6 weeks!

My, oh how life taken a nice little turn for the better this past week. Since I was given the green flag to start climbing again I have already been 3 times this week, spending approx 4 hours at the gym, climbing grades of 5.9 to 10a/b (top rope for now), on about 6-7 routes. Things that have resolved since re-climbing:

• right hip pain *tick*
• right hip stiffness and locking *tick*
• knee pain *tick* 
• mood swings and throwing tantrums in attempt to hold Kevin back from going out and having fun without me *tick*

Things that have improved since climbing:

• forearm strength. Its amazing how quickly they re-conditioned to the effort imposed on them whilst hanging with one hand and balancing on a foot trying to undo un-clip from the rope 
• happiness: my cheekbones hurt daily from smiling
• right quad strength, most notable when I am "high stepping" and can slowly but confidently push my body upwards from stepping up high 
• personal relationship: yes, the competitive aspect of our relationship can restart 

I have especially noticed that my scapular muscles and hip flexors are more open and relaxed, which makes you walk with good alignment and feeling tight throughout the body. What else....did I mention that I just feel fantastic? My spirits are happy, my mood is calm, I don't burst into random tears with "can't live if living is without you" screaming in the back of my head when looking down at my pudgy knee; and I have my stamina back, which is highly evident from now beng able to work a 8 hour day in the office, go climbing for 4 hours, and come home for some "adult cuddling" that doesn't last for 3 seconds (I'm being careful what I say here because I think my mum and dad still look at this blog).

Photo time:

No I am not naked but I bet you wish I was...

See? I'm wearing high 70's looking running pants although I'm not allowed to run...

Slight bruising but otherwise ok

Physio program at 6 week mark for the knee:

• 30 min, 5-6 days a week, spin bike with resistance. I listen to my ipod and run my own spin class depending on the tune. Slow tune = turn up resistance and bike up the hill; fast tune with heavy runs, = sprints. I used to take spin classes when I was in uni so this exercise is so much fun for me. Plus, the knee feels amazing when I am standing up on the bike peddling up the hill
• indoor rock climbing on top rope, 5.9-10a/b 6-7 routes. Some overhung with juggy holds, but mainly climb to get mileage 

Stretches:

• hip flexors: warrior with exercise ball in between legs to balance
• hamstrings, quads, and calves with yoga strap
• foam roll: I lie over the foam and roll my hips and quads over. Amazing self massage for my quad

Strength:

• physio ball wall squats with "push press" using medicine ball: 3x10-20 reps 
• leg squat/press: 3 sets x10-20 reps with heavier weight (right now I am at 75lb)
• calf and toe raises
• using aerobic steps, step ups/downs: 2x8-10 reps. Bad foot leads up. I am now balancing on the right foot and squating on it...if that makes sense. 
• physio ball hamstring curls: 3x10-20 reps

And don't forget upper body; I'm sticking with my negative resistance training to re-condition my climbing muscles, however I am very happy to say that they really hadn't left me after 4 months off climbing. The little girl muscles are still there, and are out and proud when climbing. It really did make a difference with negative resistance training during the "prehab" state. To tell you the truth, I feel quite light-footed climbing up those walls, and free in the mind...yes, I think of nothing when climbing and ain't that the best, especially after a mentally exhausting day in the workplace? 

Go climb people! 

The secret to remaining slim and fit looking is...

Hey all,

Well, I've been given the ok by my physio in regards to my climbing program! I also had a really good chat with her as I feel as though I have hit a plateau with my rehab and this is where things can go down hill, in terms of becoming lazy.
My pain is under control, swelling obviously increases with movement but as per the physio and other sport professionals, it's going to swell up and down every time I increase my movements or increase the amount I stand for, and it's going to be like this for approx 4-5 months. 
However, I can not let this hold me back, which is not really my concern. The frustration is that I want to move more, yet the swelling gets in the way and that is what makes me get angry. I voiced my concern with Maggie who was incredibly sympathetic, and sees that I have become quite strong, have worked well on strengthening my core, and so now it is time to use it to balance out the rest of the workout. I need to now work on endurance and work on strength exercises, mainly targeting the quads. 

She was quite impressed with my own program I have designed when it comes down to climbing and I think we both trust myself that I will NOT push the boundaries. I have worked too hard, and have finally got myself well disciplined to ruin this.

Here comes the gloating and the answer to the title: I have lost weight since the injury...15 pounds to be exact. But I am happy with this for many reasons as listed below. However, the reason I am blurting out this information is because of a few "run-ins" I have had at work when I've gone in to do some research work. I won't go into it too much but here is the jist:
"Oh Sarah you're back, and you look so thin! You aren't eating are you? You must be so hungry. Kevin must not be looking after you at all...you poor thing!"
Am actally I have a great appetite, and I feel better than pre surgery! In fact, I have so much energy I feel like I'm 16 again and I am very happy...oh and I look after Kevin, and I feed him well thank you very much!"


Yes, I have lost weight but I have realised that this was excess fat I had stored on me. And no I didn't reduce my carb intake or increase my cardio workouts as for the last 4 months I have not been able to do a full high impact cardio workout. I'm living fact that you do not have to complete hard core activities to have abs that stick out, especially the upper ones that are really hard to develop, to be able to cock out your biceps like Arnie does in the movies, and just because you are "sick and injured" does not mean you have to look it! 


People love sucess stories, but when it happens too close to home it scares them and their reaction is to put you down. Why? Because they want to be sympathetic with you; "oh, well you put on weight because you're not as active as you normally are...but don't worry, you will lose it once you're back to normal"
They don't want to see you looking even better than pre surgery because you're supposed to look tired, fatigued un-happy. Instead, you bounce into the unit even more perkier than usual (and guess who once got told off to be less happy because it made others uncomfortable...I told them to shove that notion up their ass...with a smile on my face), looking healthy, with your long, glossy, curly, flowing hair, all happy. Oh, can you see the pissed off faces? So what do girls do to each other when this happens? They become mean girls and say that you look "pale, and tired...you must be hungry, right?"

Um, fact number one that I am not looking sickly or too thin: My boyfriend thinks I look super, super, super hot. He is so proud of my little girl muscles, my strength, my determination and stubbornness to keep plodding on, and yet look good. And you know what, because of this, I feel proud of myself and confident. And for the first time in 28 years, I love walking around the house naked! Now if you are going to pop my confidence bubble then I don't want to know you because I am using this extra, new found strength to not get lazy with my rehab program, and to keep plodding on. 


So, here is Sarah's stuff:

1. It is much harder to lose excess fat gained weight from an injury/ilness post recovery than to put it back on. After your rehab period, whether it is 3 months or 9 months the last thing you want to do is start another program to loose that excess fat. You want to get life back on track, get back to your usual activities, and not worry about it. And you can see that I am saying "excess fat" not weight. Obesity is not just weight gain; its accumulation of excess body fat. My weight is made up of water, fat, muscle and structural content (bones, tendons). So right now I am ideal body weight for my height and ethnicity: before hand, I just had excess fat that was sitting there not being used. So, get rid of it!
2. I have my abdominal muscles back (especially the upper 2) and am so happy to have a strong core again. This is especially beneficial with bedside nursing (lots of pulling, pushing, lifting, turning, squats, etc...)
3. I know what fuel my body needs and doesn't to maintain adequte calories that gets used properly. No I am not calorie counting, I don't have time for that. But I haven't had a proper sweaty cardio workout for 4 months and the amount of food I normally eat for energy would be sitting there and turned into fat if I didn't reduce my portions. So yes, I am being careful with how much I eat but this is how you don't gain extra fat.
4. There is no miracle, no hard core workout to lose excess fat: remember, I may have lost weight, but I have gained toned muscle and I am barely 5'0, Asian ethnicity, and my weight is right in the middle of the normal range, and I have done this with barely completing a sweaty cardio workout in 4 months.
5. I have also removed excess body fat that I really didn't need. How do I know this? Well, despite having a bung knee I am more energetic, my skin is clearer (I ditched the foundation months ago), I sleep better at night (even pre surgery), I am more focused on goals of life...shall I go on more?
6. Eating fat does not make you fat, nor does eating carbohydrates. I still eat them, I love multi grains, I love fresh bread with butter. Plus we need fats. It's your body's response to excess carbs that makes you fat. We only have a limited capacity to store carbs, so the excess stuff gets converted into excess fat.  
7. I haven't increased my protein to carb ratio. Too much protein in a diet is bad for you: you will loose muscle mass and that is not good. My usual intake per meal: 40% carbs, 30% fats, 30% proteins. Balance and enjoy cooking your meals.
8. I didn't put myself on a diet. Kevin and I have always eaten healthy and well because nothing tastes better than fresh produce and meals you have made from scratch. I just reduced my portions and obviously, I was eating too much for what I needed before as I lost 15 pounds in 4 months with no hard core cardio, boot camp workout to back up the loss. My workouts have been low resistance weight and exercise band training, pilates, and stationary bike riding. Nothing flash or expensive. No hard core personal trainer making me sweat. Just me doing an hour and a half of some form of exercise 6 days a week, backed with reduced portions. Simple!

So there is my take on staying fit and healthy despite totally reducing your workouts due to injury. It's doable, you have the time to do it, so stick with it and you will be reap the rewards!

BRACE!

And now we can begin the real rehab! Range of motion is pretty darn good and I am almost too confident walking on flat at a semi brisk walk..that's right granny, I'm not that far behind you!
After getting my final fitting at the Dr.'s office on Wednesday I came home to show off my brand new shiny CTI OTI Ossur brace that cost far too much...$1400 to be exact (post discount). So of course I had to go and test it out by pulling some weeds and then hitting the gym.

I was quite happy to see my trainer at the gym and very proudly showed off my knee, it's minimal swelling, and my range of motion. Unfortunately, when I am on the stationary bike the side of the brace (the little label) hits the inner portion of the bike making a nice clunk sound every time my leg moved past it. So I decided to hop back on the spin bike after 1 month of being off it and it went great! Not only was the resistance very low, but the motion was a lot smoother than the stationary bike, so I think we will stick with spinning from now on.

Ready for action!

One thing I don't like about it (and this is purely a girls point of view) is that it bunches up my leg too much, making it look like you have a podgy leg, when really I don't think I do (see above, thigh bulges). Apart from that, I like the fact I feel more relaxed with movement, even walking. Before I was constantly on guard, my thigh and butt muscles where always tense, in protection mode. And due to that, I have some nasty knots in those regions that will require some heavy duty kneading out.

Now, just to add some contreversy, I went indoor climbing with Kevin yesterday (Friday)...and before you all stand up and yell, scream, and throw your best, "why I aught too" or, "you're throwing away all your hard work for nothing!", here is what I did:

* 20 minute warm up period
* 6 routes on the short wall (20 feet) within a 4 hour play period
* Approx 15 minutes rest in between with leg elevated, and stretching that includes calves, hamstring, and heel bends
* Routes were 5.8 and 5.9 with juggy holds that also made for great break spots
* Top rope climbing ONLY 
* A belay (Kevin) who knows your injury well, keeps the rope firm on your way up and lowers you to the ground very, very slowly and smoothly
* Brace worn at all times climbing. Taken off only when stretching 
* No bouldering!! And not for at least 6 months...
* 20 minute warm down period

And guess what? I felt safe, I trusted my body, I felt that I was not pushing any boundaries, and I knew what I could and could not do. There was no pain, nor increase in pain or swelling, and if there was, I would have stopped. Common sense prevailed and although Kevin said that I was strong enough to take the bigger wall I said no. This was my first day back and I am going to be sensible and boring. 
You can get a good work out completing 5.9's (not a cardio workout by the way), just work on your footwork and body positions. I played the game of when you touch a hold then that is your hold until you move up. You can not touch another hold unless you are moving up. But you can not move your hands around the holds, but work with what you have. This I find slows me down a little bit more, as before I chose my hold I think of the following 5 moves and if I grab that hold, how is it going to impact the rest of the movement. Kind of like playing climbing chess. It makes you think well in advance: where is my next rest position? how can I grab that hold that will be best for my body dynamics and position?

Of course I know that I am not going to be able to do any knee bends, heel hooks, or match hands to feet on holds. Nor can I do any dynamic leg thrusts up to the next hold. Instead, this was more of a "find the right angle and hold for a perfect feet placement" exercise.This was also more of a upper body and core exercise. And because my core was strong, my balance was perfect, and not much energy or power pulls was required from my lower or upper body (if that makes sense). Plus, if you have ever seen my climb, then you will know that I moved up those routes pretty slowly humming along the way!

But the best part was that for 4 hours, my mind was at peace. It was quiet, I was at rest and calm. I tuned out all the stress for 4 hours and my body was very grateful for that. My back muscles relaxed, my hip flexors got an excellent stretch and opened up, which reduced pain in the right hip. My scapular muscles lengthened and tension reduced from my upper back and neck. But mostly, for the first time in 4 months, I was perfectly happy. I can not put into words just how happy I was and that I was so proud of my body for staying strong and being able to come together to look after me and allow me to gently climb again. I had the best nights sleep too! I was exhausted by 8.30pm and had such a solid sleep. I woke up this morning and I didn't feel sore or like I had pushed it too much.


So for the next 6 months I will only top rope climb. I will stick to 5.9 routes for the next couple of months to (a), get the feeling of climbing again and re-condition those climbing muscles, and (b) to just have fun! Oh, another great part of that day? I got to hang out with my best friend again. We hadn't properly hung out and had fun with something that we both love for 4 months and I was so grateful to be able to do this again with him. While I rested, I watched Kevin boulder as well as chatting to other boulders. The great part of climbing, especially bouldering, is the social aspect. Climbers are chatty and fun to hang out with. So it was great socialising with people again, which, I dearly, dearly miss. 
What a great long weekend; life is good!

One month post-op

Hey...those are some sexy knees...again, which knee got drilled?

So I caught up with physio Maggie on Monday and here is where I stand and what shenanigans I am up to! 

Flexorama:

• 139 degree flexion...oh yea baby. I am 2 Sarah fist sizes away from my foot touching my bum
• -5 degree extension, meaning 5 degree hyperflexion

The smile speaks for itself...

Bruising: meh...

 Yup, that ankle is still bruised and more coming out on the outer side of the ankle...Any takes on what that surgeon did to me? I mean it's been a month since the surgery and there is still obvious bruising on the inner part of the ankle and now it's coming out around the outer side and it hurts to wear socks that sit above my ankle! Anyway, enough of the winging Sarah!

I really should by standing staight in the camera by now shouldn't I? Oh, new thing I learnt about myself...no in fact 2:

1. I naturally stand in hyperflexion, which is kind of bad as it is pushes my right hip forward, the hip joint locks, and then I hurt... bad Sarah, bad! So Maggie will work her manipulation magic on me to assist in decreasing the amount of  locking the joint, while I have to learn to stand straight
2. Ryan Kesler and I have the same brace...

EXERCISE PROGRAM AS OF DATE:

Warm up (each morning):

• toe/heel lifts
• heel slides
• physio ball on wall slides
• stretch with person (preferably hot boyfriend) or yoga strap to stretch calf, hamstring, and peroneals, toe pointed inwards...this last stretch is due to the fact that although I walk with no limp and with heel and toe action, my right foot ever so slightly flicks inwards, which is secondary to initial limping and the bruising/soreness of ankle

The harder stuff:

• bike, 15-20 minutes per day, stationary bike with a tad of resistance
• pilates: morning 20 minute warm up, evening core-aholic 20 minute work out
• seated leg press at THE GYM! bend only to 30 degrees, 2 sets x 10-15 reps. Weight: 20-30 pounds
• hamstring ball curls: step 1 is hips on the ground and curl in and out. Step 2 with hips off the ground in a almost plank formation
• clamshells: 2 sets x 15 reps++ and isolate that leg from the hip socket!

Drugs:

• Ibufrofen 200mg every 4 hours. at 2200 400mg to last 8 hours over night (always with food). Also recommend gel capsules due to quicker onset of action and longer half life
• Tylenol 650mg every 4 hours

In saying this, yesterday it got till 2pm when I realised that I hadn't taken any pain relief and I wasn't feeling the need to all day...progress!!

Alright guys so we are getting there. Slow, slow progress and I am on a count down: 2 more months until I am allowed to start climbing again. Top rope only and on nice juggy 5.6 - 5.9 but the goal is in sight. Post 6 months then we will look into getting back to lead climbing, but I don't want to think that far ahead otherwise I might cry and stomp my foot (good foot). 

I have to say, I still am not very good at this whole sitting at a desk to do my work. I find that ever half hour or so I still need to get up, and stretch. And I don't mean by flexing the leg from straight to bent, but I have to sit down, and do some heel slides, heel raises, etc...so thankfully I can still work from home. It's not the pain that bothers me, its the uncomfortable feeling of not moving and the pressure put on my hamstrings. The knee gets puffy in the back, it becomes stiff, and I just get annoyed and grump like a little kid who just got told that she has to go to bed at 8, not 9 like she was promised. Yup, I am that inpatient.
Lesson learnt? Move Sarah, move (like I didn't already know that...)

Show off

http://squamishclimbing.com/squamish_climbing_bb/viewtopic.php?f=1&t=3140

Check out the link above:

Thought I'd throw in my 2 cents at the local Squamish climbing website because yes, I make myself even more crazy by looking up videos, reading up about climbers and their latest achievements daily...

Comfort food

Chorizo, lentil and chick pea soup

When it's raining and miserable and you feel confined to the indoors, the best thing to make you feel better is always a bowl of hearty soup. My mother taught me this: there where countless days (and not just Sundays, but mostly after a soccer game played in the rain) when we would come home, the kitchen windows would be all foggy, and the house would smell so full and rich, you where guaranteed there was a bubbly pot of soup on the range top.
Therefore thinking of this memory made me remember mum's chorizo, lentil and chick pea soup, which I had to make!

What's this got to do with my knee? Nothing but the fact that I can potter in front of the stove and make dinner, spend 4 hours in the garden tilling my ground cover and planting more seeds, and even go do some grocery shopping! Ok, maybe it has a lot do with the knee: the fact that I have the strength and barely no pain to do household duties I think is a pretty good achievement. Kevin is especially pleased over the fact that I am back to cooking (as old fashioned as that sounds!). He quite enjoys coming home and his stay home gimpy wifey has made him antipasto for diner: buffalo mozzarella shreds, prosciutto, drizzled with extra virgin olive oil and basil, and wild mushroom bruschetta served on grilled ciabatta rubbed with garlic and rosemary...oh yea, the girl is back and back in force! 

Anyway, below is the recipe for the soup, which really took an hour tops to make:

Ingredients:

• 4 chorizo (freshly made if possible from your deli) sliced chunky
• olive oil for cooking
• 3-4 garlic cloves (depends how much you like garlic, or if you're using wild garlic) knife smashed then chopped roughly
• 1 medium yellow onion finely sliced
• 2 medium carrots, peeled and roughly chopped
• 2 celery sticks chopped roughly 
• a handful of fresh thyme, leaves picked, or a good sprinkling of dried thyme
• teaspoon of smoked paprika 
• chilli flakes: amount up your discretion but I used about a teaspoon and a half 
• half a cup of red or green lentils (soak first)
• a can of cooked chick peas: the organic brands tend to have less salt
• about a litre and a bit of organic chicken stock (none of that stock powder crap) 
• fresh ground pepper and sea salt to taste 
• fresh basil, hand ripped (more taste is produced with ripping the basil then cutting) 
• crunchy French bread

Prep you food to begin! It's not fun stirring things in the pot and trying to chop at the same time...you are asking for trouble. Prep everything first, put them in bowls in order to cook with, cans opened, etc... makes life easy.
Add a good glug of oil in your usual soup pot: I am in love with my cast iron pot (as seen in the snap above). When ready, add the chorizo and gently brown. Add the onion, garlic, carrots and onion and gently sweat them until soft. Add the herbs, paprika and chilli, and give a good spoon around.
Add the lentils, chick peas, and stock, bring to the boil, then gently simmer with lid on for about 30 minutes, or until the lentils and chick peas are soft. 
When ready for serving, season to taste, serve with the ripped basil on top, drizzle your best extra virgin olive oil over top and serve with some crunchy French bread! 


Super simple, super easy and tasty! Oh, and it totally tastes better the next day.

Chugging along

Yay for the quads finally deciding that its more appropriate to wake up and work, rather than slag off, become depressingly puny looking, then play catch-up. Thank you my little girly muscles for not going into hibernation for too long. On the other hand, am not too impresssed with skin tone:who informed you to become pasty white even for Indian status? Can not wait for striking tan lines I will develop from the brace whilst biking and running outdoors...

As the video says, it has been 3 weeks since surgery. Enter chronic frustration, enter inpatients, enter extreme stubbornness. It's becoming a chore to do my morning stretch followed by a 10 minute (no resistance) bike, afternoon 10 min bike and stretch, evening upper body pilates and resistance band training and guess what, another 10 min bike ride. In between all this I am trying to fit in my research job (emailaholic), which means I sit at the desk at home (the knee still hates driving), however I get so stiff after half an hour I have to get up and stretch. 

The stubbornness likes to rear its ugly head by means of making me think that after a long day I can cook my loving hubby a great meal, which I can time to be ready at the exact moment he walks into the house (thank you mum for teaching me that!), even though it hurts to be standing for too long to cook. I can't help the fact that I enjoy prepping the food, placing them in little bowls for easy access when I "cook" He's working long hours and how can I can not help the fact that I enjoy cooking for him and love the fact that I can greet him with a sloppy kiss and plate of heaven!


I know it may seem like a lot of activity, but it really isn't. It's all low impact, low cardio workout (I don't think my heart rate barely makes 100BBM), and if I don't move, the knee gets stiff and sore. Plus, its so easy to get bored and run out of things to do (I can only watch so many "funny cats" on youtube or check the latest status-update on Facebook), so the next best thing is to kill time with stretching.
The downside; that too gets really boring! Can not wait till I am strong enough to go on flat bike rides outside. A nice slow, meandering ride down Squamish Valley road would be bliss. Take a picnic and my camera, chill out by the river...excellent! 

Though, if you are after some truth, I'd say the real reason for boredom is the fact that rehab is lonely. Doing your exercises at home is lonely because everyone is at work and no one can work with you. 90% of my rehab is completed on my own. And I know I am not the only one who has, or is, going through this exact process and does not feel any different than I do. You see the physio once a week, you may get your other half to help stretch your hip flexors (and I don't mean through sex, although I highly recommend that), you may go for a walk in the grocery store at night to pick up some milk together. But for 8 hours a day, or in my case, 13+ hours for 4 days, you are on your own.

How to resolve, or come close to:
(1) Blast that bloody radio and pump up that bass. 
Do not put on "sad fm" and listen to songs that you know make you cry. I don't know if guys do this, but I am pretty sure girls specifically put on songs that they know have significance to them (e.g listening to Foreigner "I've been waiting for a girl like you" is mine and Kevin's kitchen slow dance song, which always makes me cry with happiness), in order to bring out emotions that have been bottled up since last month, eat chocolate, and drink far too much wine...(not speaking from experience, although the chocolate part is party true). 


(2) Suck it up and shrug off that lonely aching feeling that you are so sure it burning a hole in your stomach (or maybe that's the ulcer you developed from all that drinking and listening to sad music?). Talk it out with yourself and then pick up the phone and call your mum, or your close girlfriend.


(3) Keep and eye on what and how much you eat...
I know that might sound a bit odd, but do you want to suddenly look in the mirror and go, "where did that 4th chin come from?" 


(4) Gloat. Every now and then look in the mirror (just like I did yesterday) and go, "well would you look at that: the jeans pulled out from the drier should be tight, but they are baggy...and I finally fit into my "little bum" lingerie after 3 years of trying to do so! I've lost weight and I look good!" Take that smile you see in the mirror and get on with the day.

Can you tell which knee I had surgery on?!

Gone bruising, gone.

Yup, we still have that nasty bruising on and around the ankle. It's mighty, mighty sore. I can't wear socks higher than my ankle as the weight of a sock brings on too much pain...pathetic right? Maggie the physio is now working on my ankle...we'll leave it at that for now! 

Back to the gloating, I have to cautiously let this out because for once in my life, I am tougher and stronger than some and I am going to quietly use this as my fuel to keep persevering. I was in the unit the last couple of days for research stuff and had a chat to one person who had their meniscus trimmed 7 weeks ago: a much minor surgery compared to ACL, completed via arthroscopy but much quicker post-op turn around. Kevin had his completed a year ago and he was back to work 3 weeks after surgery, you weight bare straight away, no bone drilling, etc...
Anyway, this person, 7 weeks post op can NOT bend their knee, it is extremely swollen, they can not bend to 100 degrees , and they are in considerate amount of pain and walking with a big limp.

Me: I week post op, leg is straight and can bend to 98 degrees. 2 weeks, pain is controlled. Week 3, on my bike. The moral of the story? Be anal with your treatment. be persistent and be strict with yourself because no one is going to be strict to you. You determine your life and what you want from it, and if that means that you work on that knee every day, every 2 hours, you do it. 

I also talked to a couple of other people who had their ACL completed a few years ago. They asked me, "oh, are you waiting for surgery?"
"No, I had it 3 weeks ago"
*look of utter surprise* "you're lying, you look too good, you'r on your feet and your leg is straight! I was in agony for weeks and I still can't bend my leg properly and I had mine done 4 years ago!"
Just give them a light smile Sarah, be polite and say, "well, it's easy to get bored where I live and not much else to do but exercise!" Then walk away with your best non-limp walk, hold your head up high, and do not trip up! 

So when you are having a really shitty day, where the tears come out from no where and you can not stop them, just remember those people who you have met throughout this journey who have been utterly impressed and blown away by your progress, who only wish they had done as you have, blow your nose, wash your face,  and get on with life.

Amen!

Braceorama

We are now patiently waiting the arrival of my new slick, black, carbon fibre 'Ossur' brace that should be ready for pick up in 2 weeks time. I decided to go for a black brace as mum had the great idea of placing an NZ fern or koru design on it. The finish is quite glossy so we won't be able to spray paint it, however, I think I will ask my kiwi mates to kindly send me some water proof koru designs and decorate it with them. Then when I am running it will look pretty darn cute! 

New physio update: knee flexion is at 125 degrees, whoopee! We had to drive into town today for the brace fitting and to get Kevin's truck fixed, therefore we both drove separately and dropped off the truck. My knee was not impressed with sitting for an hour driving...sorry knee. It would behave perfectly fine, just feeling "full" in the joint, then BAM! As though some sneaky invisible person stabbed me with an invisible ice pick right into the outer part of the knee 5 times. Kind of like that scene from Psycho in the shower with the stabbing music, it was just like that. Of course, I'm humming away to the radio, blisfully aware of what lies ahead and out of now where...stab, stab, stab! the fright I get and the amount of swear words that somehow mash into one really long word makes for a very interesting car ride. Thankfully Kevin is not in the car with me otherwise a conversation would go like this:

"oh look at that lovely rainbow, I really like driving here its so COCKSUCKERMOTHERF****HOLYS***CHOPMY F*******KNEEOFFNOW pretty and nice...dude my knee really hurts"
Ah, yes, even this sweet girl who blushes at the thought of a swear word, will on the odd occasion yell them out loud and clear if in pain and alone....
 

Get on yer bike

That's right, I'm pedalling and boy does it feel good! 
We did some spring cleaning to make room for the indoor bike trainer as well as clear some stuff out as ever since I moved into the shack I was rather unimpressed over the fact that we could not get into the breakfast nook and open those blinds! I love light streaming in, especially when you're cooking up a storm on a grey dull day, but yet you can look outside and see the beautiful trees on your property. When you're stuck indoors and can't reach potential sun shinning, blind opening windows that you know will assist in brightening up your day, it's quite dreary. 
So, we cleared out some space, open the blinds, and instantly I'm "Super Bubbly Woman!" 

I got to tell you, jumping on that bike and slowly pedalling with no resistance fell so good. Instantly the knee joint relaxes and opens up and the sharp stabbing pain I have hitting the inner part of the knee disappears.

Well aren't I moving quick!

Benefits of stationary biking post ACL reconstruction

* increase or restore knee joint range of movement
* increase or restore knee joint stability
* increase or restore the strength of muscles around the knee
* decrease pain

In comparison with other exercises cycling is a relatively ‘knee friendly’ activity that can help to improve knee joint mobility and stability. Cycling is frequently used as a rehabilitation exercise modality after knee injury or surgery as well as part of the management of chronic degenerative conditions such as osteoarthritis. 

Why is the bike so good?

*non weight bearing

*low impact

* uses a range of motion that is needed for most daily activities

* controlled movement

*variable resistance

* cyclic movement nourishes joint cartilage 

So, get on your bike! 

Core Strength

Hey there,
Well I had to upload these 2 videos to show what I have using (as well as alternating with other online videos) to stretch my way through this journey. Within one week I can just about touch my head to my knee on my right side, which is such a massive change as the hamstrings and calf muscles are super tight. Poor Maggie has quite the effort trying to slowly ease through the multiple knots I have, ranging from the arch of my foot, to my bum, as for the last 4 months the leg has been guarding the knee. 
So I found that once I slowly stretched the legs and hips out, I am no longer waking with a limp and feel a little more aligned. I am so happy to see my usual flexibility coming back and am enjoying that not only am I strengthening the thigh muscles (the right one now fully contracts!), but I am working out the arms and core, as being a girl, I am petrified about the fact that I could so easily put on weight...bad huh?! I'm not going to let those abs waste away! I've had them since I was 15 and they are not going away unless I get preggies....and even after that the suckers will return!

Therefore, I thoroughly recommend these and the other Winsor Pilates. Yes, the old lady is looking a bit plastic in the face but I need to work on strengthening the core and apparently there is research out there combining core strength to ACL. For example, "the shift in hip range of motion towards internal rotation combined with the hip abductor imbalance may be associated with a position of ACL risk with internally rotated hips and valgus knees in female soccer players. Limitations in hip and core strength and range of motion may play a role in the disparity between the male and female rate of ACL injury." (Int J Sports Med 2009; 30(9))

Females are especially prone to ACL tear, mainly due to the fact that they are more lax than compared to men...and also because we are more hardcore...

2 weeks post-op update

 So for the first time in a very long time (as in months) I was almost too busy to blog. Physiotherapy and research work is ramping up, plus the fact that I am not sleeping well makes me seek a nap during the day. My mind is fairly clear although I seriously support the fact that lack of stimulation from other humans, animals, or society in general greatly reduces your ability to think, process thoughts quickly, and react accordingly to sudden changes in life...The way I react these days (for example, when I found out that the hospital pay roll department where not taking enough tax off my earnings), is to cry. 
I Bawl my friggen eyes out and loudly proclaim, "that's it! I hate this stupid country, you have not given me a single break for the last 4 months, I'm running away to the North Pole" Meanwhile Kevin is giving me that pity look that I have become so used to these last few months, and gently reminded me why I can not do that.
 Regardless of my regular brain farts I seem to be plodding forward with regular achievements noted in the last week. I had my 2 weeks post-op follow up appointment with Dr. Zarkadas on Tuesday. My aim was to be able to confidently walk into his clinic room without the use of a crutch and 'wow' him. I think I did that, although bearing the fact that he was running an hour behind schedule, briefly saw me for 10 minutes and did the usual surgeon examination (quick touch, poke, tweak, and nod), I'm still unsure as to what he thought of me and my success!


Here's how the conversation went:
"how are you? you look good, you're walking, that's nice"
"yes, well I've been doing this and that and working out...(enter the usual Sarah blabber that usually goes off in a tangent) 
"oh, I guess we should examine the knee...whopps, sorry for almost kicking you in the knee"
"I see it's straight. Good job"
"oh yes, I've been working on that every day and it's been very difficult but I know how important it is...bla, bla, bla"
"(grunt) yes this moves very well. Good flexion (nod of approval)"
"hey, what did you do to my ankle? It's very bruised and not swollen...where you holding my ankle in the OR?"
"Oh..yea...sorry...you're kind of small (laugh), I think I was maybe leaning on it, or held it at some time...anyway, don't trip up!"
"can I drive?"
"if you feel safe then sure! If I was you I probably wouldn't listen to the doctor and drive anyway (laugh)"


Thanks doc for giving me a bruised ankle that is not directly linked to the actual surgical procedure! 
He briefly explained how he strips the tendons out of the hamstring, braids them on a sterile table and then drills right through my knee, pulls through a guide wire that is attached to the new graft, puts a metal plug at the top of the knee joint (in the femur), and screws in at the bottom of the joint (at the tibia), pulls firmly, and then does whatever surgeons do! 


The next step is to go into the sports medicine clinic next Tuesday to have my brace custom fitted. This is going to be rather interesting as they first place my knee in a cast, and from that skeleton they design the brace. It's going to cost approx $1400 (thank god for health insurance), and should take about a week to be built.

Prior to surgery I did ask him reasons for getting the brace vs. not, benefits of use for the first 3-4 months, would it be used post full recovery (as in a year later), and how adaptable it is for my 3 main sports, as they all require completely different body movements (trail running, skiing, and rock climbing). 

The literature out there states that it is recommended to have a brace for the first 3-4 months post ACL reconstruction as it generally takes 10 weeks for the graft to fully attach and become incorporated to the surrounding bone. However, there is a major psychological theme associated with the use of a brace, as in, I feel safe if I wear my brace. There are many people (Paolo, for example) who have gone through ACL rehab without the use of a brace and have been able to adequately support their knee by completing careful movements and have never had any repercussions. The research is very grey: although there is support for a brace within 3-4 months post surgery, it does come down to a combined physician, patient, and physiotherapy decision, bearing in mind if the patient would physically benefit from it, rather than psychologically. 
To be honest, from a physicians point of view they are going to say, "yes, get the brace" as many of them receive discounts from the company they chose to deal with, if they sell a certain amount.


My decision for getting the brace: so I can comfortably start back at the gym and increase my outdoor activities. Yes, for me I think there is a psychological pull as the thought of it makes me feel safe. And I am ok with the fact that I could do this without the brace, but I don't trust myself as I am very prone to tripping up on regular basis! It is a difficult choice as the research doesn't sway more to one side than the other, so in the end, it's up to the patient's decision, which should not be manipulated by a surgeon's preference. 

What the brace may look at: carbon fibre CTI OTS!

The next question burning through my mind was, "am I going to need this in a years time?" It it worth spending so much money for only a 4 month maximum use? 
Because I have a bit of thing for the terrain park, there is evidence to support the use of the brace when skiing, even after a year or 2 post surgery. In saying that, again the psychological aspect kicks in, as by that time I don't need a brace as the graft if fully healed, and just as strong as my original ACL. So am I keeping it on because it feels safe? 

I looked up many websites of professional skiing athletes who have gone through this process and noticed the majority of them still wore their brace when competing. Obviously, they are engaging their muscles and body in a very vigorous way, where as I won't be doing the same, but it was interesting to note that they still recommended wearing the support. One interesting thing to note is that it is well documented that by having arthroscopic surgery it can increase your chance of arthritis in the knee by 40%, so are these long term athletes suffering from arthritis pain, therefore using the brace for that? 


In the end I think for me it's going to be a matter of ' see how you feel and how much it hurts' basis. Simple but probably the most effective method for me! 


The next day I met up with Maggie (physio) for my weekly update, measurement, and plan of attack. Good news: I can flex to 110 degrees, which means I have graduated to the level of "hop on yer bike" 
So this weekend we will set up the indoor bike trainer and the first movement will be those half-moon pedal strokes, for about 5 minutes, no resistance. 
Enter photos:

2 weeks post op: very minimum swelling and reduction of bruising

Massive reduction in bruising!

And then we bend some more!

 As you can see the bruising has totally reduced, however there is still that nasty shadowing on the ankle. Honestly, if anything touches it, the pain is worse than my knee pain, it's ridiculous. The ankle pain along with a right hip protruding forward is making my nights a living hell. Sleep is again becoming rather difficult so it looks like I might have to go back on the hydromorphone overnight to assist in reducing the pain and therefore, allowing me to sleep. No matter what angle I am on I am never comfortable. 
The acute phase of pain seems to be almost over; now it's just the throbbing background pain that seems to be taking over. 


So, the overall rehab picture at 2 weeks post-op:


Movement/physiotherapy
0 degree extension (flat)
5 degree hyperflexion
110 degree knee flexion

• 20 minute all body pilates morning workout
• 20 minutes upper body pilates workout, around 3pm
• Continuing with calf/hamstring stretch with yoga strap on foot
• quad/hip flexor off end of bed
• quad sets (without stimulation)
• heel slides
• wall (or floor) ball rolling exercises 

Pain management:

• cryocuff or ice pack every 4 hours for 20 minutes (good evidence to support using the cryocuff for up to 4 weeks post-op)
• Tylenol extra strength for muscle and joint pain (650mg per tab), 1 tab every 4 hours
• Advil (Ibuprofen) 400mg per tab, 1 every 4 hours. Alternating hours with Tylenol which means I am taking some form of pain relief every 2 hours. 

Kevin has been making sure that everyday when he gets back from work he takes me outside for a little adventure. Whether this is going to the supermarket, going down to the river for a short walk, or to the wetlands to sit and look up at the Chief, it means that I am able to venture outside the block and get some fresh air in. He is amazing and I think this whole journey would be even more harder if I didn't have him...

To end, I would like to say that we have unofficially adopted 2 ducks! Looks like the big dip in the backyard is a make-shift pond post torrential rainfall and it seems we have some visitors! I have named them Basil and Gertrude.   

Basil!

Gertrude!

Where our future home is supposed to sit has now become a wetlands tour stop for ducks...



Next adventure: indoor bike trainer!!