I’m searching “ways to make physio less boring” and found this.
“1. Link the rehab exercises to something that you love. If you’re in the habit of watching TV in the evening, do your exercises while your favourite shows are on and never allow yourself to watch them unless you are doing your exercises while watching. In my case, I pick some of my favourite albums and only listen to them if I’m doing a workout at the same time.
2. The “brussels sprouts” method. In other words, get them over with as quickly as possible before moving on to something that you love. Don’t think about it, just do it. No dessert until all the sprouts are gone.
3. If you are in the habit of exercising regularly, create pairs of exercises where the second one is an exercise that has been assigned to you by your therapist. For example, if you are doing sets of pushups, follow each set with a gait exercise rather than just resting between sets. This is called the “bi-plex” hybrid method and is my personal favourite.”
I’m already doing 1 and 2, so I think I’ll give 3 a try, work some of the physio into a routine of regular exercises that I’ve been missing.
First, I had my six week follow up with the surgeon last week. Everything looks good. Next check up is by phone at 3 months and we’ll talk then about the schedule for my right knee.
Second, the physio recommendation from the surgeon says to focus on five things: extension and flexion (bending and straightening of the operated knee), strength training, balance, gait, and a return to the Activities of Daily Living. It actually said “return to ADL” and I had the look up what that meant.
I think that means stairs, dishes, laundry, etc. I’m walking about the house now loudly proclaiming, look at me doing an activity of daily living. The thrill will wear off I’m sure.
Third, in addition to physio and my daily living activities, I’m busy with aquafit two or three times a week. I’m also riding my bike on the trainer 15-20 minutes a day. Cheddar and I are walking again. He’s such a patient lovely dog and great walking at my speed, whatever that speed is, and not taking off after squirrels.
Chase and Cheddar. My mum’s other dog Charlie is a little camera shy.
Fourth, I’m back at work and feeling happy to be re-engaged with the wider world outside my house, my left knee, and physio. The trick will be not over extending myself. I had the option of staying off work for 12 weeks, rather than 6, and so I am thinking of the first 6 weeks back as a chance to say no to some of the weekend and evening dean stuff and involve other people.
Sam in her office
I’m trying not to fret about late fall, and dark November days. I’m going to all the holiday parties this year, no matter how early. I’m going to enjoy the hot tub and sauna at my fancy new gym. It also feels good to be back in my office clothes and not just wearing shorts, t-shirts, sneakers, and hoodies. I’m also very much looking forward to extending my time on the bike. Right now, I’m spinning most evenings for 20 min or so, while watching campy movies with my son Gavin. But soon I’ll back on Zwift doing some of the slow social rides.
The tree in my front yard that’s gloriously red in October, stick like in November.
They tell you that recovery from total knee replacement is a long haul of physio and rehab.
I’m here to say it’s just dawning on me how true that is. It’s not that I didn’t believe it before. I did. But now I’m feeling it too. That knowledge is real in a way that it wasn’t before.
There were big gains in weeks one, two, and three. Not so much this week. This week I might have overdone it. Too many tiny walks? Too much mobility work? Possibly going to a Tafelmusik concert in Toronto might have been too much. But the music was beautiful and I had a lovely visit with my daughter so that was all good.
Handel’s London, Experience the energy of baroque London, a lively metropolis where musical influences intersect.
I had hoped to report that I could turn the pedals over on my bike my now, but I can’t, yet. And yes, I know there are no fixed timelines for these things and that people regain mobility as different rates. Still, in my head it seemed reasonable to be back on the trainer in a month and I’m not there yet. I mean, I’m there, but I’m not making full rotations of the pedals just yet.
Weirdly, I am so close when I do it backwards. Weirdly backwards everything is easier. I’ve been doing walking backwards without crutches drills for physio and I don’t limp walking backwards.
Why is pedaling backwards easier? Here is one explanation:
“Pedaling backwards after knee surgery is often easier because of the hamstring activation. When you pedal an exercise bike forward the quadriceps is likely more active and the hamstring is likely less active. By pedaling backward after knee replacement surgery your hamstring is pulling the lower leg back which often improves knee flexion.”
YouTube video about starting on a recumbent bike after knee replacement
The other hard thing is simply pain. I’m surprised that a month out things still hurt this much. I take pain relief medication regularly, not the narcotic stuff–the narcotic pain meds ended more than a week ago. But I’m still waking at night with pain some of the time and by end of the day things hurt a lot.
It’s also fall of course, not my favorite season, and I’ve been brainstorming ways of coping given that my options are somewhat limited this year. My friend Todd is similarly scheming and I’m enjoying reading about his plans even if I’m jealous that they include running.
What am I up to that’s positive?
🍁Well, I’m seeing more of friends and family. I’m out and about more than I was.
🍁Today I get to start driving again. Cars aren’t my favorite things but it will be nice to be independently mobile.
🍁I’ve joined a new gym that has aquafit classes and I’m looking forward to that over the winter. Aquafit isn’t my favorite thing but it’s a thing my healing knee can do once the incision heals fully . And I do love being in the water.
🍁This week the blog’s Catherine Womack comes to visit. She’s giving a talk at Guelph’s Philosophy department called “Epidemiology Food Fight: a fat feminist takes on values in nutrition science.” That’s October 6th, 430 pm.
🍁I’ve dug out my light alarm clock.
🍁I’m very happy to be planning my return to work. I miss the university. I love fall semester even though I’m not a fan of fall overall.
🍁I’m thinking I might start my November gratitude practise early this year and make it a fall thing, beginning October 1. Gratitude is good in its own right and it makes me feel better. Right now I’m thankful that I got to have knee replacement surgery and that I have lots of support through the healing process.
Even though I’m making progress, it’s still a slog. The big issues are physio–so much physio!–and also pain management. It feels like alternating between physio and icing and elevation is still pretty much a full-time job.
The hardest and most important exercises are focused on range of motion, making sure my knee can bend and straighten. But I’m also doing some balance work, standing one legged with the operated leg doing the work. The other focus is strength, lots of sit to stands, and leg raises.
I’m excited to say that I’m making progress. This isn’t a particularly flattering photo but it does demonstrate that I’m getting better at bending my knee. A lot of physio went into getting there!
Sam with crutches getting into the car
Also othe bright side I’m off the serious pain medication.
I feel more like myself
I can read again. Phew.
After four weeks, I can drive again. It’ll feel better not needing Sarah or my mum to take me to physio.
I’m getting around pretty well on crutches and in the house, within a room, I don’t really need them. I’m still struggling with carrying stuff. I need a coffee and book carrying robot to follow me around the house. I can do basic household chores like dealing with the dishwasher and cooking and sorting clothes but I can’t do things that require carrying stuff, like setting the table.
I also had the surgical staples removed and check in with the surgeon in London
No more staples
I think it looks pretty good. I’m impressed with their needlework/stapler skills. What I can’t do, until that heals completely, is immerse myself in water. I can shower, yes, but no swimming pools, hot tubs, or baths just yet.
I can now look forward to short outings.
This past weekend we had breakfast with a friend.
Sarah and I made also it to the farm. For me there’s no swimming, no hot tubbing, no bike riding. There’s still lots of physio and icing but with different scenery. It’s lovely.
Hoping to go out to the movies next week.
I’m also looking forward to getting back to work. Medical leave for knee replacement is 6-12 weeks and I’m hoping for the short end of that range.
Have you had a surgery with a long recovery period like this? Any advice you have to offer?
I’ve written before about my one seriously arthritic toe. One! What a weirdo toe. It’s the same toe that kept losing the toe nail at even the hint of strenuous activity. It’s a toenail that sees cross country skiing in its future, turns black, and falls off. The same, of course, for running. It’s my Bad Toe, and I’ve even been prescribed toe physio for it.
I confess I haven’t been keeping up with my toe physio. And issues with my knees felt more pressing and that felt like physio enough.
Until my feet started hurting while riding my bike. Toe cramps bad enough to make me want to get off my bike. Ouch! I wear orthotics in my running shoes and in my everyday boots. But until now I thought of cycling as an activity that didn’t require orthotics. The keywords are “until now.”
So I now have orthotics for my cycling shoes, in addition to my running shoes, and they seem to help. Aging bodies and activity seem to require a bunch of extra work and resources. I’m feeling extra grateful for my benefits these days.
Cycling shoes and running shoes with socks sticking out
My life has changed a lot since we started the blog and the fitness challenge. There are things I say when we’re promoting the book that now strike me as wrong or at least not as simple as that, or maybe even naive.
Things feel a lot more complicated since osteoarthritis and advanced cartilage degradation made me a candidate for knee replacement.
It’s hard to get a more nuanced message across when you’ve just got four minutes on television so I’ve been sticking with the simple story but the truth is I know it’s not so simple. I’m not staking out a position here or defending a claim other than than claim that things are messier than I thought. I do know the blog can handle more complexities than the media buzz around the book can take. So you blog readers get the messier story.
Maybe after the book promotion I have to stop saying “if you don’t love it, don’t do it.” There are a lot of things in life that I do but I don’t love. These days a lot of exercise feels to me to fall into that category. Knee physio can be tedious and sometimes painful. And I do it most days. There’s no way to love it. You watch Netflix to distract. You give yourself rewards for finishing. I need to do it but there’s little joy in it.
Instead, I take pride in my grit and determination, in my resolve.
Why am I doing it? Not love of the thing itself that’s for sure. Partly to be sure it’s instrumentally justified in terms of continuing to do things I love. Canoe camping, hiking, biking. I want to keep these things in my life.
But it’s also instrumentally justified in terms of basic movements, like walking to campus, between meetings, getting in and out of chairs.
To suggest that we approach all exercise from this “loving it” perspective comes from an incredible place of privilege. I had that privilege. I don’t anymore and I’m sorry if I sounded insufferable, naive, and smug.
I saw it again today, by the way, in an online body positive fitness community of which I’m part. Someone offered the advice to another community member to do whatever brings joy to your heart. And the thing is I too reject the imperative that we all have to do joyless exercise to tame or unruly, overweight bodies to keep them in line. I also know though that life is complicated.
Just as Tracy rejects body positivity as just one more demand, I’m coming to feel that way about “if you don’t love it, don’t do it.” No one loves knee physio. It’s okay not to like it and to do it anyway.
It’s okay to be angry and sad and roll your eyes at people who say they just don’t feel like running this morning. You don’t get to yell at them that at least they can run and tell them to just go do it because you can never run again. Just say it in your head. That’s what I do.
It’s okay to think, “I’m tough and I’ve got this” instead of I’m doing this because I love it . Because that’s what’s true: I’m tough and I’ve got this.
Maybe that’s true for you too. I’m sorry for saying you have to love exercise. You don’t. Right now, a lot of the time, I don’t. And that’s okay too.
My new physiotherapist tells me that I’m tough. She also says I’m determined.
That’s the kind of praise I need these days.
Because contrary to our usual message, I’m not exercising these days because it’s fun or joyful or at all social. I’m doing a lot of boring, repetitive, sometimes painful exercises, mostly by myself, in order to regain basic knee function so I can do things like climb stairs and get out of chairs without grimacing. I’m also making time for it when I am super busy and when the exercising part doesn’t feel like a reward at the end of a long day. It’s more like punishment.
So when Tracy wrote yesterday that “our number one piece of advice for anyone is to find activities that you enjoy” I admit that I kind of flinched. Because my life isn’t like that right now. Right now I am doing a lot of physio. My knee hurts. I’m resolute and determined to get back on my bike even though I’ll never run or play soccer again. Aikido? Maybe. I’ve got hope for cycling. We’ll see. I’m in mourning a bit for my former self!
In my Facebook memories newsfeed a happy photo came through of the Run for Retina 9 years ago. It’s me and cousin Tara doing the 5 km. Look at our smiles! Look how happy we are!
I’m not sure why I am telling you all this, except to find company and to reassure those of you, who like me, who are in pain, that you are also not alone.
I do exercises to support my knee function to my pain tolerance and then it’s all ice and ibuprofen after. I’ve missing the Fowler Kennedy game ready ice and compression thingie. I want one for home!
Yesterday, I was balancing and marching and doing squats on a bosu ball. See here for how that helps.
So contrary to our usual message of “if you don’t love it, don’t do it,” this is me saying, it’s not always fun or joyful or social and sometimes you need grit and determination and you do it anyway. That’s part of my character, a big part of who I am.
Note: At some point soon I hope to have things to blog about besides my left knee! Promise.
The surgeon looked at my x-rays and my MRI and said, “Ouch. That must hurt.”
There’s pretty much no cartilage and no meniscus left apparently. I’ve run out and there’s no growing more. I’ve got bone rubbing and grinding on bone and that hurts.
On the treatment side, things have gotten better with physio but there’s still too much pain and I can’t do lots of the things I used to love.
Hence my visit to the knee expert.
I told the doctor I’d given up soccer. I’ve also given up running and Aikido. But I don’t want to give up long hikes, bike rides, skating, skiing etc.
He tells me that I’m an easy candidate for total knee replacement given the amount of damage to my knee but he worries that I’m too young and too active.
Instead, we’re going to try to fend off knee replacement for another ten years, maybe even fifteen.
Here’s the plan:
Step 1: Try Monovisc injections
Basically it’s injecting lube into the joint. They’re $400 and it’s not covered by our provincial health plan but it is covered by my benefits. Again, I’m feeling lucky. No risk. Some people find huge relief this way. Others not so much. We’ll see. I had the first one today. Weirdly not painful but strange feeling.
Step 2: Unloading knee brace
For long walks and other activities that strain the knee, I’m getting a custom knee brace. They are supposed to work well, if you use them. Lots of people don’t. They’re clunky and not that that easy to get used to. On the upside, I don’t need to wear one at work, just walking to and from. Also, I’ll wear it on long dog hikes. Might be a great argument for commuting by bike. Again, thank you benefits.
Photo of an unloading knee brace. This is the Precision Pro brand but they all look like this. There are no “dress” versions.
Step 3: Physio, physio, physio
I’m so lucky to have good benefits.
Step 4: High Tibial Osteotomy
If all this doesn’t work, I’m also a good candidate for another surgery that falls short of knee replacement and buys me some years. It’s recommended for younger, active patients. (I like that description.)
“Osteotomy literally means “cutting of the bone.” In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint.”
“A high tibial osteotomy is generally considered a method of prolonging the time before a knee replacement is necessary because the benefits typically fade after eight to ten years. This procedure is typically reserved for younger patients with pain resulting from instability and malalignment. An osteotomy may also be performed in conjunction with other joint preservation procedures in order to allow for cartilage repair tissue to grow without being subjected to excessive pressure.”
And here, complete with an animation of the procedure.
In the meantime, I’m thinking strategically about saving my knees, what’s left of them, for the things that I love. No more knee damage for the sake of training. More on that thought later!
