First year, ACL Recovery

Better late than never

Two and a half months late, really.   So this is, in fact, a 14.5 month report.

And yes, yes, I know.  I’ve been neglectful.  I have commited the cardinal sin of blogging:   I haven’t posted for a long, long time.

It’s not that I haven’t been meaning to.  I have.  Really.  Every weekend I think I’ll get up early and write the next installment of this ACL saga.   I have had the desire.  And I’ve had the will, too.  What I didn’t have was something definite to write, good, bad or indifferent.  But I think that has finally changed. Ladies and gentleman, I give you. . .

. . .the (Mostly) Recovered Knee

For the first time in a good long while, I’ve begun to think my knee will make it back to karate.  Oh, it’s been to class a couple of times, sure.  But even a year after surgery it just wasn’t performing that well and wouldn’t extend fully, throwing off my kicks at the start and at the finish. Plus, it would start hurting fairly frequently.   The pain around the harvest area — that tendinits/bursitis — had been dogging me since the surgery.    Until recently.

Now, I’m not saying that I’m 100 percent yet.  Extension still isn’t perfect, and I can feel the knee dancing on the edge tendinitis during certain exercies.  But I have learned a few dos and don’ts that seem to be making a big, big difference:

1. Avoid leg presses.  At least for now, they seem to really irritate the tendinits.
2. Avoid certain stretches.  These include splits and others that stretch out the inside of the leg.
3. Don’t juggle a soccer ball on a hard floor.   While this one seems pretty obivous, juggling on a grassy field seems to be perfectly fine.
4. Heel slides.  Do your heel slides.  Remember them from just before and after surgery?  Well, now I know the importance of this exercise. It’s quite remarkable, but the more I do these, the better my knee feels.  It’s almost a miracle cure.

‘Sweeping’ changes

Over the past few weeks, I’d been feeling more and more hopeful about the knee.  But last Sunday, I executed a sweep that I could not have done just last month. The sweep is part of our first knife kata. Starting with the left knee up and the right knee down, the right leg sweeps out across the front while the left takes on the kneel.

I’ve avoided doing this move since the surgery.  But there I was on Sunday in the kneel just before the sweep and, well, there it was.  I knew I could do it and I did. After all this long time, it was a wonderful moment.

And now for the shoulder

Now that the knee is getting better, it’s on to the shoulder, which has never recovered from my overly eager attempt at swimming.  I have trouble reaching above my head or extending my arm forward and rotating wrist (which sometimes makes driving a car a pain).  At times it has even bothered my sleep.  Rehab exercises helped only intermittantly, and the doctor started to think there might be some torn cartilage.  An MRI showed only low-grade tendon tears in the rotator cuff, so surgery is not needed (thankfully).  But it does mean months of more physical therapy and lots of specific weight-lifting exercises.  Who knows, but by the end of this I might have a working shoulder and a fair amount of muscle.

Yeah, but what about the karate?

For the time being, I’m easing my way back into karate,  going twice a week with limits on what I can do.  No sparring.  No mat work.  No overhead blocks or strikes.  Basically, I’ve been working on getting my kicks back in shape and doing lots of one-armed kata.

It’s kind of fun and challenging doing the kata this way.  Except for niage/naihanchi kata.  Trying to do those one-armed is just plain weird.   I think this is because they are the first katas to have a good number of asymmetrical strikes where both hands are working together, but not in straight counterbalance.  It’s as if the brain views them as one strike together and so has trouble figuring out which part the good hand should be doing.  It’s absurdly frustrating at times.

In fact, frustration has been my main emotion in regard to karate over the past few months.   But I am indeed returning to my early hopefulness.  With any luck, I’ll be back at karate full scale by the end of the summer.

Cross those fingers.

Knee Report – Doctor Visit

The pes anserine bursa under the hamstring tendons and right below harvest scar.

 

Bursitis.

Pes anserine bursitis, to be specific. At least, that’s what the doctor thinks.

The theory is that scar tissure around the harvest area is irritating the pes anserine bursa and causing my pain.  In many ways, this makes sense. It’s a common enough ailment among healthy knees, and any one of the things associated with the surgery could haved caused it in my case. 

For treatment, the doctor suggested a shot of cortisone.  And  when he administered it, he had trouble getting the needle in and then injecting the cortisone in and around the bursa.   A pretty clear sign of some tough scar tissue.

At the very least, the cortisone will reduce the pain in the short run and likely reduce the internal scarring as well. But there are no guarantees. I don’t think we’ll know for sure for another couple of months. More suspense.

For good measure

I also got another cortisone shot in the shoulder. This was my second since my ill-fated attempt to try swimming as a way to stay in shape. The first shot seemed to do wonders, and I had no troubles with my shoulder until I got the flu a couple of weeks ago.  It got into my joints, which all began to ache, and I guess the area around my rotator cuff got irritated enough to stay angry beyond the illness.  Oh, joy. 

Starting over

My next karate class is just a couple of days before I hit a full 4 weeks off from exercise.  If the knee feels better, I’ll go.  But I’m thinking that this time I really need to slow down and kind of start over.   Go through the basic katas and movements only as a way to recondition my legs.  

At my school, blue belts are often called “black and blue belts” for their penchant for finally hitting targets with good power, but less than stellar control.    They also tend to have knee pain, which I believe is because,  at this point in the training, your body is working to keep up with all the stuff it’s being asked to do.  The knees are bearing the brunt of this, and I think they’re adjusting and even reworking themselves.   

This was echoed by another doctor for a follow-up of a study of ACL injuries I’ve participted in.   He said that my body is likely still “learning” the new knee — the one with new scars and fewer tendonous material.  He seemed to think that it will ultimately make the necessary adjustments, but that it could take awhile.  

I hope he’s right.

1-year Anniversary

Somehow it went fast, this year since I tore my ACL.  And yet, it seems like I should be further along in my return to sport.

True, I’ve been going to karate about once or twice a week.  And I’ve been going through kata on off days and lifting weights/doing balance work as well.  But  I haven’t really and truly gotten back to karate. 

Angry knee

I’ve continuted to have pain near the harvest area and also near that scope hole that swelled up a few weeks after surgery.   So, as I passed 10 months post surgery, I decided I needed to do something.   And nothing.

About two and a half weeks ago, I went to a karate class where we did nothing but what we call “blocking kata” the whole session.    Afterwards I was worn out  But it’d been fun.  My advances in front stance left a lot to be desired, but I had some modicum of flow at times, which left me optimistic.    The worst part was realizing how soft the soles of my feet had become.  

Two days later, though, I did leg weights and squats on the balance board, and afterward my knee was angry.  Very angry.   This is third time since late December that I’ve felt this kind of pain, and I’d had enough of it.

Rest

I decided to make an appointment with the doctor and take time off, perhaps a month or so. No karate, no weights, no balance work, no soccer with my son.  

One part of me thinks that I’ve developed a tendonitis around the tendon harvest area and that I just need to rest.  Another part of is worried that it’s a bit more serious, though the graft itself is definitely strong.

I’ve been ‘off’ the knee for two and a half weeks today.   The good news is my knee doesn’t hurt.  But it is tight, and I get the feeling that if I were to start working it out, it might hurt again.  

My appointment with the doctor is this coming Friday.  Crossing fingers that all I need is rest.  But if it is more serious, I’m hoping it’s something that can be fixed.

Month 9, ACL Recovery

My knee has a lot to say

My knee continues to talk to me, especially when I’m exercising. It chatters almost constantly I as go through my moves and get down into in my stances. Sometimes it grunts, and occasionally it just says no. With one exception, it hasn’t really screamed at me, nor has it cursed. But one thing’s for sure, it’s a real complainer, my knee.

It’s also a moody little fellow who frequently contradicts himself. For a couple of weeks now, I’ve been meaning to write an update but haven’t been able to get a coherent message out of him. So I guess that’s the message. Some days I feel better and some days worse.

An example

Just this past Sunday, my knee felt great. I was going upstairs with barely a twinge, kicking a soccer ball with my son outside, and even feeling pretty good going through my kata. My knee wasn’t completely quiet, but it was murmuring more than anything else.

Then I went to the gym on Monday. After I lifted weights I kicked a soccer ball around on the basketball court with my son for about 20 minutes or so. I stretched, iced my knee as we ate lunch a little while later, and took my ibuprophen as usually.

I woke up the next day with a very disgruntled knee. Complaining turned to shouting at times, and I felt pain even just sitting around.

The day after that was markedly better, but it was no where near how it had been before the trip to gym. I went to karate, hoping for the best, but the knee was not happy and told me so. I had to sit down a little early and ice my knee for the last 15 minutes of the class.

The good news

Even with the pain on Tuesday and the discomfort in class on Wednesday, Thursday was much better. I lifted weights again on Friday, and this morning the knee is fairly quiet.

I can’t wait for the day when the knee stays relatively quiet. I haven’t really tested it yet today, but I know that day is not today. Still, this rotten week seems to be ending on a high note, so I’m giving the knee a well deserved day of rest and, hopefully, silence. Tomorrow though, it’s back to karate class for a measured open workout.

Yes, no, maybe

Overall, I feel pretty certain that things are improving. Of course, I want them to improve faster, and I worry that I won’t ever get where I want to be. It’s hard to remember pain precisely, which makes comparing today with a few weeks ago almost impossible. You ask yourself, “Did it feel quite worse the last time I did this move?” The answer is rarely a definitive “Yes!” It’s rarely a “No!” though. It’s almost always, “Maybe.”

And that’s nine months for me, a solid, frustrating, but hopeful “Maybe.”

Little things mean a lot

Earlier this week I had to get up and perform a couple of katas. Neither went especially well, but that I’m doing them at all is still a wonderful thing. Part of it is being out of practice. Another part is not being used to being up in front of people anymore. And, of course, part of it is that my knee still isn’t perfect.

For awhile I’ve noticed that kicks with my left leg (the injured one) feel funny, like they have no “finish” to them. In contrast, my right -leg kicks feel pretty sharp, even though I’m planting and rotating on the injured leg.

I’d figured that, in most cases, the remaining soreness and swelling in the injured leg was keeping me from snapping into full extension and giving me strong, sharp finishes.

But yesterday, as we were practicing kicks with a bag, a lower belt pointed out to me that I was not turning my left foot forward when initiating my kicks with that leg. Because of this, I was bringing my knee up and around a bit instead of straight up, which was throwing me off balance.

And why was I not turning my foot forward properly? Well, because it doesn’t feel great to do it. It doesn’t exactly hurt, but my leg just kind of balks at doing it. I can override the balk, but it takes some thought and slows the kicks down.

In some ways, it’s a small thing. But it has large consequences. And I think I’ll be facing many such niceties as I get deeper into my return.

Scene of the crime

One quick happy note is that I also went through my self defenses with partners for the first time since hurting myself.

Most of them went pretty poorly for a brown belt. Ironically — and most happily — the best of the night was the very technique I injured my knee doing. I’m still going to be nervous about it, I think. But my first visit to the scene of the crime — my first time back on the horse — went well. And I took the opportunity to celebrate and crow about it immediately afterward.

Front Stance – ACL recovery

• Horse stance? Not bad.
• Cat stance? Right as rain.
• X stance? Feels fine.
• Fight stance? Tiring but solid.
• Front stance? Hmmm.

All through my recovery I’ve had no illusions that there would be a number of things that I wouldn’t be able to do for at least awhile. That sweep at the end of one of our knife katas, for instance, where we switch from one knee to the other. That one’s a real stumper for me these days and will probably remain that way well into next year.

What’s weird with the front stance is that it seems so easy. At least it’s easy to get down into one. It’s moving in one that is giving me fits. It’s not that it hurts, really. And the knee remains very stable. It’s more that my injured leg isn’t comfortable being in front, both when it needs to stop my momentum and when it needs to push off to get me moving again.

When I do single-person kata and I’m in control of the pace, it’s not that big a deal. But during two-person katas, when I have to keep up with someone else, it falls apart. I find myself either pulling my legs forward unthinkingly or having to gather my thoughts entirely and unnaturally around my knee. The good news is that whether I think about it or not, the knee can take moving at a pretty decent pace. It’s just very awkward.

For the time being, I think this is what the post-surgery, early-return phase looks like. Most things working well, with a few holdouts. A time of optimism and patience.

A promising start

My first “official” class back at karate with no limitations was essentially Niage (Naihanchi/Tekki) Night for me.   My highest is Niage 3, of which learned half (the upper half) while still in recovery.  My job was to learn  the footwork and start integrating it with my handwork. The good news is that knee seems to hold up quite well to moving repeatedly in and out of horse stance (thankfully there’s almost no pivoting in these katas).  

The not so good news — and I’ve faced this problem before – is that it’s not so easy to reverse engineer (so to speak) a kata or technique once you’ve learned to do it a certain way.  In this particular case, I had trouble pausing techniques and timing my breath when making lateral transitions, because, for me,  the handwork was just one big series that I could break up as I saw fit.  Once the footwork was added, the different series became clear; I just couldn’t get myself to do them without some of them blending together.  And, of course, we all know how catching yourself screwing up just throws you off more. 

I also found that I’d typically forgotten a couple of techniques in my other advanced kata.  I thought I’d remembered the katas pretty clearly.  So much for my memory.  Most often, what I was missing would come back quickly when pointed out, but in one or two cases I had almost no memory of learning them.   Shows what seven and half months off can do to someone at my level.

Getting back to the knee, the only time I felt any pain was during some of stretches that I hadn’t done for a while.  I laid off when it didn’t feel good.   I had on my soft brace with the donut pad around the patella, which helped immensely with kneeling but also dulled my connection to my knee and left me constant unease about its status.  Yet, when I took the brace off at the end of class, everything looked fine.  I iced the knee and took some ibuprophen, and it’s felt quite good since.   

Crossing fingers and knocking on wood, it was a good start.

Clearance!

It’s official.  On October 9, I got clearance from the surgeon to “return to sport.”

And I have. Sort of.

You see, I haven’t actually been to back to a karate class since seeing the surgeon. But I haven’t been neglecting my practice, either. During my regular visits to the gym, I’ve been doing some stance and movement work, a few kicks, and yesterday I went through all (or nearly all) of my non-partner kata.

The knee is holding up pretty dang well. Some of the muscles around the knee let me know about it later (even now, I’m still icing it regularly), but while I’m warmed up it feels reassuringly strong. I won’t say that I haven’t lost a step. I definitely have. But that’s not really a bad thing for me. I’ve needed to slow down, I think.  I now have the excuse I needed to get myself to go slow. So far, I find that I’m enjoying feeling things out and noticing what feels right.

Last appointment

My last appointment was fairly uneventful. The surgeon asked me a few questions, lightly examined the injured knee, tested both knees with the arthrometer, and, after determining they have the same play, pronounced me able to start back at karate. He doesn’t see why I should avoid any pivoting motions, nor did he recommend using a brace. And based on how things have gone so far, I’ll probably only wear my old soft brace for compression and leave off the supports.

While I was there I asked him about my shoulder. He did a couple of physical tests, stated that I probably made my rotator cuff “angry,” and gave me a cortisone shot. It feels so much better, but for the next six weeks I have to refrain from doing any heavy lifting over my head.

Next class

My next class is this coming Tuesday. I’ll not miss it, and I’ll report on how it went afterwards.

In the meantime, I’m lifting weights for my knee and shoulder, doing some balance work, and grooving on the bongo board whenever I can.

Minus Two Weeks

It’s just a couple of weeks until my 6-month post-op with my surgeon. I’m guessing that this will be a mostly pro forma session. Of course, I’ll have some question about what to expect from here on out. But really my recovery seems right on schedule, and I don’t expect any surprises.

My Knee: the good, the great, and the strange

Near the end of my “six-month recovery period,” the only thing I wish were better are the muscles and tendons around my graft incision. They’re strong, but they tire out very easily and feel tight and “twingy.” The knee itself is very noisy and is nowhere near as readily flexible as the other.

The great part is that the joint is rock solid. There’s no bouncing or ‘tricking’. I can go up stairs two at time at pretty quick clip and change directions at an easy run almost without thinking. I can get down fairly low in all my karate stances, and when warmed up can even kneel comfortably (though getting back up can be a slow and arduous process).

The strange thing is that, in some ways, my injured leg is stronger, has better balance, and can extend higher than my good leg. And I mean a lot higher. My left front kick now reaches up a good 8+ inches higher than my right. It kind of blows my mind how easily it does it. Gotta be all that extra stretching since March. A bonus, no doubt, even if hard won.

My Shoulder: the bad, the good, and the strange

The last time I did an in-depth update I was making good progress swimming. Well, that’s on hold, because a number of weeks ago I strained my shoulder enough to make swimiing impossible and some of my karate difficult. I may have to drop lap swimming altogether.

The good news is that, after a couple of weeks of resting and several more of some targeted weightlifting, the pain is now limited to occasional twinges. I’ve never really liked weightlifting but I’ve come around to its great benefits beyond body-building for its own sake. I’m not out of the woods yet here, but I’m definitely beter than I was.

The strange here is that the swimming may not be to blame. Because of my knee, I’ve been going through my Niage (Naihanchi/Tekki) handwork in a high stance. When my shoulder started hurting, doing some of the in-to-out strikes became nearly impossible. However, when I got well enough to practice in a good, deep horse stance, the pain all but disappeared. Maybe swimming was the original cause, but it is possible that high stances aren’t great for certain kinds of techniques. Yet another reason to stay low.

Staying the course

Aside from adding weightlifting for my shoulder, I’m still doing pretty much the same exercises several times a week, with more weight or for longer periods. The best new thing I’ve started doing is squats on the Bongo-Board at my gym. Bong-boarding is simply just fun and does the same things as the balance board, only better. Since I’m not likely to build one at home, I’ve put it on my wish list for impending birthday.

Until my appointment with the surgeon I’m back to karate once a week. There are still many things I won’t do. But there’s still plenty to do, and I left my last class with a worn-out but happy knee and a nicely sopping gi. Bliss.

ACL Poll – First Physical Therapy Appt.