A lot of processes follow some kind of decay curve. Some of them are annoying.
I hurt my knee on November 5 while out in the Zion Canyon Narrows. I was jumping off a ledge about 4 feet high and landed on some uneven ground. All my weight shifted onto my right leg, which was awkwardly tilted and my knee buckled inwards. It actually felt more like the lower half dislocated and shifted inwards and then popped back in place. I somehow executed a very stylish roll onto my right side and even managed to keep the $3000 of camera gear in my right hand off the ground. To those watching, it probably just looked like I collapsed in a heap.
Needless to say, it hurt. I'd never felt my knee do anything like that before so I wasn't initially sure what shape it was in. I tried a variety of motions to test its strength (while having to take the time to tell the random people nearby asking me how I was doing that I wasn't sure yet) and it actually seemed ok until I tried to take a few more steps and it buckled again. Fearing the worst and lacking any medical insight, I decided that I might have torn an ACL. I figured out later that I probably just sprained an MCL (a much less serious injury) and got confirmation of that a few days after when I finally got home and saw a doctor.
The particularly interesting part of all this is the recovery arc, which I'll break down in a log format.
November 5
10:30am: Initial injury.
10:32am: Pain is mostly gone, knee is highly unstable while trying to walk in a rocky river or even on a relatively smooth beach. I'm still not entirely certain how limited I am.
10:45am: I've decided I can't continue upwards with the hike and basically haven't moved.
11:00am: I've decided I need to just work my way back down the river and give myself as much time as I might need. Greg offers to go back with me, which was actually really helpful. Thanks Greg!
12:00pm: Greg had to catch up to the rest of the group to let them know he was turning back. I spent the hour just standing around trying to figure out how I could best walk without exacerbating the injury. By now it was clear that I was stable front-back and on the outside of my knee, but not on the inside. I figured out that I could shuffle to the right and thus keep the weight off the inside of my knee.
2:00pm: We made it out of the river. The hike back was really annoyingly slow. I basically spent the entire ~2 miles bracing on my hiking pole in a preemptive posture. I had to adapt my right-shuffle to river crossings. When crossing left-to-right it worked fine, but right-to-left I actually would turn around and face up-river. I had lots of little tweaks on the knee. The slightest misstep would cause it to wobble. Once we got out of the river, we were back on relatively flat paved ground.
2:30pm: We covered the 3/4 miles or so to the bus stop. I was actually able to walk pretty ok, without the stick. I decided to try it just because it was so damn slow ... and it worked!
3:30pm: We've ridden the shuttle to the visitor center to find that the shuttle back to town wasn't running. Queue another 3/4 miles of walking. That also went ok.
At this point I went to the medical center which was closed, but self-diagnosed that I wasn't as badly hurt as I initially expected. A trip to the grocery store yielded a wrap and brace, which helped a lot.
November 6
Another day in Zion, this time with an off-road hike portion. I managed to scramble around for that with a couple tweaks. My knee didn't feel any more stable, but the brace helped. I'd also learned how to better compensate as well.
November 7
My brace wasn't compatible with jeans so I didn't wear it. Most of the day was spent sitting or driving, until we got to Las Vegas. That evening, however, I did walk around a fair bit without the brace though I was protecting the knee still and not going full speed.
November 10
I get my official diagnosis, twice. The doctor gave me a full immobilizing brace to wear in the morning. I felt much better wearing it to walk over to the health center later for my PT appointment. My PT then tells me not to wear it and puts me through 30 minutes of workouts, stressing the muscles around the knee. I still put the big brace back on to walk back to my office, but leave it off after taking it off to drive home.
November 11
I go to work without a brace. Tatiana questions my judgement, but I cite the PT. I'm able to get around on level ground pretty well, but still completely avoid the stairs.
November 12
I do my PT workout in the garage and feel confident enough to go up and down stairs normally, but still slowly.
November 13
I actually feel quite good. I did some stationary biking at the gym and I'm walking full speed on level ground and up and down stairs without holding the railing. I haven't tweaked the knee in a couple days at this point which implies the strength is coming back. Interestingly it's more sore/stiff than before, it almost seems like the swelling could be as much or more as in the early going.
The next markers will be when I feel like I can walk on uneven terrain, run and twist. I predict most of these within the week. I also predict the stiffness and soreness will last for about 4-6 weeks. I guess my big question is: if the initial recovery seems so rapid, why is there such a long tail to the whole healing process?
Updates
November 17
I'm walking pretty comfortably now and worrying less about slips and stuff.
The swelling is subsiding.
November 19
I was finally able to squat all the way down, but still with some pain. Before that, I couldn't get through the pain when my leg was fully bent. I'm also starting to test a light jogging step.
November 26
All this limping around caused an old hip strain to flare up with a vengeance.
Note: finally around Jan 9 it's starting to come under control. I've had to dig up all my old hip PT and work through it like a madman.
December 1
My PT decided to "push me" and see how I responded. I was able to do a number of more things than I thought I could, including even lateral movements over a low exercise dome. Unfortunately on the 2nd set I collapsed again, feeling the same pain I felt during the original injury. I was painful and a little limpy again for a day or two. I was able to walk the same as before, but there seemed to be more damage than before.
December 19
At my PT's recommendation I've scheduled an MRI. Using a Lachmann test, he was still unable to definitively feel my ACL. Two other PTs at the office were also unsure about the state of my knee. He also recommended some surgeons in case I needed them.
December 28
Went in for my MRI. The machine is loud. I received earplugs and headphones. The overall process is about 15 minutes, and about 15 minutes overhead for checkin, switching into MRI pants, paperwork.
December 29
I received a call from the tech that the doctor saw a tear in the ACL, so I needed to schedule a consult with an ortho surgeon. I called immediately and got an appointment for a week out.
January 2
Submitted an appointment request for a consult with Neil Roberts (USWNT team doctor).
January 5
I had a consult with Vincent Santoro. Overall impression of him was good, he didn't feel rushed and engaged me in solid conversation, answered all my questions, told me roughly what to expect. The tricky thing at this point is the scheduled trip to Hawaii (Feb 11-20). He did tell me that there was no immediate rush to get the surgery done with the caveat that I am more fragile until I get it. In other words I need to be careful like I've been thus far. I also heard back from Roberts' office and scheduled a consult with him for Jan 12.
January 6
Talked with Bryan who had his ACL done (almost 10 years ago). He called out that 4 weeks post surgery "walking across Key Arena was intense". This made me realize I had not been clear with Santoro about what I wanted to be able to do in Hawaii and I needed to clarify. We also hadn't actually discussed the graft details.
January 9
Called Santoro to cover extra questions. I decided that "can walk 1-2 miles on pavement and half a mile on a beach" were good estimations of the activity levels I wanted to be able to do. He told me no way, we'll do the surgery after Hawaii. He said at about 4 weeks out the graft is still too fragile and can get torn out inadvertently. We also talked about the graft. He recommends an allograft, explaining that they had gotten a bad rep because they used to be sterilized via irradiation (which weakened them). His supplier uses a chemical sterilization process which leaves them much more intact. The downside is the full healing timeline is closer to a year instead of 6 months with a patellar tendon. He didn't recommend the hamstring option, though he volunteered that he had a bias against them because he had two of them fail in his own knees.
The upside of delaying surgery is that I'll be predictably functional in Hawaii and I can spend the next 5-6 weeks rehabbing my hip in preparation for being limpy again post-surgery. If I get the surgery done right after I return from Hawaii, I'll have 9 weeks before Yellowstone. I still need to decide on allograft vs patellar tendon.
January 12
Consult with Neil Roberts. He's super thorough about details, explanations, etc. Left a very good impression. He also recommended an allograft as the top option. Also agreed that before Hawaii is too soon.
January 14
Went hardcore on hip and knee PT and working out in general. I added squats and deadlifts (with small weights, lots of reps) into the routine and that has helped a ton. As a result my hip is noticeably better. The weakness/issues seem tied to the state of my hamstrings. I'm no longer getting numbness down my leg when I sit, which is great. I can tell it's still not at 100%, but based on the previous injury I wouldn't be surprised if end-to-end healing was closer to 2 months (from late November, at the earliest). I do feel like I'm out of the woods though.
January 19
Scheduled surgery with Roberts on Feb 24, using an allograft. Until then I'll just do my PT, keep my hip strain in good shape and enjoy Hawaii.
I'm walking pretty comfortably now and worrying less about slips and stuff.
The swelling is subsiding.
November 19
I was finally able to squat all the way down, but still with some pain. Before that, I couldn't get through the pain when my leg was fully bent. I'm also starting to test a light jogging step.
November 26
All this limping around caused an old hip strain to flare up with a vengeance.
Note: finally around Jan 9 it's starting to come under control. I've had to dig up all my old hip PT and work through it like a madman.
December 1
My PT decided to "push me" and see how I responded. I was able to do a number of more things than I thought I could, including even lateral movements over a low exercise dome. Unfortunately on the 2nd set I collapsed again, feeling the same pain I felt during the original injury. I was painful and a little limpy again for a day or two. I was able to walk the same as before, but there seemed to be more damage than before.
December 19
At my PT's recommendation I've scheduled an MRI. Using a Lachmann test, he was still unable to definitively feel my ACL. Two other PTs at the office were also unsure about the state of my knee. He also recommended some surgeons in case I needed them.
December 28
Went in for my MRI. The machine is loud. I received earplugs and headphones. The overall process is about 15 minutes, and about 15 minutes overhead for checkin, switching into MRI pants, paperwork.
December 29
I received a call from the tech that the doctor saw a tear in the ACL, so I needed to schedule a consult with an ortho surgeon. I called immediately and got an appointment for a week out.
January 2
Submitted an appointment request for a consult with Neil Roberts (USWNT team doctor).
January 5
I had a consult with Vincent Santoro. Overall impression of him was good, he didn't feel rushed and engaged me in solid conversation, answered all my questions, told me roughly what to expect. The tricky thing at this point is the scheduled trip to Hawaii (Feb 11-20). He did tell me that there was no immediate rush to get the surgery done with the caveat that I am more fragile until I get it. In other words I need to be careful like I've been thus far. I also heard back from Roberts' office and scheduled a consult with him for Jan 12.
January 6
Talked with Bryan who had his ACL done (almost 10 years ago). He called out that 4 weeks post surgery "walking across Key Arena was intense". This made me realize I had not been clear with Santoro about what I wanted to be able to do in Hawaii and I needed to clarify. We also hadn't actually discussed the graft details.
January 9
Called Santoro to cover extra questions. I decided that "can walk 1-2 miles on pavement and half a mile on a beach" were good estimations of the activity levels I wanted to be able to do. He told me no way, we'll do the surgery after Hawaii. He said at about 4 weeks out the graft is still too fragile and can get torn out inadvertently. We also talked about the graft. He recommends an allograft, explaining that they had gotten a bad rep because they used to be sterilized via irradiation (which weakened them). His supplier uses a chemical sterilization process which leaves them much more intact. The downside is the full healing timeline is closer to a year instead of 6 months with a patellar tendon. He didn't recommend the hamstring option, though he volunteered that he had a bias against them because he had two of them fail in his own knees.
The upside of delaying surgery is that I'll be predictably functional in Hawaii and I can spend the next 5-6 weeks rehabbing my hip in preparation for being limpy again post-surgery. If I get the surgery done right after I return from Hawaii, I'll have 9 weeks before Yellowstone. I still need to decide on allograft vs patellar tendon.
January 12
Consult with Neil Roberts. He's super thorough about details, explanations, etc. Left a very good impression. He also recommended an allograft as the top option. Also agreed that before Hawaii is too soon.
January 14
Went hardcore on hip and knee PT and working out in general. I added squats and deadlifts (with small weights, lots of reps) into the routine and that has helped a ton. As a result my hip is noticeably better. The weakness/issues seem tied to the state of my hamstrings. I'm no longer getting numbness down my leg when I sit, which is great. I can tell it's still not at 100%, but based on the previous injury I wouldn't be surprised if end-to-end healing was closer to 2 months (from late November, at the earliest). I do feel like I'm out of the woods though.
January 19
Scheduled surgery with Roberts on Feb 24, using an allograft. Until then I'll just do my PT, keep my hip strain in good shape and enjoy Hawaii.
No comments:
Post a Comment