Week 10, ACL Recovery

It looks like I am way overdue for a progress report. But a slowdown in PT visits and a scheduling snafu left me without any good numbers to share for the last three weeks.

I’ve cut back physical therapy to every 14 days.  I’m still going to the gym every day or every other day, using the weight and aerobic machines and doing my balance exercises. I haven’t changed much on the aerobic machines, staying on them only about 10 minutes and rotating through the bike, elliptical, and step by days. I have been steadily adding weight on the abduction, adduction, leg press, and hamstring exercises. Too much so, possibly. I’ve had some hamstring soreness, and my PT has warned me about developing tendonitis, which is apparently very common with the hamstring graft. So, I’m going to back off for a bit on the weights and maybe not squat so low on some of my balance work.

Swimming

I’m still not allowed to run, which is not a big deal for me because I’ve never really liked it that much. But I have started swimming, which is a very big deal because I always thought I disliked it even more. Now, however, I think I like swimming more than just about anything except karate.

I’ve actually been thinking about starting to swim for a long, long time, mainly because the worst part of my karate is my breathing. And what is swimming if not controlled breathing? The benefit seemed obvious, but my last few attempts to swim always ended me gasping like a fish on a sidewalk before finishing even just one (olympic-sized) length. With my knee injured, the challenge, the benefits, the opportunity, and even the necessity of swimming all came together to push me into action. Right now, I’m just doing the crawl, using only my arms, and am focusing on form and breathing (and not drowning). By taking numerous breaks during each session, I’ve been able to go from 1/6 mile to just over 1/4 mile in less than 2 weeks. I’m still sucking in water pretty frequently and feeling that momentary panic, but my overall sensations are of focus, peace, luxury(!), and accomplishment. It’s pretty cool and I’m hoping that it improves my karate when I return.

A fist away

A couple weeks ago, I started using a new measurement for flexion. I found that after exercising and stretching, I could get my heel with a fist of my butt (using the atomic wedgie method). Who needs degrees when you can measure progress in digits? Right now, I can get to within three fingers, after warming up.

Goodbye Pacino?

Well, it’s too early to say goodbye to Pacino. Really, he won’t ever be gone. But he has diminished a great deal recently (though a good shave would bring him back to the fore). The swelling around my knee still ebbs and flows, but it is down significantly, and my kneecap is starting to be its old protruding self again. Especially noticeable is how much that “bursitis” on Pacino’s right “eye” has gone down. At my last visit, I asked the surgeon about it. His explanation was that the scope hole was larger lower down than the visible scar implies and that sometimes (maybe when the patient aggravates it by nearly falling of his bike) that part takes longer to heal. He recommened wearing a compression brace, which I think has made a big difference.

Week 10 Benchmarks

Exercises

  • Aerobics: Stationary bike, or Elliptical, or Step Machine, 10 minutes.  Swimming, 1/4 mile.
  • Weight machines: Abductor, Adductor, Leg Press all at about 100lbs. (up 50lbs. from week 4) and Hamstring curls at 17.5lbs. (up 15lbs. from week 4).  Each about 2 sets of 10-15 reps.
  • Balance board squats while moving a 4lb. ball side to side, 10-15 reps balancing side to side and 10 front to back.
  • Balance on one leg standing on blue TheraBand pad doing star drills and, starting day 68 leaning forward and touching the ground with each hand. (My injured leg is actually better at this in than my good leg now).
  • Lunges on the squishy half-circle Bosu ball, about 25 each leg.
  • Stretches!

Flexion

  • 143 degrees flexion (passive) day 68 (compared to about 148 on the uninjured leg!).   I could only get to 125 degrees just using the muscles of the leg itself.

Walking/Navigating Stairs

  • No brace with metal support (except when lifting a heavy object) but wearing a soft brace for compression.
  • Ascending/descending stairs is not a problem.  Can even ascend two steps at a time, but wisdom typically prevents me from doing so.

Swelling

  • Generaly, the swelling is about 5 millimeters above my good leg.  Much improved.
  • R.I.C.E. – Not resting too much, these days.  Icing at night and if swelling merits. I’m wearing a neoprene ACE brace for compression almost all the time.  And just for good measure, I’m still elevating when sleeping.   

Karate

  • Trying to do some kata in my head every day.
  • Using flash cards to keep sharp on what our techniques are.  (I’m supposed to know 15 punching combinations, 15 one-step (block/evade and counter) combinations, 15 self-defense moves, and 15 knife defenses in addition to 16 katas and a good number of kicks.  They can get kind of confused if you don’t constantly do them or think about doing them.)
  • Learned first half of handwork for our third Niage (Naihanchi/Tekki) when stopping by karate class for a visit :-)

Tiger Woods ACL

I was at the gym during lunch going through my exercises when I saw the news that Tiger Woods will be having surgery to reconstruct his ACL.    It was difficult to watch videos of him limping around and to think about all that rotation and torque his knees go through in every long-shot swing.  At first I was confused, because just this past weekend, I’d read he’d recently had surgery to clean up some cartilage in his knee and there was no mention of the ACL.  

According to his official website, he tore it last fall while running and waited to get surgery.   The article also said he’s suffering from stress fractures brought on by rehabilitation following the surgery to repair the cartilage damage that had “developed as a result of the ACL injury.”  Can we say repeated subluxations? 

Now, I don’t want to fault him.  I know why he waited.  He’s a great competitor, and I wish him a speedy, painless return to play.  Gosh knows he deserves it.  But I think it’s a good lesson for anyone facing a possible or diagnosed ACL injury and who wants to continue their sport.   Think seriously, and think quickly, about getting your ACL fixed, so you don’t risk ripping your knees and legs apart. 

Kick the can

One of my physical therapy assistants likes to entertain her clients (and herself) by picking on them, lightheartedly cajoling them during their exercises or pretending that her tasks are overly burdensome.   It’s all in good fun, really, but I once told her that the only reason she does this is because most of us pose no physical threat.  Even if she really angered one of us, she can quite easily move out of our range of motion.  “Just wait until I can move again,” I said as she was feigning impatience with my lack of speed.  “You’re gonna get kicked.”   She laughed at that, and we decided that, a la Kwai Chang Caine snatching the marble from Master Kan, when I can do that, it will be ‘time for me to go’.  

It’ll still be quite awhile before that happens, but I did recently make a small step toward that goal.  Sort of.

I should mention that one of the great things about studying a martial art is the sharpened sense you develop of the physical space around you and the movements of others.   Outside of the dojo, this is useful for many things, such as working with someone in a small space, like a kitchen, where you make lots of quick movements, often with hot or sharp objects.  Or with the simple act of picking up something that’s fallen near a table where you’re liable to hit your head, if you’re not careful.

Since my injury, though, I’ve noticed that this sense of space has diminished somewhat for me, and I’ve banged my head more times in the last two months than in the previous three years.  Mostly, the only results have been a bit of pain and some mild chagrin, but it did hit a comical note a few days ago when I was working on my physical therapy excersices at my gym.

I was balancing with my injured leg on one of those the soft blue TheraBand stability pads (like the ones you see being used at right) and reaching out with my good leg in four directions.   I’d positioned myself away from traffic near a trash can and was concentrating on a focal point and on bringing up my knee as a high as possible between each reach.  I was starting to feel pretty confident in my balance, so I decided to also extend as high as possible.   Kick forward high.  Kick oblique high.  Kick side high. Trash can.  Bang! Ooops.

It was classic lesson in spacing and targeting. Aiming down I wasn’t reaching that can. But with little upward adjustment, bingo! A more than palpable hit. Sure it was embarrassing. It turned a lot of heads, and I certainly felt like it was something shouldn’t have caught me off guard.

But you know what?  It felt kind of good, too :-)