Week 4 was a pretty quiet week. Not a whole lot changed from week 3. I used a little more weight and went a little bit longer on the elliptical. Also, the proprioception exercises got harder.
Post-op Day 22-28 (Week 4)
Routine schedule:
Day 22: ROM, Proprioception, Strength
Day 23: ROM, Conditioning, Proprioception
Day 24: ROM, Proprioception, Strength
Day 25: ROM, Conditioning, Proprioception
Day 26: ROM, Proprioception, Strength
Day 27: ROM, Conditioning, Proprioception
Day 28: ROM
Crutches
-Should be eliminated by end of the week.
> I definitely could have started walking sooner, and a lot people do, but I wanted to get in a day or two of walking in the pool before I completely opted out of crutches.
For me and what I need to do in my daily life, there isn’t much difference between walking with one crutch and walking with none. So why not take advantage of this and use the crutch a little longer?
Bracing
-Can be removed based on ability to walk with proper gait, no pain, etc. Be honest with yourself.
> I still wear my brace at night to make sure my leg never bends past 90 degrees.
Depending on your daily environment I might continue to have something on the knee, like an ace bandage. This continues to let your environment know you have an injury and to stay away from you.
Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)
-Extension: Maintain 5-7 degrees of hyperextension.
> This is still a bitch. Every-freakin-day I need to check this. And multiple times per day at that. My knee is that prone to tightening up and losing full extension.
-Flexion: Active flexion allowed only to 90 degrees. BUT, no RESISTED flexion allowed. Gradually improve passive between 0 and 125 degrees by end of week.
-Patellar mobilizations
-Sitting hamstring stretch
-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.
-Clamshells
-Straight leg raise
-Plantar flexion / dorsiflexion
-Hip flexion
-Hip adduction / abduction
-Seated knee extension 90-0 degrees
Strengthening
Day 22:
A1) Squat to 45 degrees 4 x6-8r (15 lbs)
A2) RDL 4 x6-8r (25 lbs)
B1) Single leg leg press to 45 degrees 3 x10-12r (27 lbs)
B2) Glute Bridges 3 x10-12r
C) Single leg Calves w/Leg Press 4 x6-8r (27 lbs)
Day 24:
A1) Squat to 45 degrees 4 x6-8r (10 lbs)
A2) RDL 4 x6-8r (25 lbs)
B1) Single leg leg press to 45 degrees 3 x10-12r (35 lbs)
B2) Glute Bridges 3 x10-12r
C) Single leg Calves w/Leg Press 4 x6-8r (35 lbs)
Day 26:
A1) Squat to 45 degrees 4 x6-8r (15 lbs)
A2) RDL 4 x6-8r (30 lbs)
B1) Single leg leg press to 45 degrees 3 x10-12r (35 lbs)
B2) Glute Bridges 3 x10-12r
C) Single leg Calves w/Leg Press 4 x6-8r (35 lbs)
Proprioception
-Weight shifts eyes open and eyes closed
-Weight shifts on bosu ball.
–Single leg standing with knee straight; unsupported.
> Works on balancing on one leg. Something that was pretty hard for me.
Conditioning
-Elliptical
– > Day 23, 25 and 27 were 15 minutes, 20 minutes and 22 minutes
-Pool– Walking all directions
Nutrition
Calories = Bodyweight x 15 x 1.10 on strength days.
Calories = Bodyweight x 10 on other days.
Protein always high.
Nik
August 22, 2015
Hey Brian, I am at week 3.5. So far so good. I am at 0 extension, maybe -1 (trying to get to -3 which I was told is my other leg). Towards end of week 3 I got to 120 flexion. Been walking at home without the brace and using it outside and when I sleep. Sleeping with brace sucks! Knee still feels stiff but seems to loosen a bit with every day going by. Almost no limping without the brace, definitely limping with it, its kinda suffocating wearing it. My swelling is about 25% of what it used to be after surgery. I am actually able to see my knee cap and part of my quad. Basically working out everyday all the time, doing stuff and feeling pretty good overall. Gym, everyday – bike, elliptical, stair master, etc Things are getting easier with every single day even if its just small steps. Now, the funky part. After stitches were removed at 2 weeks, i started massaging my scars probably about 4 days after. Still by now I am definitely feeling some scar tissue forming right on the surface of the patella underneath 3 of the small holes they did for the arthroscopy. Scar tissue is probably the size of a pea. I am massaging multiple times a day and starting to use bio oil. Sometimes it hurts sometimes it doesn’t. Definitely getting the “crunchy” effect a lot of people talk about when I flex at random times. Sometimes I feel like I have small bubbles inside and they almost lock my knee at a certain degree of flex in one direction. PT told me to go back and forth a few times to sort of unlock it. It works, but my question is, would this eventually disappear the more I work on it and move and massage? Is this something to worry about? Obviously this is not the massive amount of scar tissue some people report to have inside their knees which later on needs to be operated on and removed but still I want to find out what else I can do while I am still at relatively early stages of all this.
Thank you!
reddyb
August 25, 2015
Hey Nik,
-You may want to entertain getting around during the day with a wrap on the leg rather a brace now. It’s good to have something on the leg, as it serves as a reminder to you and your environment “Don’t F with me, I have a recovering leg.” But I, along with many others, disdain that damn brace.
-Have you seen this post? http://b-reddy.org/2014/07/14/whats-up-with-the-noise-my-knee-makes/
-So long as you’re keeping the rehab going solidly, it sounds like you’re off to a great start, you’re likely to have no issues from a scar tissue perspective. Scar tissue *is* normal though. You had a lot done to your leg, and scar tissue is part of the deal. Scar tissue isn’t always bad though. It’s not like it can’t move. For instance, here’s a study showing scar tissue formation not impacting hamstring strain recovery: http://www.ncbi.nlm.nih.gov/pubmed/25748473
Overall, as time goes on, the knee may very well feel a little different, both mentally and palpatively, and or sound a little different. Often nothing to worry about.
Nik
August 27, 2015
Thanks Brian! Will take a look at everything you sent!
reddyb
August 27, 2015
Sure thing.