Stage Two Exercises

Increasing the strengthening exercises mostly involved just building up the stage one exercises by increasing the number of holds and repetitions. The following have also been added to the routine.

Short arc quads

This is the next stage in the quads regime and aims towards achieving the straight leg lift (below). The idea with this one is to raise the knee using a wedge (rolled up pillow or towel will do) preferably on a solid surface and then to push the knee into the wedge in order to try to raise the foot. Once the lift is achieved, hold for 5 seconds and slowly lower, keeping control of it as you lower it down. 

Straight leg raises

See separate post on this one. But basically it goes like this ... flex ankle upwards, push knee down into bed to lock leg straight, then raise your foot until the leg lifts off the bed. Try to raised it about 10 inches off the bed, hold for 5 seconds, then lower slowly back down. Try not to let the leg bump back down, this one's about control. Repeat 5, then 10, etc.

Full arc extensions

This one builds on the short arc and helps to make the straight leg raises become easier by working on the quads again. Sit on a firm chair with leg bent at 90 degrees. Slowly start to raise leg, aiming to get it straight out in front of you (you may not make it that far at first). Hold for 5 seconds, repeat 5-10 times. Increase reps and holds as it becomes easier.

Standing wall slides 

This one will work the quads and improve lower leg strength. Stand near wall, feet slightly apart. Place your hands on the wall for support (but don't lean on them), slowly slide up and down 10 times. Progress to holding for 5, repeat 10 etc. You don't need to bend too far to begin with, just as far as is comfortable. Try not to lean to one side, favouring the good leg - I did this, and its apparently "cheating"!

MUA Cancelled, Hardware Removal Postponed

Well the jury is out on the MUA and my doctor has decided that it doesn't need to go ahead. He feels that although my Range of Movement progress is slow (70-90 in two weeks), it is nevertheless steady and the strength in my quads is building (also slowly) so he doesn't want to disrupt that. 

The sudden pain that started last week, just above my patella is apparently a shifted pin, digging into the ligament there. It only occurs when engaging my quads when my leg gets to about 20 degrees. Before 20 degrees, no pain - past 20 degrees, no pain hence the feeling that its a shifted pin causing it. He felt that the hardware should probably be removed, but because the skin over my knee is quite tender and shiny, indicating possible scar tissue/nerve healing problems, he doesn't want to go ahead and cut it open again just yet. So I have to wait a little while longer for that, and basically keep doing what I'm doing with PT for now.

He also suggested that I need to move onto using just the one crutch now and agreed that I can arrange a date to return to work. Driving may be a bit more of an issue, so I'll need to find a way around that for now, but the doc said that as soon as I feel confident enough to have a go at it I can go ahead and try.

So all good I guess ... not sure my Physio Therapist will see it that way when I see him tomorrow, he was quite keen to have me get the MUA done! To save him some work maybe ......?

Squidoo-ing Knee Injuries

Dealing With a Broken Knee Cap

Filling in my time since I've been off work by experimenting with blogging and other forms of online writing. I've found out lots of useful information about knee injuries on the Internet but have to admit its quite tricky to find. I've already mentioned below the Knee Geeks forum, which is great for getting advice and ideas from people who have been through similar experiences. But there is so much out there!

I've recently come across Squidoo, which is kind of like a blog, but more of a hub to pull together ideas and useful resources related to a specific thing. I've created a "lens" (that's what they call their pages) about Dealing With a Broken Knee Cap that pulls together some of the hints and tips I've picked up along the way. Its quite addictive though, I'm now creating other lenses on anything and everything I can think of!

Considering Manipulation Under Anesthesia (MUA)

13 Weeks Post Op - Quad Atrophy

After three weeks on the Physio rolling program, my range of motion had increased from 48 degrees to 72 degrees and my quad muscles had finally begun to wake up and I could do a straight leg raise. I had completely ditched the support brace and had learnt to walk more confidently on crutches (I still have the zimmer frame, but only use that if I'm having a bit of a wobbly day). My leg was feeling generally stronger and my confidence was gradually coming back. It felt like progress to me, considering that less than a month before I was a dithering wreck unable to take even the tiniest step without panicking.

My physio therapist said that he would update my orthopedic doctor ahead of my six week check up the following week. When the day arrived I waited in the cubicle whilst the physio and doctor "discussed" me the other side of the curtain! Then the doctor came in to see me, saying that he'd been told I was struggling with the strength and bend in my knee and that they were considering an MUA. He explained to me that there is only a small window of time in which to carry out the MUA and its important to get it right. Wait too long and the scar tissue and adhesions may become too hardened to do the procedure effectively - do it too soon and it could cause further set backs. I don't know what these set backs are, but imagine they have something to do with muscle soreness and confidence. I'd read about MUA's on KneeGeeks so it wasn't complete news to me, I'd kind of expected that this may crop up sooner or later.

The doctor examined my knee and asked me to demonstrate the bend and a short leg raise whilst sitting in my chair. He seemed surprised to see how much I could do with it and that it was "better than the picture" he'd had from the physio. I explained to him that there had been hold ups with my commencing proper physio therapy and that I felt there had been a lot of progress generally since I'd started the program. He agreed that this seemed to be the case and said that he would have more concern if there was no progress at all in that time. He decided to give it a couple more weeks to see how things go and revisit the possibility of MUA when I next see him on 14 March.

I was fairly happy with this, it seemed like a reasonable bargain, so now its down to me to see how much I can work on the ROM and improve my quads before my next appointment. Scare tactics to make me push it more perhaps? Whatever it is, it seems to be working because by the weekend my ROM was at 80 degrees, it would be good if I can achieve 90+ by the time I see the doctor again ... but will that be enough?

The Straight Leg Raise Challenge

A few weeks ago, one of the physio therapists I saw told me that until I could do a straight leg lift, I wouldn't be able to begin to think about walking without some sort of support (aka frame or crutches). Well, finally, 12 weeks post-op, I managed to do three! It hurt like hell but I did them and felt rather smug afterwards too.

A straight leg raise is one of the initial tests for a broken patella. I was asked in A & E on the night of my accident to lift my leg and was met with a knowing look from the doctor when I failed dismally. The mechanism for carrying out the straight leg raise involves the quad muscles, the patella and the ligaments above and below it. If the patella is shattered, there is no sturdy lever to facilitate the raise. So, given the nature of my injury combined with the state of my wasted quads by the time the fracture was fixed, a straight leg raise was going to take some time!

The physio showed me how to carry out the actions necessary to trigger the movement, even though I couldn't actually see it through. This involved pulling my foot back at the ankle, pushing my knee down to lock the leg straight and then engaging the quads to give the power needed to lift the leg. Well, she may as well have been asking me to lift a ten tonne weight! There was no way on earth my leg was going to lift off the bed, not yet anyway.

For three weeks after she showed me the procedure, I religiously went through the motions at the end of my increasing physio routine. Ankle back, knee locked, quads engaged .... nothing! Well, nothing apart from the pathetic shaking and trembling up and down my thigh.

Acknowledging that my quads had by now finally started to wake up and say hello, the physio announced that "we" were actually going to do a straight leg lift now. I began to go through the motions again, not imagining for one second that it would achieve anything other than a wobble. She told me that it was ok for me to bend my knee just a tiny bit in order to get the lift going. Then as she shouted at me to "go on, lift, lift, LIFT" I felt a sharp tugging just above my knee cap and suddenly, my leg started to lift slowly off the bed! Instantly, I shut my eyes tight and concentrated on slowly lowering it the 20 or so inches back down, terrified that it would crash back down with a bump. I'm not sure who was the most elated, her or me! She made me do it again, this time with my eyes open to "train" my brain to work with my leg again.

So the straight leg lift was now added to my physio regime and I can now (2 weeks later) do a set of 10 lifts, raising my leg higher than I can lift my good leg!. The first couple still hurt like hell, and I'm still wary of my quads giving way (not that they have at all), but the strength that I'm building up as a result of being able to do this is helping my walking progress no end. Like they say, no pain, no gain...