a series of ‘cookie cutter’ exercises taken from a protocol or insta page. If only I was actually getting anywhere with it.
Yes, set backs are all part of ACL rehab but putting in the effort and not getting the results is the part of this process that drives me mad the most.
After two weeks of following the new plan, the general knee pain wasn’t resolved but I did gain knee pain going up stairs (not just downstairs) and was pretty fed up of it all.
Walking challenge
An end-of-the-week walk with my friend exploring a new, hilly and off-road route just outside Bewdley meant deciding whether or not I should take my brace again. Isn’t that precisely where this whole phase of the ‘fix the knee’ process started? With the realisation that it wasn’t stable for simple, day-to-day activities?
As it turned out, taking the brace was the right call. When we went off road again, a muddy, rocky woodland descent down to a brook saw me sliding downhill with nothing to grab onto other than a barbed wire fence to steady myself 😬. Luckily I managed to keep most of my weight on the good leg and the brace held the ACL knee pretty steady. Fun, in its own way, but really just symbolic of the increasing reliance I have on the brace if I’m going to do anything that has a chance of being unpredictable. It's certainly not a sign of confidence in a new and stable knee.
So, where to from here?
For the first time in this phase of the ‘fix it’ journey, I really couldn’t face going back to the gym to do THE SAME STUFF AGAIN that weekend so decided to stop altogether for a few days. Those few days turned into just over a week before I could begin to give it headspace again. For the first time, I’ve also been giving some real consideration as to whether it is simply time to give up on it all now.
If I was a betting person, I’d wager that this isn’t going to be fully sorted without re-doing the ‘still-lax’ ACL but there doesn’t seem to be any intent from the clinical team to go back in that direction, whatever the conversations at the start of this phase may have been.
My instinct is that the excess movement, ongoing instability (even if reduced), tight ITB, rotational clunk, leg extension problems and pain when twisting if my foot is planted all (or mainly) point back in that direction. And while I can keep on doing the physio, it isn’t going to change that fundamental physical factor. It may not have completely blown out on Palm Sunday but the ongoing wobbliness and shifting out of joint is not the level of function I was looking for, nor one that gives me any confidence to do anything more ‘adrenaline fuelled’ without resorting to wearing the brace.
So, if the clincal team aren't keen on that direction (supposition), at what point do I accept I’m flogging a dead horse?
I have another physio session booked next week and think I probably need to use that to get some straight answers on where I’m headed:
If this is just a set back/plateau, what timeframe is realistic to start seeing progress again now? In reality, I feel back to where I was pre-op but certainly no further forward.
Are the original goals (kneeling, surfing, zipline) genuinely realistic?
When / what criteria do I need to meet to start reintroducing plyos and turning work?
At what point would you refer back for:
plate removal?
exploring options beyond physio to get this knee stable ie getting on with the reconstruction?
Are there any downsides of redoing the ACL? Is this being actively avoided? If so, why?
If I’ve got three physio sessions left before health insurance renewal (and excess payments kick in again), how can we best use those?
And if referral back to the consultant is the best option, is that likely/now within a sensible clinical time frame before my insurance comes up for renewal again?
I can motivate myself through pretty much anything if I know what my goal is and what the timeframes are but drifting, like I have for the last few months, just becomes intolerable. And while it may still be classed as early days in this ACL rehab (I don’t agree, obviously!), ACL surgery rehab has been going on for 14 years. It may not be psychologically helpful to think of it in that context but that’s the reality of how long it has lasted, give or take a couple of years of normality, so I think I have reason to be grumpy!
New benchmarks
Anyway, having done nothing for a just over a week, the discomfort completely went away, creating a good opportunity to benchmark where I'm at and start testing reactions to different activities before my next appointment.
At one point, I even began to wonder whether the discomfort was just from doing too much for a while and the rest might re-set it 🤔
However, after a few sessions this week (Day 1 - 20 minute jog, then loading and proprioception work; Day 2 - loading and proprioception work at home; Day 3 - 20 minutes cycling then weights) not a lot has changed. The knee still hates being the trail leg for lunges and doesn’t really know where it is in space; the hop preps generate the same kind of pain that actual hopping did; I’m getting quite a lot of anterior and lateral hamstring tendon pain on the squats; and the shooting pain through the middle is back on leg extensions. On the plus side of the equation, I did manage a new single leg press PB 🎉
It’s all data, if nothing else.
So, I guess I’ll keep going over the weekend and then back to physio next week. On my daughter’s birthday. I think I wrote something previously about the impact of auspicious dates. Hopefully this time I don’t end up with blood streaming down my neck!! 😂
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