To: lira-kin@flick.com

Subject: Another knee update...


Date: Thu, 05 Mar 1998 17:19:47 -0800

The knee is progressing nicely.

My health insurance changed at the beginning of March, so my Group Health medical, which I've had for more than ten years now, ended at the end of February. So I went through a lot of doctor stuff through the latter part of February, including a full physical and everything else. I also decided that I wasn't going to get operated on by Group Health and then have to get physical therapy elsewhere, so didn't really tell Dr. Knight about my insurance change until the end of the month.

He did, however, recommend some physical therapy before the end of the month, and I did get to go, with John, to see what there was that I should do about my knee while figuring out the surgery options. It was a very good thing that I did.

I've been getting around okay. Walking, biking about every other day on the exercise bicycles.

The biking hurt for about the first hundred rounds. I'd follow the right pedal with my right foot for the first fifty, then put just part of my foot on the pedal for the parts of the round that could be done, but it was awkward, painful, and sometimes jolting on the joint. But it was doable. Even when I was in San Fransisco and San Ramon for business and fun, I actually went to the hotel exercise rooms and pedalled away to odd music, TV shows and the sounds of kids screaming in the pool. It didn't seem to get much better, even though I was exercising regularly.

The good thing was that kept up some of my conditioning from soccer, worked out my muscles and kept some of my thigh muscles from atrophing too much. The bad thing was that it was starting to hurt often enough and consistantly enough that those first ten minutes were gradually building into a bigger and bigger barrier for getting on the bike at all. That was no good. They often say that it isn't the pain itself that makes torture so effective, it's the memory of pain and the anticipation of it that breaks people. I'll readily admit that I was at a point where I was starting to avoid the bikes when I had any excuse to, which would have been really unfortunate.

The other problem that I'd run into was the simple fact that my leg would not straighten. I found myself, by the end of the day, mostly on the ball of my right foot, with aching calves on both legs, and a crick in my back for trying to compensate. Not good for a long-run kinda thing.

So, in comes the lady Physical Therapist at Group Health. I don't even know her name, sadly, I'm lousey with names, but she made a huge difference with just one concept: Pain, at this point, is okay to ignore, and, at this point, even something to be encouraged in order to get full range of motion in my knee.

The difference it's made is huge.

The biggest is that I can now consciously put my joint under steady, controlled exercises that I know will help it and that the pain that's involved is entirely under my control rather than being inflicted at random by a process that I wasn't too sure of in the first place.

The first order of business was to straighten my leg. That's all there was to it, too. Lie down with my leg on the floor and use my quads to try and straighten it, gradually, slowly, completely. Then prop my ankle up on a roll of towel or something and try and straighten it some more. The pressure of fluids in the knee would push against that, cause some steady pain, but pushing against that was good. So I could and did. In just the first day, I straightened my leg enough that, for the first time in a month, my calf could touch the ground.

Turns out that with all my walking around with a bent knee, I was doing some slight extra damage to the ends of my leg bones that came to the knee because each impact was on the joint when it wasn't straight. Normally, when the heel hits the ground in a step, the leg is straight and the bones aligned with each other to take the impact in the way it's built to be taken. With the knee bent slightly, the bones were at angle to each other and the joint was taking the impact in the wrong places.

I also had a bone bruise in the joint as well, and those impacts were not making that any happier. So, knowing that, I started to walk heel then toe rather than the slide along the ball of my foot way that I'd been doing.

I quickly found out what an ACL is for the minute I actually got my leg straightened out. My joint started sliding in startling ways. So it definitely looks like I'm going to have to go through the surgery, there isn't really any other way around it. It feels bad enough that I find myself walking with that knee bent unconsciously trying to keep control of the joint even when I can't, really.

The other half of the equation was getting my knee to bend. Since the accident I've been unable to bend my knee enough to pull my leg into the car after I sit in it without levering myself up and out of the seat enough to give my leg the room to swing in. After just a few days of doing the bending exercises I'm now not only able to do that, but I can get on the exercise bicycles with no pain whatsoever by getting the leg to bend enough to accomidate the full circle of the bike first. That was most excellent.

What's funny is that all the exercises are relatively simple. The bending exercise simply has me sit in a chair and pull my foot in as close to my body as it will go. Go to the point of resistance and then rest there for a count of five and let it relax into that position. Then let it loose and then do it again, and if it now lets me get the foot closer, move it closer, again to the point of pressure and then slowly stretch and relax into it. I can now get my foot *under* my chair.

What's odd is the feeling of being able to deliberately seek out the pain and defeat it. Rather than getting victimized by it when I'm trying to do something else, this is something that I can attack up front, get it over with under my terms and then do what I want to do. That seems to be making all the difference.

So. Sometime in the next week or so I'll be contacting a local doctor that's known to specialize in ACL surgery. I've had three seperate recommendations of the same doctor, so I'm fairly sure that he is the best in the area for the problem that I have. The insurance should take care of nearly all of it, and I should get into real physical therapy soon after the surgery. But it's really good to know all the steps, now.

All in all, I seem to be getting gradually better for the nonce, and while it is pretty bothersome to not always be able to do what I want to do, it's far better than it was.

I got to watch a soccer game the other day and realized that for all that I've been kinda happy to get into the nice, safe environment of just pedelling away on a bicycle rather than having people trying to run me over on the soccer field, that I would far rather be out there playing. Ah well. It looks like, with time and effort, that I'll be getting there. So that's good.

© 1998 by Liralen Li.

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