PT Hot Tip

On Sunday, I got a really nasty reminder that I’m old. (I know, that’s what mirrors are for.) My wife and I were going for an early morning bike ride and while I was waiting for her to get ready, I attempted to swing my leg over the bike and ended up lying in the middle of one lane of our county road. In a matter of a fraction of a second, I went from feeling pretty good for a 72-year-old man to feeling like someone had driven nails into my left knee. Just before the lights went out, I felt something pop in or near my left knee and the leg totally gave out; toppling me onto my back, bouncing my safely helmeted head off of the asphalt, and leaving me squirming on the road in pain. 

Getting back up without the use of my left leg was difficult. Once I was able to stand, I discovered I could flex my knee without much pain and my general leg strength seemed good. Being a guy, since I had started the day off expecting to go for a bike ride I went for a bike ride. Mostly, I did fine, but every time I stopped getting off and on the bike was painful. By the time I gave up and came back home, my left leg would barely support me and climbing the basement stairs was really painful. 

My wife had a knee replacement last fall and we still have the cold therapy machine the Mayo Clinic sent home with her. I used up a 15 pound bag of ice on the knee for the rest of Sunday. And I did lots of leg lifts with both legs, but especially the left one while I was trapped in a chair with the icing machine. 

The next day, Monday, I boiled my leg in the bathtub, first thing, and hobbled around doing what I could after loosening it up with some flexes, stretches, and leg lifts. Monday was a rough day. Any sort of side-load on the left leg brought shouting-level pain. My wife has struggled with knee pain for years and I was moving almost at her pace for the first time since I had a hip replaced in late 2011. My empathy for her problems and pain has always been moderated by her complete resistance to any serious physical therapy (PT). This injury gave me some direct and personal perspective on the pain she’s experienced, though. 

It wasn’t hard for me to imagine, though, that if this level of pain and disability lasted I might end up being a non-stop whiner. After a day of limping around and getting the occasional shock when I planted my left foot slightly off of dead flat, I was seriously thinking about a peg leg. It would take a lot for me to get used to going up and down stairs slowly and one-step-at-a-time. I mean, carefully lift the right foot to a step while using the handrail for at least 50% of my weight, then lifting the left foot to the same step, pause for pain recovery, and repeat. Between spurts of activity on Monday, I was in a chair, usually re-reading Jim Bouton’s Ball Four for the n-teenth time. Every moment I was in a chair, I was doing leg lifts. By the end of Monday, my leg was feeling much stronger, I had less pain, and it was obvious that my damage was in either a tendon or a muscle; not the actual knee or cartilage in that hinge. That is, by the way, usually the case with knee pain in the beginning. Let the muscle deterioration go one long enough, then you’ll start chewing through meniscus and causing destructive inflammation.  In retrospect, I think I strained or ruptured the lateral collateral ligament. 

Tuesday, I got out of bed, tentatively tested the knee while I sat on the edge of the bed, got up and on with my day, almost normally. By Tuesday morning, I would estimate that I had held my left leg in the air, unsupported by anything but the muscles necessary for that position, for at least 3 hours. For most of the day, I pretty much went through my normal tasks and activities normally. Any time there was a bit more than 10-15^o of outside side load (think bow-legged) I’d get a minor twinge reminder that I was still injured. Otherwise, I was most of the way back to normal. To the point that I hiked up our backyard hill to fill the bird feeders and do some construction work on the outside of the house; ladder work, even.

Wednesday, as I write this, I would say I am about 80% back-to-normal. Remember, that is a 72-year-old “normal,” so I’m unlikely to ever be a physical specimen anyone sentient would aspire to. Especially me. At noon today, I have racked up 8 hours of leg lifts since Sunday afternoon. As a matter of fact, my left leg is lifted as I write this and has been almost constantly since I began. 

And that is the “hot tip” I promised in the title of this essay; leg lifts for knee injuries.
 
35 years ago, I was bicycling to work 5-10 miles one-way almost every day in California. After a couple years of that, my knees hurt badly enough that I quit wearing long pants. The weight of the pants on my kneecaps was so painful that I could barely stand it. Like all good Californians, I went looking for an instant fix: surgery. Somewhere in that same period, I crashed my bicycle racing downhill and busted my left collarbone. I went through an extensive period of getting lousy advice from doctors and orthopedic surgeons before I finally lucked into a young sports medicine doctor. My collarbone had been fractured and unstable for almost a month by then and he convinced me that surgery, at this point, would be likely to fail. He prescribed a support brace that was actually strong enough that I wouldn’t be able to shrug is loose. He also gave me a PT routine that involved grinding the edges of the fracture to reopen the injury at the bone to restart the natural healing process. Within a month, the collarbone had fused, although fairly misaligned, and I was back on a bicycle and enjoying my screwed up knees again. I went to that same doctor about my knee pain. 

His advice was, since I spent a lot of my work days in meetings, anytime I’m seated “stick that leg out and hold it there as long as you can.” The idea was that bicycling is mostly an posterior (backside) muscle/tendon activity which strengthens those connective tissue structures until they overwhelm the functions of the anterior (front) muscles. That allows the patella, for example, to wander across the area it has traditionally been positioned, grinding up the ligaments and meniscus. The backside of the patella is grooved from years of wear and blood flow and those grooves align with similar wear on the connective tissue and meniscus. Allowing new position and movement of the patella uses those grooves as a sort of file. [I realize this is a really pitiful explanation of what really goes on. However, it is pretty close to the dumbed-down explanation my doctor provided and how his recommendation might correct my knee pain. 

He also said, if that didn’t work, we could always “try surgery.” 

So, 35 years ago I started sticking my leg out as straight and high as I could get it anytime I was at my desk, in a meeting, at a restaurant, or sitting down for any other reason. 35 years ago, that exercise absolutely fixed my knee pain. Even more incredibly, when I overstressed my knee this past week, a few hours of leg lifts helped me get back to my life in three freakin’ days. Now you know. 

I’ve given this advice to a half-dozen friends with knee pain in the last 30-some years and not a one of them has ever had to resort to knee surgery. On the other hand, I suspect my wife hasn’t done an hour of leg lifts in the last 30 years and she still has knee pain, had a knee replacement last fall that she still describes as “horrible,” and moves with lots of pain and general difficulty. Your choice, I guess. 

Blissful Ignorance?

When I started planning for the possibility of a hip replacement, I did what all geeks do in situations of ignorance; I went to the internet for advice. What I found was a lot of stories about hip replacements gone badly, unhappy patients, people who had gone from misery to more misery, and lots of legal sites trolling for patient-clients. That was a year ago. So, I decided to live with the pain and hope for the best. I made it through the summer, surviving a slightly lower MSF class load but ending the summer feeling my years and miles.

After I got back from my Lake Superior Circle with my brother, I was struggling. In a 1/2 mile walk, I was literally dragging my left leg for the last couple of blocks. After a day of work, I could hardly get out of the car and seriously considered spending the night in the garage rather than deal with the pain of trying to get my lame leg out of the car. Even with fairly consistent dieting and a year of physical therapy, I'd gained 30 pounds the previous year because it's tough to seriously burn calories without a working lower half. Last year, I added a lot of upper body cardio exercise to my routine and cut out even more of the casual part of my diet to get rid of about 25 pounds of lard, but I hit a plateau and the next 30 pounds stuck to me like it belonged there.

By early October, I'd come up with a surgery plan and started looking for a doc to perform it. I wanted a "resurfacing," in spite of the fact that is is a "new" procedure in the US, most US docs won't do it for over-60 patients, and, worst of all, the procedure wasn't invented here (it's Australian, like an awful lot of sports-oriented surgical procedures). Of the six guys who do resurfacing in Minnesota, five wouldn't talk to me at all because of my age; including the surgeon who had trained the other five surgeons. I made an appointment with the one guy who considered me a possible resurfacing candidate, but after reviewing my hip deterioration (too much bone loss) and making a judgement of my physical condition he said he wouldn't consider a resurfacing for me. In the end, I scheduled surgery for mid-December and started looking at how a total hip replacement would affect my life.

While I was considering the new plan, I looked into the company that made the prosthesis my doctor favored, the various surgical options, and anything else I thought was related. I know two guys who had hip replacements and their recovery has been less-than-inspiring. One has serious non-hip-related bone conditions that probably explains his progress and lack of same. The other is a classic American "patient": disinterested in the procedure's details, half-hearted about his doctor's physical therapy and medication, diet, and personal habits recommendations, and downright squeamish about the surgery. That seemed to be a characteristic of a lot of people who were complaining about their surgery's results. I kept looking and found two other people who had had hip replacements and were doing magnificently less than 6 months out from being cut. Both of those guys were conversant in the details of their surgery, were monster physical therapy junkies, and almost overwhelmed me with their insight of all aspects of being cut in a clinical environment and being in control of the recovery afterwards. They both set a standard of patient participation that I hoped to emulate.

Using their model, I went hunting in the weeks between being scheduled for surgery and the actual surgery date. I loaded up on background materials. One of the more education things I found was this Edheads hip replacement "video game" (link at left), which puts the player in the surgeon's seat. As a reference, neither of the poorly recovering patients could stomach playing surgeon (my favorite part of the video is the "pop" sound effect the animation uses when the leg dislocates from the pelvis socket) and both of the high-functioning ex-patients thought this site was the coolest thing on the web, although both criticized the procedure's technique as "out-dated."

Last month an old friend complained that "doctors are always treating symptoms with drugs etc. but never going after the root cause." I have to disagree, doctors have been going after the root cause, at least, since I was a kid. We've had the food pyramid, the diet plate, anti-smoking warnings, anti-lardass warnings, years of "get fit" encouragement, and everything short of boarding up fast food franchises and covering them with poison ivy, but Americans are uninterested in the symptoms. We want easy solutions. Blaming our health problems on unnatural food is like blaming our tanked economy on poor people; it requires a surreal perspective on reality and a massive math incapacity. Blaming the medical industry for focusing on repair procedures is as rational as blaming auto mechanics for buying tools and fixing busted cars instead of giving driving maintenance lessons. We're fat because we eat too much garbage and we exercise too little. We have crap-loads of problems recovering from surgical solutions to our poor health because we're lazy, ignorant, and squeamish (wimps, in plain language). I'd like to think that motorcyclists are an exception to this rule, but there is some serious pork on those Hogs and too many of us use our motorcycles like overpriced wheelchairs.

At four months out, I still have a ways to go to consider myself "recovered." I'm still old, overweight, and weaker than I should be. The older I get, the harder it seems to be to recover from anything. If I work everyday for a month to improve my physical conditioning, but take a couple of days off to relax on a weekend, I've lost ground. From here out, I suspect that will only get worse. However, this picture of John Turner (at 69), from 50 Athletes over 50 Teach Us to Live a Strong, Healthy Life, has been stuck in my head for more than a decade and it's evidence that if you have a little luck, work at it hard, and don't give in to gravity, you can go down fighting. We're all going down, eventually, the trick is to do it with style.

Back in the late 90's, I watched Dick Mann celebrate his 60th birthday by slaughtering the over-500cc competition on the vintage motocross track at Steamboat Springs. I'll never been Dick Mann, but I could do a lot better job of being Thomas Day.

Not a Baby Step

You know the bit about physical recovery coming in "baby steps?" It's mostly true. Every inch of my range of motion has been painful and slow. Going from barely being able to move my foot to moving my dead leg from the bed to the floor to walking with a cane to walking unassisted has been slow (8 weeks yesterday) and frustrating.

However, this event was nothing short of instant gratification. No, I didn't go anywhere. I didn't even start the bike. But swinging a leg over the WR is an accomplishment and it was effortless. This was the first confirmation I've had that I'll be riding this spring. If I can get on this bike, I can ride it.

My wife took this picture Saturday. Since then, I've been walking 2.5-3.5 miles a day and/or cranking the stationary bicycle for 30 minutes. Nothing like a goal to provide motivation.