Saturday, December 29, 2007

Bending The Knee

One of the most confounding things about recovering from ACL surgery is how difficult some very simple actions become.

Take, for instance, jumping and bending the knee.

I anticipated that it would be hard for me to bend my leg in the first few weeks after surgery. (It's shocking how much enthusiasm the physical therapists, who in my clinic all seemed like the girl next door, put into bending my leg to its extremely painful limit!)

However, I didn't anticipate that, a few months later, it would be difficult to support my body weight while bending my knee. Even just a little bit.

One of the first ways you notice this is how difficult it is to descend a stairway in normal, "reciprocal" fashion (right leg goes down a step, then left leg). This is something you feel long after you've begun walking again without a brace.

One of the exercises my physical therapists gave me later in my five months with them was to stand on a step or platform, weight on the recovering leg, and simply bend the knee enough that your other heel touches the ground. It's almost embarrassing how difficult it is to accomplish. As the exercise progresses, the therapist raises the platform higher.

Now, I don't know if this diffculty is unique to having gotten a patellar-tendon graft, rather than an allograft or hamstring graft. But I have a feeling it affects all types of ACL surgeries to some degree.

The most frightening thing my therapists asked me to do is to jump a couple of inches off a platform and land on my recovering leg. (This is clearly an advanced level of PT.) My therapists said it's very common for people to feel afraid about this. For one thing, before surgery, if you jumped and landed on your knee, you would collapse painfully because your knee was unstable. For another, you've just been through the most painful period in your life, centered on this knee--so you're very protective of it. Here again, part of the issue is you need to bend your knee to absorb the shock when you land, and that's hard to do.

I got my surgery in late March, and today I'm walking stairs reciprocally without limping or needing to hold onto a rail. But truth be told--this speaks to Michele's point about it taking up to a year to get your strength back--I still feel a little weaker in my left knee walking down stairs.


Blackbeltmama said...

At PT on Friday, I was told that going up the stairs puts 7x the amount of pressure on your knee. Going down puts 14x the amount of pressure, so your apprehension is understandable.

Getting leg strength back is one thing and I'm working very hard right now to get mine back so I can get rid of the crutches. But the other aspect is purely psychological, and I honestly think that may be the bigger of the challenges (at least for me). Your description of jumping and landing on that leg makes me squirm just thinking about it. I imagine it will be a while before I'm asked to do that. Hopefully by then, I'll be able to run and can get away before they make me. ;-)

BobSpar said...

Lol, good plan, BBM!

Michele said...

I was surprised how difficult stairs were to navigate. I definitely had more trouble going down stairs. When I was just out of the post-op brace, I remember approaching a curb. It was a normal curb about 6-8 inches high. I stood at the curb for a good 30 seconds. I wanted to step off the curb with my "good knee" leaving my new ACL on top of the curb. I could not do it! I may as well have been standing on a cliff because I was not moving off the curb. It was at that moment that I realized how challinging stairs/steps were going to be.

I am still working on the excercise with the platform. It is extremely difficult. I dug a Jane Fonda step aerobic step out of the attic and work on this excercise daily. I am hoping this excercise will improve my stair climbing ability and my cat stance!