And now I’m at 3 weeks post op! For context: my surgery was on a Friday – so my weekly benchmarks logically fall on Fridays.
I’ve had a busy week comparatively speaking – I actually got to get out of my apartment to DO things.
Last Sunday I met up with a friend at the cafe in my neighborhood to grab a treat – there were no seats there I could use comfortably so we just strolled back to my apartment building and chatted for a few hours. After that I was picked up by some of the ladies so I could hang with them during the Sunday ladies BJJ class. I told them to start jogging for warmups and they unanimously rebelled against my authority – presenting the logic that I’m going to be pent up and angry when I get back on the mats anyhow, so it doesn’t matter if they make me mad at them now or not. I respect the logic and therefore am not angry. It was really nice to get out and see people I care about again after being locked away for two weeks!
Monday I had physical therapy and told her I had a concern about my incisions. I had been told when my stiches were removed the previous Tuesday, that they were putting the steri-strips on just for a couple extra days and then they could be removed. That seemed a bit off from how I remembered steri-strips working, but I always follow directions, so I removed them from the lower less angry incision that Friday evening. That one looked good but when I went to remove them from one of the upper ones it was still open – so I covered it back up quickly but was worried that I had messed with the integrity of it. My physical therapist confirmed that my lower incision was closed up nicely and said that the upper one that I had tried to remove tends to take longer to close up because it’s an area of more movement – it was also a lot more swollen and a larger incision since it was one of the primary entry portals. She made sure there were no signs up infection and reapplied fresh steri-strips for me. We are just going to leave those on until they show signs of wanting to fall off on their own this time.
Monday afternoon I got a text message from my coach to let me know that he had gotten back into town from the Jiu Jitsu world championship and was going to promote my teammate, Ray, that evening in class. I have known Ray since I first started training (he was in our kids’ program), and I told coach that if he didn’t find a way to get me over to the gym I would be severely upset and never let him forget it. He was super busy but knows I don’t raise a stink very often, so made the trip out to pick me up before class. It was pretty exhausting hanging around, but one hundred percent worth being there to celebrate. Congratulations Ray!
Tuesday was my first day going back into the office after over two weeks of working remotely from my apartment. The hardest hurdle for being in the office is trying to figure out how to handle the 8-5 office hours schedule when I’m not supposed to be sitting for extended periods of time – and I can only stand for so long really. We decided to try this setup using a comfy chair from a coworker’s office. It worked pretty well for the first half of the day but was getting pretty achy on the hip for the second half of the day and I ended up needing to be taken home a little bit early.
Here’s where it gets a bit tricky for me. Even pre-surgery I can’t drive myself due to a permanent disability. So, in order to get into the office, I need to get a ride into work. Usually, it works out to where a coworker or my coach is able to pick me up on their way in and then I hitch a ride home afterwards usually after evening jiu jitsu training since the academy is in the same building. I live fairly close by and seasonal biking is great when I’m uninjured! On off days I take an uber. Currently I’m unable to ride uber to and from work because I have to ride in the front seat (due to hip movement restrictions), and I am unable to juggle my crutches and my dog while safely getting myself in and out of an Uber. A friend driving me won’t mind holding Dmitri – but a random uber driver might not be so chill about it. So, I’m highly dependent on someone consistently being able to pick me up and drop me off for work.
Tuesday ended up working out okay although a bit uncomfortable, so I spent some time stretched on my stomach that evening and decided on a plan for Wednesday.
Wednesday, I asked a coworker to place an extra cushion on the chair so that I could sit a bit higher and at less of an angle for my hip. This definitely helped from the start, and I also tried walking around a bit more as well, so I was hopeful! It was unfortunately still too much culminated sitting time that I think snowballed onto the sitting time from the previous day. I hid my discomfort as well as I could and tried to see about finding a ride home when the office closed at 5, but it was a very busy evening unfortunately for everyone, so I ended up stuck which was quite frustrating and it did make me break down for the first time since surgery (I’m sure there will be others coming). My Jiu Jitsu academy is in the same building, so I waited around for the 5:30 class to end at 6:30 and one of my teammates was able to give me a ride home. I loaded up my frozen water bottles in my ice machine for the first time in over a week to wrap up my hip and went to sleep like that.
Thursday was a physical therapy day. I had established that PT days were going to be work from home days because of the logistics of interrupting coworkers’ workflow to get them to come pick me up after my sessions when all my work can be done from home anyhow. She checked in on my incisions and said they are looking good still. I mentioned the past two days in the office to my therapist and her professional recommendation was to work from home as much possible until I’m at least off crutches and have some better range of hip motion for sitting. Thankfully my workplace is extremely accommodating and has given me the green light to take the time I need – especially since my work can be done from anywhere. I do prefer to be in the office for efficiency and communication purposes, but recovery is important so I’m going to rein myself in here.
Speaking of PT:
I haven’t gone into much detail on what that is looking like so I’ll summarize a little bit. I did a lot of reading and research and noticed that most post-op therapy schedules were all variations of the same theme. Some have you using stationary bikes right out of surgery, some have you using resistance bands, some have you non-weight bearing, etc. The similarities are that the first few weeks are all about keeping the muscles moving, preventing adhesions/controlling inflammation response, and protecting the surgical repair work while it heals. The differences are in how they approach these goals and you should follow the protocols laid out by your surgeon and his team – you trusted them enough to let them do surgery on you, you should trust that they know how their work will heal best. Disclaimer: discomfort is to be expected, but if you’re in pain bring it up of course.
My PT clinic is attached to/downstairs from my surgeon’s office, and they can even read each other’s notes in my file which is very nice for communication. So far it appears that my first 4 weeks is a very strict table work only protocol – no weight bearing in PT since I’m strictly 50% weight bearing on crutches for the entire 4 weeks regardless of how I feel. I’m told that after next Friday we can start working on weaning down to one crutch and if I’m doing well, we can work off to none at all, but it will be very slow so long as I’m not limping or having any other gait issues.
My table work generally starts with doing some warmup mobility work. Heel slides don’t do much for me since I was comfortable with 85 degrees flexion in my hip in my first day in PT and am not allowed to flex past 90 yet, hip internal rotation reps (not allowed any external rotation yet), prone quad stretches which feel amazing, holding cobra pose which also feels amazing. For strength I currently have a base lineup of isotonic glute squeezes, quad squeezes, hamstring digs into the table, adductors against a ball, abductors with a strap around the thighs. In the past week we have started adding some more movement in the shape of hamstring mobility curls on one of those large exercise balls (only flexed to 90 degrees of course and no lifting of the hips), and then using the same exercise ball braced against the knees to crunch against while on my back to maintain my 90-degree limitation while still getting to activate my core. I also get to do quad extension reps with an ankle weight while sitting with my leg dangling off the edge of the table.
One of the new exercises we added yesterday was prone hamstring curls with the ankle weight. That one felt good on my quad since I have the mobility to get a counter stretch on my quad as well as quad activation at the top before handing the muscle activation back to my hamstring. The other exercise we added in that my PT was very happy I did well with was bridges – I knew it was coming eventually and she had me do 20 with a 3 second hold at the top.
At some point in the middle of all of this my therapist will do some manual therapy on me as well. She is usually overseeing 2-3 people at the same time with the help of 1-2 assistants. Currently manual therapy for me consists of passive range of motion with her moving my leg around and feeling for any restrictions in my range of motion and then checking my quad and IT band to make sure I’m not developing any tightness that could be a sign of things to look out for. This part will probably get more uncomfortable for me in a couple weeks when I’m clear of the majority of my hip movement restrictions – but for right now I don’t really feel anything besides a very slight pull at most extreme of allowable angles. She was already comfortably flexing my hip at 85 degrees 3 days post-op and again at 90 degrees my following session.
All together therapy generally lasts about an hour. I have the option to use the game ready ice machine at the end as well for a bonus 10-15 or so minutes but I haven’t taken them up on this offer as of yet since we aren’t doing anything really inflammatory at this stage of rehab. I’m anticipating things getting spicy later on once my post-op protective restrictions loosen up.
Other Closing Tidbits
I’ve now met my out of pocket maximum now with my insurance provider which is super nice and means I should not be paying any more medical expenses for the rest of the year thanks to an insurance plan with excellent coverage. I’m really thankful to have great insurance coverage through my employer – he makes sure we have high quality coverage! I was able to pay for all surgery and associated costs with less than one paycheck thanks to that – certainly a far cry from the financial hole my knee surgery put me into (I’m still paying off some if it!)
So for today, Friday, I was working from home. In Nashville it is CMA fest weekend as well as several other big events in town, so we are going to be cancelling our usual ladies’ class this weekend because navigating the city is going to be a nightmare. I already had groceries delivered and am stocked up for the weekend. I have one more week of being guaranteed on full usage crutches – I was worried that I was wearing out the tips, so I bought some new ones. A friend of mine loaned me the crutches and I didn’t want to give them back to her entirely mangled so I figured she would appreciate them being a bit prettier than just standard gray.
I see my surgeon again in about 4 weeks on July 8th. He told me originally that his plan for me was to have a very staged 3-4 months time period of physical therapy and then I’d be released back to doing whatever I want 6 months after surgery – which would be in November. I plan to ask him his thoughts about me competing in the European Championships in January now that they are finally back in Lisbon. I imagine he will probably tell me to wait and see how I’m doing a little closer to the date, but I do so like to have a concrete goal to help keep me focused on the process.
Of course, I do also know that a surgeon’s release to activity essentially just means that I am no longer in danger of ruining the reconstruction work that he did in my joint. There will still be a longer rebuilding and recovery process that will take some time afterwards. When I had my knee surgery it took a solid year after my surgeon gave me his “return to play” release before I really felt like I was back to full functional useability again. I have similar expectations for this process, and it seems to ring true with what I have read online about other people’s experiences.
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Coach's Killer 