1st day of physiotherapy

First Milestone reached: jump for joy!

 Well I had my first physio appointment today and I was a bit nervous as I wasn't sure if I was ahead of the game or behind. I was booked to see Maggie at Reach Physio http://reachphysio.com/
Located in down town Squamish, by the senior centre (which is another story), and came highly recommend by Ed and Gwen. I will be followed by 2 physios, Maggie and Patrick as Maggie is returning from mat leave and the centre thought it would be good for me to see the 2 of them as they both trained together, and to fit around mine and Kevin's schedule (so he can drive me there on days off). 

Maggie took down my usual details: how I injured myself, when was the surgery, what I do for work and for recreation, what type of graft they used for surgery, what where the surgeon's post op recommendations, and what I have been doing since then. I demonstrated to her my program, what pain relief I use, how often I use the CC, my daily regiment, etc...
I pretty much blew her away! 

• swelling: very minimum, most likely due to using the CC every 2-3 hours for 20 minutes, including overnight

• Knee flexion: lying on my back I can slide my heel up towards my bum till it reaches 98 degrees. As per physiotherapists guidelines, they aim to progress their patients to 90 degrees flexion at the 2 week post-op mark. I got there and further in one week! 
• knee extension: 0 degrees, which as the diagram above shows, is perfectly straight..excellent!

This is the one thing that put fear in the back of my head: not being able to fully extend with the first 2 weeks post surgery. Many studies, and from speaking to others who were not able to gain full extension within the first 2 weeks found that their rehab was delayed, they struggled with hyperflexion in the long run (or could not achieve it at all), which in turn has caused hip and pelvis issues. 
By being able to fully extend on my own with no pain, this will greatly improve my range of motion quicker compared to if I still was struggling with straightening my leg. 

• hyperflexion: we want to be careful with this within the first 6 weeks post op as this puts a lot of strain on the graft. But with Maggie supporting the knee, she could gently assist me in hyperflexing my knee, which I can do with no pain up to 5 degrees. Below is a little video explaining it a bit more:

So needless to say, I was extremely happy with the progress I have made, but most importantly, with the program that Paolo set for me, which I have followed like as though it was my bible...thank you Paolo!!! I told you he was God.

Maggie and I hit it off instantly. She is very proactive but cautious at the same time and is helping me to set boundaries and within them to explore different ways of stretching and heeling. So, below are the guidelines and some recommendations I have been following. (the new ones I am to start working on are in pink!). These can be all applicable for the first 2 weeks of your rehab post-op:



Pain management:

• Cryocuff, every 3-4 hours x 15-20 minutes (including overnight use)
• Tylenol extra strength (acetaminophen extended release) 650mg per tab, every 4 hours
• PRN (as required) Hydromorphone 1mg or every 4 hours for breakthrough pain relief 

Please remember that this regiment is specific to me as Codeine was not kind to my body. However, your physician may prescribe completely different meds to you and I think it is best to talk with them to find a regime that works perfectly for you. 
 
Alternative treatment:

• PRN Bach Rescue Remedy, 16 drops in 1lt of water, sipped throughout the day
• 3 prunes and apricots daily for regular bowel motions
• "Poop smoothie" every morning at breakfast 
• have started taking Metamusil Fibre supplement 3 times a day only because I am still taking hydromorphone (opioid) and because I am slowly building up towards my regular diet, which is very high in fibre, roughages (raw vegetables), nuts, berries, multi grains, bran, and omega 3's (thankfully Kevin is just as much into healthy eating as I am). I recommend these remedies if you can not maintain a diet that is rich in the above ingredients as a balance of these and daily exercise will keep you incredibly regular, happy and glowing! 
• Pranayama: yoga breathing! Honestly, this really helps to calm that mind when you are moving through that stretch and it twinges and hurts. Simple and used for anything, but I found this as a useful tool to assist in blocking the sound of my inner voice shouting "mother f*****! this hurts!!"
• *long term* acupuncture to the knee but I will go over that once I start

Stretch and strength:

• calf/hamstring stretch with yoga strap on foot
• quad/hip flexor off end of bed
• quad sets with muscle stimulation (will explain further on this)
• heel slides
• bending/straightening the knee on your side
• wall (or floor) ball rolling" exercise ball placed under your knees, you on your back, legs out straight, and roll in towards your body, slowly and back

I take my time with the above exercises, no racing or trying to beat a time here. Approximately every 3-4 hours I'll spend 20 minutes on these, as well as sitting on the chair and using my good leg to assist with extension of the bad leg. 
If I am sitting in the chair in the shower, lying around in bed, or doing the dishes, I am generally flexing the ankle joint, or slowly moving the knee back and forth as I find that it can stiffen up quickly and that hurts.

I have been setting my alarm clock over night to take the pain meds and apply the the CC and I have found that this has not disrupted my sleep, or cause me to wake up groggy in the morning. I don't want to wake up due to agony. It's not fun, and it's not fair to yourself or to your partner. So, at 10pm I take one Tylenol and 1mg of Hydro, at 2am 1MG Hydro, and at 6am 1mg of Hydro and 1Tylenol. Both at 2 and 6 I apply the CC and after 15 minutes of it on I seem to fall asleep rather quickly. 
By doing this I find that when I wake up around 9am-ish and slowly stretch and get ready for the day I am not groggy, I feel clear in the head, and my pain is at a discomfort that does not hold my back from my usual active daily routines. 

Maggie gave me a TENS machine to use for the next 2 weeks. A TENS (trancutaneous electrical nerve stimulation) machine is a well known device used among many health care professionals, across many diverse practises. For me, this will be used whilst completing the quad set exercise. Because I have very little self nerve stimulation of the quad muscles and fibres, by applying the TENS machine will stimulate quad nerve fibres and increase the nerve action potentials. Basically this will assist in increasing muscle movement and indirectly reduce pain levels. Once I am able to fire the muscles on my own then we will not need the machine. Check out the video below! 

So looks like we are on the right track. After a day of feeling like hell, there is light. We all knew that, I knew it, but when you are stuck in the ditch it's hard to see what's over the hill. 
I know that there are going to be many more challenges and bad days ahead of me. And there are going to be many sections of goals to achieve, such as, re-assessing in 4 weeks, 6 weeks, etc... But it was such a relief to know that what I have chosen to make up my exercise schedule is working, and showing progress. I am not going to ramp up anything, I will keep with the same schedule for the next couple of weeks and slowly increase range of motion as I can tolerate. 

I will now go and celebrate by having a nap as Maggie gave the leg a good massage as whole right leg, from foot to groin is incredibly tight! 3 months of guarding that knee. The massage technique she used was to aid the lymphatic system in flushing out the excess toxins and lactic acid building up in my leg, as evident by swelling (which is also a normal part of your body's inflammatory process). 
Night!