Old Runner Frank

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Don, how did your visit with the doc go? Does he think you're progressing well?

I, too, am a lifelong runner. I did a lot of walking during my down time. I couldn't bend my leg enough to ride a bike until almost four months after my surgery. I was able to start "running" (really, a slow jog) at around four months. Before that, I put in some time on the elliptical trainer, which I found helpful and somewhat satisfying. Have you tried that? I am envious of your ROM, as I'm still struggling to gain the last 10 degrees or so of mine.

I would agree that given your history, you should be careful about putting a lot of strain on your knee until around 6 months and when you have the OK from your doc.

Good luck to you!
 

martyg

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See the Doc tomorrow. What questions should I ask? At the 12 week mark. Pretty close to full ROM 120/140. Little strength in leg. There is some swelling and soreness around knee but nothing major.
Still clumsy walking down stairs and even going up the strength is not all there.
Need some more balance work. Want to avoid activities like lunging? Or other exercises that can not help recovery.
I can not run. I try but the bad leg just wont cooperate. Walking faster is happening so I hope jogging may be something that can be done soon. ( I am a life long runner).
Biking - been spinning but with no resistance which does not do that much. I actually get a higher heart rate from walking.
Thinking yoga exercises and Pilates are needed more. Afraid of lunging knee stretches though.

Your doctor is now out of their element. This is your PT 's domain.
 

martyg

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I would agree that given your history, you should be careful about putting a lot of strain on your knee until around 6 months and when you have the OK from your doc.

Don't agree with that. The most profound cellular changes will happen within 12 weeks of surgery. That is when controlled stressing has to occur. Otherwise collegen does not lay down and allign properly to create a robust repair.

At 6 months you should be hammering, but in a controlled fashion, and in the gym. So much of what I read in this thread is people wanting to get back to normal life, and normal activities. This is a 12 month process, with a very well defined protocol. Yeah, it sucks. Yeah, you can cheat it. However you are not doing yourself any favors, and risking reinjury.
 

peter826

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I'm at 17 months. I agree that this a year long process -- or more. You'll be amazed at how well you feel at a year, and look back and think how weak you were even at six months. I "graduated" from physical therapy with good ROM, because that was what we worked, but incredibly weak. I've been working on that ever since, and it is still getting better this far in. My doctor tried to tell me that everything would be pretty normal at six months, clearly not the case. Maybe they have to say that so people don't get depressed. Keep after it, it will get better with time.
 

martyg

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I'm at 17 months. I agree that this a year long process -- or more. You'll be amazed at how well you feel at a year, and look back and think how weak you were even at six months. I "graduated" from physical therapy with good ROM, because that was what we worked, but incredibly weak. I've been working on that ever since, and it is still getting better this far in. My doctor tried to tell me that everything would be pretty normal at six months, clearly not the case. Maybe they have to say that so people don't get depressed. Keep after it, it will get better with time.

My sense is that "pretty normal" is doctor speak for day-to-day activities. In my case, that was definitely true. Getting in and out of cars, stairs, getting off the toilet, etc. were all normal.

Performance, however, is so off. At 8 months I am pushing the fine line between muscle growth and overtraining. I have no prob turning myself inside out with workouts. And can manage that fine line when structurally sound. This is a different thing for me altogether. If I go too hard, my joint capsule just feels janky. The other week I had a number of hard days, above timberline. Mostly off trail and overland, and with pack. My knee was not happy after three days.

As much as I 'd like to be ticking off high alpine objectives and enjoying all day high alpine mtn bike rides, I am finding that it really has to be all about the gym, and recovery pace rides on the bike. I am probably 85 days from being on skis, so I am working towards that goal.

At 8 months strength and ROM is maybe 90%. It feels like gaining that last 10% if going to be a battle. Without racing, and going hard on the bike, my overall fitness has suffered. I am definitely more "gym fit", than my usual level of fitness.
 
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Don379

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Good replies ! My Doc liked what he saw in knee, did confirm the discussion points that this is a Year long heal. And to take caution in recovery. PT then have stair and ROM strengthening exercises.
I can spin inside but am cautioned to ride outside for work out. Have been doing the leg extensions (down only) with 15 pounds - which is fine. Will introduce some light leg presses. Squats are fine. Lunging not so good. Running I can't do yet, glad to hear I should wait longer, PT said same.

This is not a simple or fast heal/recovery process and I am slowly accepting that. My day to day functions are fine, there is stiffness and soreness (low) in knee which is expected still.

Glad to have a support forum here. Reaffirms or points in ways to focus and cope with this tendon! Thanks everybody!!!
 

martyg

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Good replies ! My Doc liked what he saw in knee, did confirm the discussion points that this is a Year long heal. And to take caution in recovery. PT then have stair and ROM strengthening exercises.
I can spin inside but am cautioned to ride outside for work out. Have been doing the leg extensions (down only) with 15 pounds - which is fine. Will introduce some light leg presses. Squats are fine. Lunging not so good. Running I can't do yet, glad to hear I should wait longer, PT said same.

This is not a simple or fast heal/recovery process and I am slowly accepting that. My day to day functions are fine, there is stiffness and soreness (low) in knee which is expected still.

Glad to have a support forum here. Reaffirms or points in ways to focus and cope with this tendon! Thanks everybody!!!

Look at split squats before lunges. Once split squats are solid introduce risers so that your front foot is elevated. Then add a bit of weight in the form of dumbells. Once you master that, at 6ish months, it will likely be time to start plyometrics and explosive movements - all on the advise and schedule of your PT.
 

Old Runner Frank

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Peter, I appreciate your taking the time to check back here after nearly a year and a half to provide guidance and inspiration. Glad to hear that you're doing so well.

Don, good to hear that things are coming along for you. That has to be a real test of mental toughness, to endure a second recovery from a recurrence of your injury. I should mention that when I started back "running" after four months, it was a really slow jog, but it's gotten better in the months since then. So hang in there and don't get discouraged.

Marty, you sound extremely knowledgeable. Curious about your background? Our injuries are only about a week apart, so it's interesting to hear of your progress.

Subjectively, I feel like my knee is really strong and stable. I have not measured specifically how much weight I can lift with it, but functionally, it seems OK. But I feel like I'm still stuck at about ten degrees short of full ROM (as compared to the other leg). My options at this point appear to be:
1. Keep trying to stretch it, but it feels like I'm not making any measurable progress with that.
2. Have arthroscopic surgery to remove scar tissue, followed by another round of PT.
3. Learn to live with it as it is.

I've made inquires with a couple of other PT places to see if they have any additional treatment modalities to offer. Any further thoughts on this would be welcomed.

Best regards to all.
 

martyg

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Marty, you sound extremely knowledgeable. Curious about your background? Our injuries are only about a week apart, so it's interesting to hear of your progress.

Lots of time performing at a high level, training under various national team coaches, and having USOC resources available to me.

My wife is also a full-time trainer. Many of our town's top PTs refer clients to her, post PT care (and our town has more world champions, Olympians, national champions, etc. than any other town, per capita, in the US). Between that network, and my network, I have really smart people to chat with in this domain.
 

Old Runner Frank

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As I still struggle to regain my last twenty degrees or so of ROM, I've started a different treatment modality. EPAT (a form of ESWT) uses shock waves to break up scar tissue, which I presume is what is holding me back. Treatment is done using a device that looks like something between a high-powered massager and a jack hammer. Had my first treatment a few days ago, and while I did not notice dramatic improvement, I was told it would take several treatments over 4-6 weeks before I saw significant progress. The session was only mildly uncomfortable, not even close to painful.

I'll check back to post my progress as treatment continues.
 

peter826

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18 months! I should probably stop checking in. I spent last week in Portugal, mostly in Lisbon and Porto. Lisbon is all hills...and they are steep. Lots of stairs, too -- stayed on the 5th floor of a building, no elevator. I had to haul all my crap around on my back. So...my one weakness had been stairs, hills, etc. The knee came through like a champ. All the hard work pays off in the end. Hope everyone else is doing well.
 

Old Runner Frank

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Peter, it's good to hear that at 18 months you are living a normal life, and your knee can handle the rigors of hauling weighted gear up and down hills and steps.

I had my third EPAT treatment a couple of days ago. I neglected to mention in my previous post that the procedure is not covered by insurance, but I was offered a discount if I did PT with it. Sounded like a good deal, so I'm having a new round of PT with different folks with some slightly different approaches.

I would love to say that I have seen dramatic improvement, but the reality is that things are mostly unchanged. Plus, while I thought my ROM was around 120 degrees, I've been measured several times recently, and I'm consistently in the 110-115 range. So I'm still looking to add 25 or so degrees.

That's it for now. Best regards to all. ORF
 

Old Runner Frank

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Frank, how does the lesser ROM impact you day-to-day? Is it even noticeable?
Peter, that's a damn good question, to which I have given much thought. I would say it really only affects me a little bit doing things like trying to get socks on and off, going down steps, and on certain stretches that involve bending my leg.
Also, I feel it has affected my running stride, making it tighter and shorter than it was already getting due to my advancing age. Are those worth undergoing another surgery, another period of convalescence, and more rehab? I'm not sure. But to me, it's worth spending a few hundred bucks and a few hours time to try a non-invasive therapy that might help.
 

Old Runner Frank

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Just wanted to update this to say that I had my fourth EPAT session last week (plus, I've had a couple of PT visits a week for the past few weeks), and my knee hasn't budged. So I'm back to Peter's question: How much does it affect my life? Do I try something else, or just learn to live with it?

If anyone else can provide any thoughts on further options, I would love to hear them.
 

Don379

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ORF, you continue to embrace any setback (mentally at least). Keep moving at all costs. I just started with swimming lessons, which needs a lot of ankle turn and coordination between quads hamstrings and arm stroke. A bit uncoordinated but a different focus. I would like to try to run am know at 4 months. I have range of motion but strength is probably at 50-80% of good leg.
So learn to live with what you have, but don't give in to any setback unless it furthers injury etc. I like the stretch where I lay face down on floor and use rope to pull bad leg up and hold - which seems to help range. In some respects both my legs knee range was never that good to begin with too, probably form running alot.
 

Don379

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My knee has been swelling. I am not sure if it is the tendon or other cartilage meniscus ? problem. Range of motion is ok, been swimming, biking and weights.
 

peter826

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Are you pushing it too hard? I never had any swelling, at least that far along, but it took many months for my knee to more closely resemble the uninjured one..so I think there was a lot of residual swelling just from the surgery.

I am perhaps the poster child for long slow recovery...I keep making gains even at almost 19 months.

Frank, any more luck on the ROM? I was thinking about where I reach max ROM, and for me it's mostly only when doing things like kneeling down and sitting back. Actually, my PT told me I was unlikely to ever be able to do that, but I took it as a bit of a challenge, and it's not a problem for me.
 

Old Runner Frank

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Don and Peter, thanks so much for your interest in my recovery. I had my sixth and final EPAT treatment yesterday, which coincidentally marked 10 months since my injury. While the folks at Trinity Rehab were very kind and caring, and used some approaches that were new to me, my knee did not budge. So I'm stuck at around 110-115 degrees ROM (not even the 120 degrees I previously thought). I'm considering getting a second opinion from another orthopedist to see if he or she agrees that it is scar tissue that is holding me back, and if so, would another surgery be likely to correct it. Also, I would inquire if there are any other treatments that might be feasible, like deep tissue massage.

Alternatively, I could just decide to live with it. It's really not much of a burden. It can sometimes be a bit uncomfortable going down steps, especially first thing in the morning; and I feel like it might be limiting my stride length somewhat when I'm running. But at nearly 70 years of age, I would have to grudgingly concede that my days of fast running and competition are just a distant memory. Lol!

Don, be careful with that swelling. Is there much pain, and if so, where is it located? Never hurts to ice it. I've mentioned that I developed pain in a different spot on the same knee which turned out to be a meniscus tear. Fortunately, I was able to work through it, and it has been fine now for several months.

Peter, glad to hear that you're still continuing to improve after over a year and a half. Thanks for being kind enough to check in here from time to time. I believe my limitation is now in the same range that you are describing.

Marty, have not heard from you in quite awhile. How are you coming along? Ready to hit the slopes again in another month or two?
 

n0ragrace

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ORF, have you had an xray or any kind of imaging to see the potential scar tissue that's holding back your scar tissue? I had some imaging done in April and discovered that a bone spur actually grew within my tendon as it healed and expanded - I guess it was my body's way of healing as quickly as possible since my bone was also impacted due to the suture drilling? Something to consider if you are asking for a second opinion.
 
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