Monday, September 1, 2008

Knee Rehab.....Smooth Sailing

I want to thank all of those who called or wrote emails to me after my recent surgery. It was appreciated. I have often been asked about how my rehab and recovery is going, so I thought I might document it here to allow others who may have this procedure take a peek at what is involved in the rehab and recovery. Of course, everyone is different and some surgeries are more involved than others are. My surgeon tells me that I am way ahead of the game in my recovery.

Originally, I mentioned that my plica was lateral. Contrary to that belief, it was in fact a medial plica, which had torn loose and settled in-between the two condyles of the femur. I have pictured it above.

I went into this procedure in very good shape. I was swimming a lot (4-5 x /week), and despite some pain in my knee, I was able to ride my bike three times a week fairly hard and had built my Critical Power up to a season best. I wanted to go into the surgery in good shape with the rationale being that I would lose some fitness but, once recovered, I would still be reasonably fit.

I am currently a practicing Anesthesiologist, but I am also trained and board certified in the specialty of Physical Medicine and Rehabilitation. I knew what I needed to do to recover as quickly as possible. My enemy would be muscle atrophy in the quadriceps muscle group and swelling, which would limit the range of motion of my knee.

I have documented below how things went for the first few weeks of my rehab.

Day of surgery: Ice and ROM (range of motion). I didn’t need any oral pain medication. The knee felt kind of squishy to move it but I made sure I ranged it often. My knee actually felt better after the surgery than before. This was a good sign. It is important in this period to keep the range of motion. If it is kept stiff, the collagen in the knee capsule can remodel quickly resulting in a contracture making it more difficult to move later on. This becomes more of an issue with knee replacements than with arthroscopic surgery. However, contractures can occur if the patient becomes complacent about ROM.

Post op day one: I went to work with my portable ice pack and crutches with partial weight bearing (WB) through the right leg. I worked on ROM a lot that day. I provided the anesthetic for a long back surgery. I was able to sit in one place for a while which I would have been doing at home anyway.

Saturday, Post op day two: Ice, ROM, dressings off, crutches, compex muscle stimulator on the quads for an hour to maintain some muscle tone.

Sunday, post op day three: Ice, ROM, and one crutch, advance WB

Monday, POD four: Back to work, ice, ROM, one crutch and at end of day, no crutches. I got back to training today and swam 3300 yards including a 1000yards in 12:02 pushing off the wall with one leg. It still hurt a little pushing off the wall full force. Knee is still swollen. I might have overdone it a bit with the kicking today. Compex on the quads.

Tuesday, POD five: worked all day and into the night and next morning. No time for exercise but I was able to occasionally ice, ROM, stretching, full WB walking with a slight limp. Some pain and swelling.

For the rest of the week I swam daily and by the following Sunday I was on the trainer spinning 100-120 RPM 120 watts for an hour a day. I occasionally iced the knee when I felt I had pain and swelling or the joint felt warm. Riding the bike actually helped ease the tightness and discomfort at the portal sites. There is some residual scar tissue at the port sites and I massage those areas frequently.

By two weeks post op, I advanced to 200 watts intermittently on the bike trainer. Currently, I am able to ride 200+ watts for a few hours and rode outside the other day hitting some 30-second efforts in the 500-watt range with no ill effects. My 1000-yard swim time is down to 11:35, so things are good on the waterfront. I am holding off on the running for a week or so and I should be able to be back to full triathlon training including running 4 weeks post op. I’m back and it feels good.

My motivation has been low this year because of my pain issues and burn out from the past few years of really hitting it. It’s tough fitting in the training, a greater than full time job, and a family including a wife that does this crazy sport. I just had to shut it down this year and have fun. However, after I watched my buddy, Marky V, lead IM Canada for the majority of the race, and my wife, Dana, do so well there a few weeks ago, the motivation to race and train is starting to come back. Dana and I are already making plans for next year.

I guess that my future plans of buying and relaxing on a sailboat, hoping for a windy day will be replaced again with getting on my bike and hoping for a windless day.

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