So while physio pretty much always begins with painful mobility work, it doesn’t always end that way. Sometimes it ends with dancing to Lizzo.
I was thinking about physio the other day and how I keep going back even though it’s pretty tough going. Lately we’ve been working on leg extension and getting my leg to lay straight. The physiotherapist straps my leg to her table and works on mobilizing the knee cap by pushing it down. At first it doesn’t hurt that much and then it really hurts and then we stop.
After that, it’s over to the gym area for feats of strength and balance. That’s the fun part of physio. We began with pulling a weighted sled backwards. That backwards motion requires full leg extension. After the we moved on to balancing on a bosu ball. You might know how this goes. You start out with both legs on the ball, and then one. Or you start with eyes open and then move to closed. Sometimes Estee the physiotherapist tries to gently push me off the ball.
Last time I was there the physiotherapist one station over was blasting Lizzo and I started bosu ball dancing. The next thing you know we were both dancing. It was fun and a good reminder that physio isn’t all suffering. It also makes sense that Estee ends with the fun stuff.
This time I’ve irritated the Tibialis Posterior. According to Wikipedia it’s the key stabilizing muscle of the lower leg.
For a few days it’s been painful putting weight on my left foot and then the cane wasn’t enough to make walking possible. For a couple of days I’ve gone back to using crutches. I was worried at first that I’d done something to my knee. But my knee is fine.
My physiotherapist says it’s the Tibialis Posterior, which certainly hurt when she put pressure on it. So for now I’m back to aquafit and physio exercises, including new exercises that target that muscle. So much for my plan to return to bike training…
She says that the muscle hasn’t been used in a bit and I went from asking nothing of it to asking a lot. Fine!
I’m in “take it easy” except for aquafit and physio mode. Bah. Grumble. But also I’m just relieved it’s nothing to do with my knee.
Crutches
This happened to coincide with our first serious snow so I’m actually glad to have the crutches for navigating my way through that. The bright side is that they’re much more stable than just the cane.
Sam’s street with snow
Here’s a video about how to strengthen the Tibialis Posterior:
Early in the recovery from knee replacement surgery process I blogged about what makes physio so hard. And it’s true. It’s hard, it can be painful, and it goes against our instincts–when in pain–to curl up on the sofa/bed, under a bunch of blankets, and not move.
But there are also some respects in which physio is easy for me. People note that I’m ‘good at physio’ by which they mean that I actually do it. Various physiotherapists through the years have noted it too. I’m a compliant patient. If they say to do exercise x, y times a day, then that’s what I do. They’re the experts, offering expert advice, and I follow it.
Why?
Well, everyone assumes I’m highly motivated to get back on the bike and start riding again. And that is true. But I don’t think it’s motivation that does the work on a daily basis. I am motivated. It’s true. But I don’t think that on it’s own it would be enough.
An important part of it is habit, plain and simple. I have the time available. If you normally exercise an hour or more a day, and you can’t because of injury or recovery, then physio just takes the place of the thing you would be doing if not injured. It’s why athletes are very good at physio. I’m not struggling to find time to do physio. I have the time and I’m just doing physio instead of other physically active things. In my case I was doing physio pre-surgery to get ready for surgery. And before that to help manage my condition.
What I didn’t do while recovering? Well, I’d hoped to read a lot. I thought I might even do some writing (ha!). But I did neither of those things. Twice daily physio (with ice and elevation after, plus, in the early weeks, naps) took up most of my day. I did watch a fair amount of TV while icing and elevating!
The other bit that helps is my identity as a person who can do hard things. Cate has blogged about grit and it’s a quality we share. Like Cate, it’s part of my self conception that I’m a person who can take on physical challenges. I ride in uncomfortable conditions, too hot, too cold, too hilly and so on. Knee physio isn’t as much fun as riding my bike in tough conditions but I do feel proud of being able to do it in the same way.
Today is my first day back at work and my challenge will be keeping it up with a job that can be very busy into the evenings and weekends. I need to remind myself that medical leave for knee replacement is 6-12 weeks and I’m just taking 6. I’m going to try to count the next six weeks as part of my recovery, keeping up with physio and getting help with the parts of the job that spill over into evenings and weekends. I’ve cancelled two conferences this month and while I will feel sad missing them it was the right decision.
I did round one of physio in bed this morning with icing and elevating after. Instead of TV I caught up on some much neglected email. Tonight at 7 pm I’ve got a meeting with the physiotherapist to assess progress and learn some new moves. After that, it will be an early night. Zzzzzzz!
So I am the sort of person who is good at following the advice of physiotherapists. I’ve successfully rehabbed some serious injuries and I trust the professional advice of physiotherapists. I do what I’m told.
It’s also worth noting that I have exceptionally good benefits and they cover almost all of my physio costs. And yet, even for me, physio after knee replacement is tough and I thought I’d explore why.
First, advice about recovering from knee surgery can sound contradictory. The take home sheets from the hospital say to use your new knee as much as possible each day. It will help you heal faster from surgery and improve your chances of long-term success. But also it says to avoid pushing yourself too far too soon. So as much as possible but not too much. Yep.
And practically it feels like that too.
The knee feels good and so I go for a short walk. After that it swells up and is painful so it’s time for ice and elevation. I’m constantly moving between making the knee work and then helping it recover.
After I posted about going for a very short walk this morning, friends commented, great, now rest!
What’s as much as possible but not too much? There’s not really good intuitive measure at this stage since everything hurts a lot of the time.
Second, unlike other physio I’ve done this is really painful. It’s the kind of painful where you ice before and after and take pain medication around your pt sessions. Since you’ve just undergone surgery and things still hurt from that, you feel a bit like hiding on the sofa, covering yourself in blankets, and waiting until the pain goes away.
Third, it’s pretty time consuming.
Here’s a rough schedule of my days this week. Next week I’m hoping to be able to get on the bike trainer to help with my range of motion.
6 am breakfast, drugs, ice and elevation in bed
630 physio round one, basic stretching and mobility
700 more elevation and icing and getting ready for the day
Tiny walk
800 Breakfast round two, more pain meds, more elevation and icing
900 Physio round 2 mobility and stretching plus regaining strength
930 ice and elevation
10-12 free time for reading possibly napping
12-1 lunch
100 ice and elevation, more pain meds
130 Physio round 3, mobility and stretching and regaining strength
200 ice and elevation
230-4 free time for reading and napping etc
4-6 dinner etc
7 last round, 4, of basic mobility physio
Tiny walk #2
Bed with all the ice and more pain meds
That’s me on the deck post tiny walk, resting and icing, as friends and physio advised.
My mother has back problems. And shoulder problems, neck problems, and arm problems. In short, she’s a chronic pain patient. It started when she was in her early fourties. One day, her shoulder started hurting and never stopped. The rest came as she went along. She tried cycling, she got back problems. She tried swimming, she got elbow problems. Knitting, lifting anything even remotely heavy, too much yoga (and you never know in advance what “too much” is), sitting anywhere with even the hint of a draft, are all out of the question. Being my mother – one of the most strong-willed people I know – she soldiers on. She’s now 71 and still does light yoga, a lot of hiking, and a huge amount of daily physio exercises.
I’m in my mid-30s now. Needless to say, one of my main fears is that I will run into the same issues. Granted, I have a few things going for me that might, at least, buy me some time and at best, prevent me from ever having the same amount or intensity of issues. My mother was born in rural post-war Germany, when good nutrition wasn’t a given. As the daughter of farmers, she spent a lot of time crouching in potato fields when she was young. She worked as a nurse for years and did a lot of heavy lifting. She didn’t really exercise regularly until she was middle-aged.
I, on the other hand, started swimming when I was in primary school (at the insistence of my mother, because it was supposed to be good for my back). I’ve always exercised regularly. I was well-nourished from the start. I’ve never worked a physical job. And yet.
So, in anticipation of Really Bad News, I postponed visiting the orthopaedist for a Really Long Time. But earlier this year, fear finally got the better of me, so I went. “I don’t want to end up like my mother”, I told him, and asked what I had to do to prevent it. “Are you in any pain?” he asked, which I happily denied. He looked at me slightly funny, but gave me a thorough examination. Apparently apart from a tendency to hunch and wonky hips, there’s absolutely nothing wrong with me. But just so my insurance could get its money’s worth out of the visit (by paying more money), he prescribed me five sessions of physiotherapy.
Photo of a bendy wooden doll. Bettina is trying to get her body to stay that flexible. Photo by Kira auf der Heide on Unsplash
I went to the physiotherapist and got similarly quizzical looks. It seems like if you’re not in pain, you’re not supposed to be there? I was surprised. And I realised my privilege of being relatively young, fit and “healthy”-looking has a consequence I hadn’t really considered much: people mostly concerned with healing don’t expect me. That was an interesting experience.
Luckily, my physio is awesome and adaptable, and was happy with damage prevention rather than control. He realised quickly that I actually do a fair amount of sports. So in the first session, we did a test that’s normally administered to athletes to discover their musculoskeletal weaknesses.
My lower back, hips, and shoulders are my weak points, with the lower back being the weakest. So my physio has been giving me exercises to do at home to strengthen it, and I’ve been trying to incorporate them into my routine. Honestly, I don’t enjoy them much. They’re exhausting, which probably means they’re working, and fairly boring. But that’s why I went, wasn’t it? To do things to hopefully prevent me from being in pain. So I’m going to take a page out of Sam’s book and try to do my un-fun physio exercises regularly. I’m also trying to focus on yoga routines that centre on my “problem areas” and incorporate asanas that are similar to the exercises I’m supposed to do, like Warrior 3, or chaturanga.
So what’s the verdict after four out of five sessions? I have a better awareness of my weak points and how to correct them. I have a bunch of exercises I can do at home. I’m curious to see if they will bring long-term improvement. Watch this space to find out how long my newly-found love… er, tolerance of physio lasts.
Do any of you have experience with physiotherapy? And how to be disciplined and make it stick, even if the benefits aren’t immediately obvious?
