5th Week Mark after ACL reconstruction

30 June 2010 Marked 5 weeks after my ACL Reconstruction

_I went to physio this morning, it was testing as my muscles are stiff from the gymning
We were able to get flexion in knee joint to 5 degress less than the othe leg.

_I didn't walk too much today , 2/3kms in total (podometer)
_i did 1 hour on the exercise Bike : Today I started now pushing it to my Heart Rate Maximun : I could push to 176 , then it took 2mins roughly to return to 117 ( low HOUR within zone for fat burn)
_more stretches for legs /hamstrings etc .. As I am working muscles harder they are getting more stiff &shortening.


1 July
_1 hour on exercise bike 7:30am
& 1 hour 30mins Exercise bike 6pm = 2hours 30minutes total.

2 July
_6pm : 1hour 20mins on exercise bike
_stretches and calf exercises (step work /calf raises)

3 July
_Walking: lots of it at the farm: from 9am - 3pm 4.5km!! Most in 5 weeks !!
_4:30pm. on Exercise bike for 1hour 20mins , fat burn only , no cardio (high heart rate about 140 bmp) While I Watched World Cup Soccer: Ger vs Arg.

4 July
~on exercise bike for 2hours
~Calf raises left leg only
~step streches
~"Bosu" ball squats and balancing



~scar split open as pressure in knee couldn't excape , I was wearing knee brace for suPport. Puss came out , I cleaned with Hydrogen Peroxide 10% Volume,diluted and put absorbent plaster on
~i didn't walk much today




5 July
~4kms walking
~Gym:
Exercise bike 30mins fat burn
Step machine 10mins
Lats pull down : 3 sets of 15 reps on 22.5kg
Pullover : 3 sets of 15 on 22.5kg
Quads press (left leg only ) many sets of 10 reps on 7.5kg
Ab cruncher : 3 sets of 15 on 45kg
Mat work : stretches,hamstring curls , calf raises/stretches
"Bosu" Ball : Balancing and light squats

6July
*2hourse exercise bike
*5mind /500m Run(treadmill)
*Matt work
*Bosu* Ball : squats / balancing exercises / toe up&down &stepping up & down
*leg stretches etc,.
*3800 steos (step counter/ podometer)

Goals From the 7th Week to the 12 week

Goals From the 7th Week to the 12 week:

Early sports activities can be started and patients can often begin light jogging, cycling outdoors, and pool workouts. Side-to-side, pivoting sports -- such as basketball, soccer and football -- must be avoided.

Toward the end of this phase, some athletes can begin shuttle runs, lateral shuttles and jumping rope.

In the 4th Week post-ACL Reconstruction.

Lots of Gym time , spent on exercise bike & Loving the workout!
I have 1 more day left(sunday 27th June) of anti-biotics.
I am on 2 pain pills per day :
Coxflam (S4) Morning and Night (one each)

Exercise summary_
_Thursday 1 hour Bike
_Fri 1 hour Bike
_Sat 1 hour Bike

_Sun 27 June
** 1hour 20Minutes Bike
& Lats Pull down 3sets X 20 reps
& Quads : leg Press 3sets X 15 reps 15kg
& Abs: Cruch 4kg 3sets X 20 reps
& Verticle Stationary Rowing 3 sets X 20 reps
& Ball work :Hamstring/abs/arms shoulders

Anti-Biotics Finished Sun 27 June !

_Mon 28 June Nearing end of 4th week:
1 hour 20mins on exercise Bike

_TUES 29 June
1 hour 30mins on exercise bike.
& overhead lats , triceps pull over ( 4 sets of 15 on 22.5 kg)
& abs on matt
& quad presses 15 kg
& ball work on matt , hamstring curl and stretches
& step work - calf raises . 15 (both legs), 15 left leg,


--- I'm OFF PAIN-MEDS ,take occassionally at night when needed.

--- I am Happy, I feel the frwd Progression !

Today its 4 weeks :23 June

Past weekend been waking up in tremendous pain.

I found I had infection under the skin- the scar burst on sat,sunday I was in terrible paain.

I went onto anti-biotics.
And new painkillers..

* Myprodols ineffective.
Haven't been to gym since last week. It was too sore.
Today I went to gym_ on the exercise bike for :r (hats right folks no prob- I was thrilled and feeling great all the way ddnt even have 2 Half pedal' to warm joint up'...
Let's see how I feel tomrw.

Good night & God Bless

Week 3_ Day 5_ Monday 14th

Scar Tissue:
Scar tissue is the fibrous connective tissue which forms a scar; it can be found on any tissue on the body, , where an injury, cut, surgery or disease has taken place, and then healed. Thicker than the surrounding tissue, scar tissue is paler and denser because it has a limited blood supply; although it takes the place of damaged or destroyed tissue, it is limited in function, including movement, circulation, and sensation. Other than with minor cuts and scrapes, scarring is a common result of any bodily damage.

http://www.wisegeek.com/what-is-scar-tissue.htm

What I did at gym:
15mins exercise bike
_Overhead pulls_on 22.5kg ( 3 sets of 20)
_Stomach Crunches_on 25kg ( 5 sets of 20)
_Stomach curls_ (external obliques) -( 3 sets of 10:left and right)
_Leg raises 3 sets of 15_
_Heel slides and lifts: proved extraordinarily sore.

So much so , I left the gym and i cried out of frustration when i got home.
My myprodols were finished. I remembered I never took before the gym session, they are by far necessary because with out them I don't /can't push through the discomfort - fear of making it even more sore.

I did walk the rest of the day without crutches....
tomorrow is a new day :)

Week 3_Day 4_ Sunday 13 th June

This morning i went to gym.
wow..can i say it? ...\IT WAS GREAT TO BE BACK IN THE GYM.

I'm off the crutches from today. I have decided.

also the brace catches me across the biggest scar (on the front of the tibia) , so i am wearing it less nd less.

What i did at gym:
* Exercise bike: 15mins ( on lowest setting, no resistance, just the flowing motion)
* Leg raises and hamstring curls ( free weight no resistance)
* Upper body: Pecs : 3 sets of 20 reps on 7.5kg
Verticle rowing machine - (biceps,deltoids,rhomboids) 22.5 kg at _3 sets of 10 reps_
Stomach crunches: 5 sets of 20 on 25kg (ab machine)

My scars hurt quite abit today. There is alot of scar tissue, so when the skin stretches (as in walking and exercise) it "pulls"tremendously.
so i bought Bio-Oil and am now rubbing the scars - as mucg as pain and dicomfort allows. To loosen the scar tissue beneath the skin.

I drove to church(automatic) this evening, and i didnt wear brace or use crutches, i did howere take one with me,
why? because the brace's front strapping is right across the biggest scar below the knee on the Tibia....= Sore!

Had a good day.

WEEK 3_ DAY 3_ FIRST DAY AT GYM

This day was my first day back at Gym after my ACL recon.
What i did:
15mins slow/light on exercise bike, 5mins of which were half pedals, (like a swiminging boat)
my knee "softened up"and i could then go all the way around (backwards first) This was less "tight" this way.
I then could go forwards pedalling in the right forwards motion. It was not sore. I just had to work on my right hip over working to compensate for the "stiff"movement on my left knee.

Other exercises:
* Leg raises 2 x ( 3 sets of 10 reps)
* Hamstring curls (no resistance) me on my stomach) : 3 sets of 10 reps each
* Latissimus dorsi - 3 sets of 10 reps on 30kg
* Over head pulls - 3 sets of 10 reps each on 22.5kg
* Stomach crunches (machine) 25kg = 5 sets of 20 reps each
* Bicep curls - 7.5kg = 3 sets of 10 reps each

__________
I had a lot of pain and discomfort as i did not take pain meds until the afternoon when the pain got really bad.

But all in all it was a good day.
I am very glad to be back at gym.

Week 3_DAY1 _ saw the orthopedic surgeon today.

Today was a great day. I was very productive this morning, lots of typing done, sitting at a computer for many hourse gets straining on my hamstring, but very soon i was up.
When your knee is stiff, it can be difficult to stand from a sitting position

Had 2 Myprodols each at:
7pm, 12:30pm
3pm and 8pm.

The Doc was very happy, sitting today he got the range in my knee joint to about 95degrees, that is still passive not active flexion:
Continuous Passive Motion Improves Active Knee Flexion .

Flexion is a movement which moves the two ends of a jointed body part closer to each other. In this case, knee flexion is how close you are able to move the heel of your foot close to your buttocks. This distance is measured in degrees.
*The three muscles of the posterior thigh (semitendinosus, semimembranosus, biceps femoris long & short head) flex (bend) the knee

Flexion

Bending the joint resulting in a decrease of angle; moving the lower leg toward the back of the thigh;Hamstrings


Extension

Straightening the joint resulting in an increase of angle; moving the lower leg away from the back of the thigh.
Quadriceps femoris


______________________
Doc's orders.
______________________

* Alright... in two weeks time : ditch the brace
*only put as much weight on the leg as pain allows
*get onto a stationary bike asap, we need to build up quads and hamstrings (as seen above needed in flexion and extension of the knee joint)
*on 6 wkees, slight jogging and must be nearing full extension (have 4 weeks to achieve that)
*on 8 weeks, ( 6 weeks from 2day) a proper cycle -out and more jogging
*between 6 and 12 weeks , full bend and use of hamstring, and then we have to build it up..

Week 2_DAY 7 The end of the 2nd week.

Well Today started with ALOT of stiffness and pain,
2 Myprodols administered @
7pm, 10:30 , 1:30, 6pm and 10pm.

I am walking unasissted more @ home.
Hamstring very stiff, i massage my quadricep and hamstring group after bathing (muscles warmed up)
Did alot of office work today , all the sitting make my leg tired.
I do "toe pull-ups" , hell slides, leg raises and muscle contractions when i think of it while im working.

I had a good day.

Week 2_Day 6_ TUESDAY

This Day started as any other....knee sore/stiff/ joint tight, muscle sore.
Myprodol was taken 4 times....every 4 hourly.
It does work.

Did alot of sitting today -on chairs-
I find this gets very sore as the edge of the chair hurts the mamstring.
The Hamstring is taped up still from Yesterday's visit to the physio.

I also did alot more walking today- with brace on , and in controlled area (my room) - without.
I walk with and without crutches , slowly, in controlled "known" environment (my flat)

Note to self-
*go places where you will be sitting with a cuchion for your leg.
*always have extra painkillers , just in case.
*a sand arena is NOT crutch friendly...

Tomorrow is the end of the 2nd week, and i have not been on a statonary bicycle.

Statistics on ACL Reconstructions

Pre-Op Statistics
*Runners who rupture an ACL (this usually happens when they participate in another sport; ACL break-ups during running are very uncommon) will sometimes - after the knee swelling and pain diminishes - go on to run for several years without realising that a key knee ligament is missing. Eventually, though, problems usually arise, especially in higher-mileage runners, because the loss of the ACL leads to a lack of stability in the knee, which increases the risk of damage to the menisci and (ultimately) arthritis.

*After an ACL tear, doctors sometimes tell patients to 'test their knee out' for a period of time while they're considering the possibility of surgery. While this can help the person who exercises fairly lightly decide whether to have surgery, the strategy can also place the patient at risk of further damaging the menisci inside the knee, or eroding the cartilage caps at the ends of the femur and tibia - the two important bones which form a junction at the knee. An important point to remember is that if your sports activity produces pain, you shouldn't blithely continue exercising. Stopping a painful workout is disappointing in the short run but far better for your health over the long term
http://www.pponline.co.uk/encyc/0281.htm



Post_Op Statistics

*Statistics also show that female athletes have a 25% chance of tearing their ACL a second time after having the reconstruction surgery done.

*Individuals who sustain a rupture of the anterior cruciate ligament (ACL) are at an increased risk for developing early-onset knee osteoarthritis (OA).
_______________________________

The following study presents the first data with 2 year follow-up from the Danish ACL registryAll orthopaedic departments performing ACL reconstructions in Denmark, inlcuding private clinics, report to the registry. .

*Established in 2005:
During the first 30 months, 5,872 knee-ligament reconstructions were registered.
A total of 4,972 were primary ACL reconstructions, 443 were ACL revisions and 457 multiligament reconstructions.

*A total of 85% of all knee ligament reconstruction were reported to the database. A total of 71% of primary ACL reconstruction used hamstring tendon grafts and 21% used patella tendon graft.
*Meniscus injuries were treated in 35% of all patients
*A total of 17% had significant cartilage lesions.


IN THE UNITED STATES IT IS DOCUMENTED:
*The average cost for surgical repair of an ACL tear is approximately $11,500. If all *ACL injuries were repaired, the associated expenditure for 100,000 procedures would eclipse $2 billion annually
*ACL injury rates are estimated to be 2-8 times higher in women than in men
*Not a single report of mortality was found in 6 different studies examining the morbidity and mortality of anterior cruciate ligament repair.

Race
No known correlation exists between race and occurrence of ACL injuries.

Sex
According to numerous studies, female athletes sustain a greater number of anterior cruciate ligament (ACL) injuries than do male athletes. These results are well supported in 2 different papers. The first paper, by Arendt and Dick, showed that female athletes sustained significantly higher incidences of ACL injuries than their male counterparts did when competing in collegiate soccer and basketball.1 The authors' data demonstrated that women have a 2.4 and a 4.1 times greater chance of incurring ACL injury when compared with males in soccer and basketball, respectively. A second paper, by Hutchinson and Ireland, reported that female athletes competing in the 1988 Olympic basketball trials sustained 81% of ACL injuries during the trials.2

Age
Anterior cruciate ligament injuries occur most commonly in individuals aged 14-29 years. These years correspond to a high degree of athletic activity


Up to 50% of patients with acute knee injuries who report feeling or hearing a snapping or popping sound are found to have an anterior cruciate ligament (ACL) injury.

http://emedicine.medscape.com/article/307161-overview
http://www.springerlink.com/content/r37w344rj74r0h16/ACL
http://www.pponline.co.uk/encyc/0281.htm

Week 2_Day 5_ Monday The interferetial current machine{Physical Therapy Equipment}

At The Physical therapist this morning from 8:30.
Got muscles massaged .

And had treatment via the interferetial current machine:

A piece of equipment commonly used by physical therapists is the interferential current machine. This machine produces electrical currents (~4000HZ) that pass through the affected area of the patient. The current tends to penetrate deeper than other electrical modalities and has a number of physiological effects that have therapeutic value.

The physiological effects include:
1. an increase in localized blood flow which can improve healing by reducing swelling (the additional blood flowing through the area takes edematous fluid away with it) and as a result helps remove damaged tissue and bring nutrients necessary for healing to the injured area

2. the stimulation of local nerve cells that can have a pain reducing/anaesthetic effect due to potentially blocking the transmission of the pain signals (pain gate mechanism) or by stimulating the release of pain reducing endorphins (opiod mechanism)

3. some degree of muscle stimulation as muscle contraction can be achieved through external application of an electrical current, overcoming some of the muscle inhibition often caused by local injury and swelling


Also treatment via infrared:

Medical effect

*Infrared light is an important energy force that promotes healing. It raising the white blood cell counts. Improved cell growth, DNA synthesis and protein synthesis in cells.
*Promote blood circulation: Cue chronic rheumatism; eliminate sourness& pain, fatigue, stress and relief from all forms of arthritis.,
*Hyperthermic therapies for detoxification.
Sport injuries; musculoskletal injuries, such as repetitive strain injury,
*Hypertension, arteriosclerosis, coronary artery disease. (dilate your arteries blood vessels and tiny capillaries.
*Infrared ray stimulate your metabolism, promoting the elimination of some really nasty toxins that accumulate in your cells. Such thing as poisons carcinogenic heavy metals, toxic substances form food processing, lactic acid, free fatty acids, uric acids and fatigue.
___________________________________
Today:
2 x Myprodol 3pm.
For pain and discomfort.




Read more: http://www.automailer.com/tws/interferentialCurrent.html#ixzz0qBle2avB

Week 2_Day 4_Sunday

Today started very slow , had breakfast, took meds , and had to sort out dogs /feed them,let them out/in, that kind of thing.
Made me think of having kids ??(Same effort)
Did some leg muscle contractions ,all exercises &iced, My leg.
Then I got picked up for church.
Sitting in church for the duration of the time was manageable but it did get very uncomfortable after 1st hour. Luckily it ws not much longer than that...
My dad and I proceeded to the movies : watched THE GREENZONE (if u must know ?!)... Also quite uncomfortable sitting, I did toe points and calf muscle contractions and all sorts all through movie ,it did get better once we started moving (left the cinema) .
I am now walking using both legs, with crutches , and just relying on the crutches to take most of the weight off my left leg.
I just move very slowly.
Came home, relaxed ...did more exercises...
Dinner time had anti-inflammatories and 1 x synap forte with dinner.
I now feel ready for bed.
Goodnight.

Week 2_Day 4_Sunday

Today started very slow , had breakfast, took meds , and had to sort out dogs /feed them,let them out/in, that kind of thing.
Made me think of having kids ??(Same effort)
Did some leg muscle contractions ,all exercises &iced, My leg.
Then I got picked up for church.
Sitting in church for the duration of the time was manageable but it did get very uncomfortable after 1st hour. Luckily it ws not much longer than that...
My dad and I proceeded to the movies : watched THE GREENZONE (if u must know ?!)... Also quite uncomfortable sitting, I did toe points and calf muscle contractions and all sorts all through movie ,it did get better once we started moving (left the cinema) .
I am now walking using both legs, with crutches , and just relying on the crutches to take most of the weight off my left leg.
I just move very slowly.
Came home, relaxed ...did more exercises...
Dinner time had anti-inflammatories and 1 x synap forte with dinner.
I now feel ready for bed.
Goodnight.

Week 2_Day 4_Sunday

Today started very slow , had breakfast, took meds , and had to sort out dogs /feed them,let them out/in, that kind of thing.
Made me think of having kids ??(Same effort)
Did some leg muscle contractions ,all exercises &iced, My leg.
Then I got picked up for church.
Sitting in church for the duration of the time was manageable but it did get very uncomfortable after 1st hour. Luckily it ws not much longer than that...
My dad and I proceeded to the movies : watched THE GREENZONE (if u must know ?!)... Also quite uncomfortable sitting, I did toe points and calf muscle contractions and all sorts all through movie ,it did get better once we started moving (left the cinema) .
I am now walking using both legs, with crutches , and just relying on the crutches to take most of the weight off my left leg.
I just move very slowly.
Came home, relaxed ...did more exercises...
Dinner time had anti-inflammatories and 1 x synap forte with dinner.
I now feel ready for bed.
Goodnight.

Week 2_day 2_

Ok So WE are into the 2nd week.....

Rehabilitation After ACL Surgery
By Jonathan Cluett, M.D., About.com Guide
says......
"Weeks 1-2:
Range of motion exercises can begin immediately after surgery. The initial focus is to regain full extension (the ability to fully straighten) of the knee. In general, flexion (ability to bend) is much easier to regain than extension.
Patients will work with physical therapists to work on gait training (walking), gentle strengthening, and aerobic work. I like to get patients on a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity"


Full extension in knee= CHECK
Work with physical therapist= CHECK
Pon a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity = THIS WILL BE THE FOLLOWING WEEK'S GOAL

__________________________________________________________________

Todays stats:
8am:anti-inflammatories
9am:Physio
1pm:Anti-inflammatories and 1 x Synap Forte
8pm:Anti-inflammatories and 1 x Synap Forte

__________________________________________________________________

This day was a difficult one, as i went out in the morning for physio , and then was out and about for breakfast with my gran, went to her house, didn't really relax , as my leg was uncomfortable,
i went home and just took it easy for awhile.
Tonight i am not so tired.
But what i can say is today is the first day in one week that i have had "real" caffeine! Real coffee! i've bn having de-caf so that i would not have a problem sleeping, which i sometimes can because of a sudden inactive lifestyle.

Week 2_day 1_

I had a good night. Slept well.
Woke at 3am, with alot of inflammation in my knee and it was hot to the touch and 'pounding'. So went and got ice pack, after it was firmly attached i fell asleep.
This morning the gel- ice-pack. was WARM(WARM Water Bottle temperature).

Didnt have pain this am.
Had Voltaren Anti-inflammatories, and Synap Forte at 12 pm.

The afternoon was spent mostly with ice on leg.

Today i was putting more weight on my leg, but i notice an imediate swelling thereafter.

Anti-infammatories and pain meds at 6pm again. That should set me for the evening.

DAY 7 _ week 1 _ Post ACL op.

Left Leg ACL RECONSTRUCTION:

Note:

Muscle atrophy

is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle.

Today i dont feel so great.
Woke up with pain all -over my body, couldn't wait to get pain meds in and for them to start taking effect.After a long night without meds, i tend to wake up feeling like a bus has gone over me.
From 7:25 , it takes till 9am till full effect of the meds are noticed.
i take them every 5.5 hr / 6 hr.

midday meds taken at 13:30.
effect less pain, but drowsiness.

Exercises completed successfully today:
hamstring & Quad contractions
Heel Slides
Leg raises
Ankle pumps and roles

Hamstring Tendon Graft Reconstruction of the ACL

There are many different ways to do this operation. One is to take a piece of the hamstring tendon from behind the knee and use it in place of the torn ligament. When arranged into three or four strips, the hamstring graft has nearly the same strength as other available grafts used to reconstruct the ACL.

This is the method that was used on my knee!

The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the tibia. The graft used in ACL reconstruction is taken from the hamstring tendon (semitendinosus) along the inside part of the thigh and knee. Surgeons also commonly include a tendon just next to the semitendinousus, called the gracilis.

The hamstrings function by pulling the leg backward and by propelling the body forward while walking or running. This movement is called hip extension. The hamstrings also bend the knees, a motion called knee flexion

__________________________________________

What does the surgeon hope to accomplish?
__________________________________________

The main goal of ACL surgery is to keep the tibia from moving too far forward under the femur bone and to get the knee functioning normally again.


There are two grafts commonly used to repair a torn ACL. One is a strip of the patellar tendon below the kneecap. The other is the hamstring tendon graft. For a long time, the patellar tendon was the preferred choice because it is easy to get to, holds well in its new location, and heals fast. One big drawback to grafting the patellar tendon is pain at the front of the knee after surgery. This can be severe enough to prevent any pressure on the knee, such as kneeling.


For this reason, a growing number of surgeons are using grafted tissue from the hamstring tendon. There are no major differences in the final results of these two methods. When it comes to symptoms after surgery, joint strength and stability, and ability to use the knee, either method is good. However, with the hamstring tendon graft, there are generally no problems kneeling and no pain in the front of the knee.

Day 6 _ after Surgery (week 1)

Day started the same, wake up, pain meds, anti-inflammatories, bath (without wetting plasters) and ICE-LEG and ELEVATION.

i Have serious pain in my hamstring!
it feels like its being ripped aprt from the inside out& torn off the bone like its being eaten off by savage wolves!

Am on new anti-inflammatory dicloflam..

sitting on a chair is a mission as gravity pulls me leg down, onto my hamstring, this hurts!

i've just had my pain meds:
What is Synap Forte® ?
answer~ paracetamol + propoxyfene + caffeine + dephenhydramine (a sedative)~

Thats Why i feel drowsy after administering it!
Because ot the dephenhydramine.

Day 5 (week 1)
This was by far the worst day so far after surgery.
here's my stats:
Pain-high
miserable-high
sleep-low
eat-medium
weight gain-high
water retention-high
any work-low
*i didnt sleep last night because of pain coupled with my little dog princess being too active:)grrr....


The day started well, with me going to physio = Lynette
She said im a great patient, i was able to to quad and hamstring isometric contractions. The range of momevement= =- 75 degrees

i went to sister at doctors room to change (and clean) on of the plasters, there was dried blood on it!)

Definition Wikipedia: Isometrics are done in static positions, rather than being dynamic through a range of motion. The joint and muscle are either worked against an immovable force (overcoming isometric) or are held in a static position while opposed by resistance (yielding isometric).

These contractions are done while i sit or lie in the bed.