1 Month, 9 Days

Friday was the final PT session with this therapist, and from next week I'll be starting sessions with my old therapist. We did:

1. Stationary bike, 5 min, 106 RPM, 139 BPM, 141 W.
2. Leg raises, 2 x 15 repetitions.
3. Heel pulls, 2 x 10 repetitions.
4. Balance with opposite leg extensions on the foam pad, 2 x 6 repetitions.
5. Shallow single-legged squats on the foam pad, 1 x 10.
6. Leg abductions with the elastic band, 2 x 15.
7. Squats leaning on the Pilates ball, 2 x 15.
8. Massage.

Yesterday I went for a ride on a bike-share bike again; seven minutes around the block, light tempo but a little faster than last time - I even switched to second gear out of seven when I got some momentum going. The knee feels OK, there is no pain and it's tracking straight. However, I can feel that pushing harder with the other leg, sparing the bad one. I think that's to be expected, but I'll try to make sure it doesn't become a habit.

Here's an overview of the current stage in my recovery:

• Finished the first block of physiotherapy where I had 9 sessions spread over two weeks; the next block will include 9 sessions with one session per week.
• I'm doing a combination of glute and quad exercises daily using an elastic band, balance board and exercise ball (with one rest day per week).
• I'm also doing hamstring and glute stretches daily; I occasionally try to do hip flexor and TFL stretches, but at the moment they still cause some pain in the left knee before I feel the stretch in the actual muscles I'm targeting.
• I can walk up stairs one and two steps at a time.
• I can walk and even run down stairs (not super fast though).
• I can walk at a fairly quick pace, around 7-8 minutes for a kilometer for a couple of kilometers or more.
• I can ride a stationary bike for five minutes about as hard as my current cardio conditioning allows me with no limitation from the knee.
• I can ride an actual bike outside at a fairly easy pace (no idea of the speed); if I push harder, I start loading the good leg more.
• I can swim breaststroke and crawl as long as I don't try to push too hard with the legs.
• I think the hematoma at the incision site is completely gone; some swelling appears if I spend a lot of time on my feet and disappears with rest, ice and/or NSAIDs.
• There is a hard bump in the area of the incision that feels different than the hematoma on touch; not sure what it is.
• I still can't really run - the last time I tried I did some ten-fifteen meters at a jogging pace and I could have gone further but it was with a pronounced hobble and each step hurt, not too much but enough that I was unwilling to push it further.

1 Month, 5 Days

Three day update! There's less change day to day nowadays, so I'll be doing to around two updates a week from now on.

The previous two days I again spent too much time on my feet so I again went lighter with exercises that load the knees, focusing instead on the hip abductors. Today was PT day, we did the following:

1. Stationary bike, same resistance as last time, 5 min, 105 RPM, 137 BPM, 141 W.
2. Balance on the foam pad.
3. Balance with leg extensions, 7 + 6 repetitions.
4. Shallow single-legged squats on the foam pad, 7 + 9 repetitions.
5. Squats with the exercise ball, 2 x 15.
6. Leg abductions with the elastic band, 2 x 15.
7. Leg raises, 2 x 15.
8. Heel pulls, 2 x 10.
9. Massage.

For the rest of the day I tried mostly to give the knee some rest. I did take a bike-share bike for a very quick test spin, no more than five minutes around the block in the lightest gear. It felt interesting - unlike the stationary bike, it did not feel like I could push at all, but at the same time it felt good to spin the legs and get the blood moving through the knee. I'd like to go swimming again, but that will have to wait for next week when the visiting friends leave.

1 Month, 2 Days

We went for a day trip with friends yesterday, and I spent most of the day on my feet. It was leisurely pace walking, but nevertheless the knee felt sensitive and a little sore by the end of the day. I applied ice and the diclofenac gel, and decided to skip the exercises - today was meant to be a rest day anyway, so I just moved it a day ahead.

Today it's still a little sensitive, but better. I didn't walk as much during the day and I didn't have any problems when doing the exercises this evening. I went harder with the exercises targeting the hip abductors and skipped some of those that involve loading the knee, just in case.

I haven't mentioned it before, but in the last couple of weeks I've really made it a point not to sleep on my left side, to avoid putting pressure on the operated area. It doesn't feel bad when I first lie on the left,  but I've come to the conclusion that most of the time when the knee was swollen in the morning, it was because I'd spent most of the night on the left side. I think I've now come to the point where I avoid that side even in my sleep, and the knee is no longer swollen when I wake up.

Speaking of the swelling, I think the hematoma is really and truly gone and the red bump has disappeared. Left remaining is a general light swelling in the area that's most noticeable after I've spent done time on my feet, and that mostly disappears with rest and icing. But now that the swelling is mostly non-existent, a hard bump has become noticeable under the skin in the same area. I can't tell if it's some sort of deeper swelling, scar tissue, or something else; I'll see the doctor next week for a scheduled follow-up, so I'll ask him about it.

1 Month

Yesterday I applied some diclofenac gel to the red bump and the rest of what's left of the swelling, not for pain but for the anti-inflammatory effect. It actually worked quite well, better than icing definitely, and with longer lasting effect. Definitely something that would have been worth trying from the start instead of or in combination with the oral paracetamol and ibuprofen.

Today's PT:

1. Stationary bike, we decreased the resistance by one step so I can spin at my preferred cadence: 5 min, 101 RPM, 138 BPM, 138 W.
2. Leg raises, 2 x 15.
3. Balance on the foam pad.
4. Balance with opposite leg extensions, 2 x 7.
5. Shallow single legged squats on the  foam pad, 1 x 12.
6. Squats against an exercise ball, 2 x 15, hold the last squat for a few seconds.
7. Leg abductions with the elastic band, 2 x 15.

Massage at the end, like last time. For next week, she recommended starting to do short and easy rides outside on my bike. Keeping in with the doctor's recommendations, I will start with 5-10 minutes, just around the block, and I'll keep the rides under 20 minutes until the end of the month.

Day 30

So, is been a month since the surgery. The state so far:

• All stitches and bandages are off and out.
• The swelling has subsided significantly, but hasn't disappeared completely yet.
• I can walk, go up and down stairs and swim with no or almost no pain. Tried going up two steps at a time today, no pain there either!
• Physiotherapy rehabilitation is in full swing, doing exercises and stretches daily. Rode a bike for the first time today, though just a stationary one. No pain, but I could feel it would start to hurt if I tried to push harder.
• I can't run yet, except for a few wobbly steps in a light jog.

These are the exercises from today's PT session:

1. Stationary bike, 5 minutes at 125 BPM, 85 RPM, 133 W average. Not very comfortable with the wide saddle, wide stance and steep seat tube, but no pain in the IT band.
2. Leg raises, 2 x 15.
3. Squats against an exercise ball, 2 x 15 with an extra squat-and-hold at the end of both series.
4. Balancing on the foam pad.
5. Balancing with opposite leg extensions, 1 x 8.
6. Balancing with shallow squats, 1 x 15.
7. Leg abductions, 2 x 15.
8. Massage to finish (no massage before exercises this time).

No changes to homework, but I will be mixing it up with different exercises hitting the same muscle groups on different days.

Day 28 (4 Weeks)

No physiotherapy in the last couple of days, and I took a rest day today. Well, it was rest from exercising, but I did go for a nice walk, leisurely pace but a good 2-3 km covered. The knee started hurting a little near the end, but I think I managed not to overdo it too much.

I've noticed that I can really feel the left glute medius, TFL and hamstrings working, and even straining a little, when I start walking a little faster. That's interesting, seeing as my left side now feels stronger than the right when doing the exercises targeting those muscles, yet the right side doesn't complain while walking. It could be a combination of many factors, but the top two I can think of is 1. that those muscles on the left side are now waking up and activating more than the on the right side thanks to all the exercises, and/or 2. that the left side is getting better at doing the exercises, but the functional strength in real world conditions is still not up there compared to the right.

Whichever is the case, I think the following course of action will be in order:

• increase work on the right side to bring it up to speed when it comes to exercise proficiency;
• start mixing it up with different exercises still targeting the same muscle groups in order to improve actual functional strength - so for example do leg abductions one day, side steps the next, and so on.

Regarding recovery in general, I have been able to do a few steps of something resembling a jog - the last time I tried, it a few days ago, it was still not at all doable. It still takes focus however, and when I tried to RN the last couple of stops across the street without really thinking about it, I reverted to a hobbling locked-knee gait.

The hematoma/swelling is mostly gone now, with just a pea-sized bump and some redness right around the middle of the scar. The redness doesn't look very good, but it responds well to icing, so I'm not too concerned yet. All in all, it seems to be getting better at an unchanging pace, which is perfectly fine with me.

The bump is between the third and fourth suture marks; picture taken after icing, so it's not very noticeable

Most of the swelling is gone

Day 26

Physiotherapy yesterday:

1. Knee press, 2 x 15.
2. Heel pulls, 1 x 15.
3. Leg raises, 2 x 15.
4. Balancing on the foam pad.
5. Single-legged shallow squats on the foam pad, 2 x 12.
6. Balancing with opposite leg extensions, 2 x 8.
7. Squatting while leaning into an exercise ball against the wall, 1 x 15, focused on pushing off with the left leg.
8. Leg abductions with the elastic band, 2 x 15.

Next session will be Wednesday next week, and we'll be doing some exercises on the stationary bike. The next two weeks I'll be having two sessions per week, and after that my usual physio comes back from vacation, so I will switch to working with him. Most of the exercising will be done at home now, so I bought a Pilates ball and a balance board today.

I went to the swimming pool today, a light session of some twenty minutes in the water. I tried crawl and breaststroke and both are doable, but require careful and deliberate movement. For crawl I need to let the left leg mostly hang in the water, just a little stroke here and there. Breaststroke is OK as long as I go very slowly and I don't force the leg strokes.

In other news, I'm officially descending stairs without any pain. Well, I can make it hurt if I intentionally put the leg into an awkward position, but stepping normally is perfectly fine. I can't really pinpoint when exactly was the first time I descended with no pain, but I noticed it today. Encouraged by this, I tried to run a step or two as well, but that's not really happening yet, though it is better than the last time I tried to take a few quick steps. 

The hematoma is receding but not completely gone, it feels like a slight thickening of the skin now. It is still visible though, when I look at it from the right angle. The bone and the tendons underneath feel interesting, definitely different than the other leg. It will be interesting to see what it will be like once it's fully healed and settled down.

Day 24

Yesterday at physiotherapy:

1. Knee press, 2 x 10.
2. Heel pulls, 1 x 12.
3. Leg raises, 2 x 15.
4. Balance on the foam pad.
5. Shallow one-legged squats on the foam pad, 1 x 12.
6. Balance on the foam pad, extend the other leg forward, side, back, 2 x 5.
7. Leg abductions with the elastic band, 2 x 15.

The same as last time for homework, plus balancing with leg extensions (number 6 above) - no foam pad so it will be easier to do, but that's OK. Next week we are starting exercises on the stationary bike - first time on pedals after the operation, very excited to see how it will feel.

Today, the DOMS is subsiding, I can finally feel how the knee is doing (the signal was sort of getting lost in all the noise from the aching muscles). Nothing exciting to report, still the slow march of progress goes on. Standing in one spot for too long is still not very pleasant - after an hour in the kitchen the knee feels swollen and stiff. I was hoping this wouldn't be such a problem by now, but not too worried taking into account the overall improvement that's happening. I haven't gone swimming yet, we had some guests over for a few days so I didn't have too much time in the evenings.

Day 22 (3 Weeks)

Yesterday's physiotherapy session (starts and ends with massage):

1. Knee press 1 x 10 repetitions.
2. Leg raises, 1 x 15 + 1 x 10.
3. Squats with vertical lower legs, using wall bars for balance, focused on using mainly with the left leg, 2 x 15.
4. Balancing on the left leg on a foam pad, not sure for how long.
5. Shallow single-legged squats on the foam pad (not even close to 90 degrees of flexion), 2 x 10.
6. Leg abductions with an elastic band, 2 x 15.

Homework for today: exercises 1, 3 and 6, plus a stretch done by laying flat on the back with laterally extended arms, bring extended leg flat down to the opposite side at 90 degrees to the body (e.g. bring left leg flat to the right side of the body) - all exercises 3 x 10 repetitions.

The knee felt very good right afterward, but became a bit sore and sensitive once it cooled down. I've noticed a change: it used to be least sensitive in the morning or after a rest, and it would get more tender and sore the longer I'd spend on my feet. Now it feels worse when I first get up, and then gets a better as it warms up.

Today is DOMS galore. Muscles throughout the thigh are sore and it's been getting worse as the day goes on. We'll see how capable I'll be to push it at therapy tomorrow.

The hematoma feels like it's starting to break apart and flush out. The swelling doesn't look much different, but it is softer to the touch, with less clearly defined borders. I hope it will be gone completely by the end of the week.

Day 20

Yesterday morning, a phone call woke me up quite early. I checked the incision scar habitually, and the swelling was the smallest I've seen it yet, it looked almost completely gone. This was not very surprising as I did ice it before bed the night before. I went back to sleep after the phone call, and when I got up later, the swelling was back to full size, about as big as I've ever seen it. Strange.

I realized I haven't taken any photos that show the swelling, so here's a couple that show what it looks like these days:

Leg flexed to around 90 degrees

Leg partially flexed, around 45 degrees from fully extended

The incision is almost completely healed. There is just one spot with a small scab remaining:

It looks bigger than it is - actual length is almost exactly 5 cm

Today it's been mostly business as usual. I'm descending stairs almost normally now, just a little hitch here and there. I had a nice walk, forty minutes at least, and it felt quite good. There weren't any big oscillations in the size of the hematoma during the day - even after the walk there was no noticeable increase in swelling. All in all, feeling better and better, looking forward to more physio exercises tomorrow.

Day 18

I had a session with the new physiotherapist today. She started with massage, focusing on stimulating drainage of the hematoma and making sure there is no adhesion of the IT band around the area that was cut.

Next she had me do the following exercises:

1. Knee press: lying on the back, with her closed hand placed between the knee and the mat; push the knee down into the hand as hard as I can, hold for a few seconds, relax, repeat. Maybe fifteen repetitions, didn't count.
2. Heel pulls: still lying on the back, pull the heel back until leg fully flexed while she is providing resistance against the pull. Again didn't count the repetitions, but at least fifteen.
3. Leg raises: same position but with a hard pillow under the knees with an ankle weight. Extend the leg, then raise to 35-40 degrees; hold a few seconds, slowly lower down and relax, then repeat. Around fifteen repetitions.
4. Repeat exercise 2.
5. Repeat exercise 3.
6. Leg abductions with an elastic band: standing next to wall bars, straight leg abductions with an elastic band, around fifteen repetitions in two series.

To finish the session off, more massage focusing again on the swelling and on keeping the IT band free and loose. She told to me do the exercises 1. (against a pillow or a bottle) and 6. (3x10 repetitions) at home at least once during the weekend.

Day 16

I had the first physio session today. This one consisted of an ultrasound treatment, followed by electro-stimulation of the quads and finished off with a massage. Starting from Friday, I will be having more active sessions with exercises, three times a week for nine sessions in total (including the one from today).

In regular news, after the previous somewhat doubt-filled update, I'm now positive that the knee is indeed improving steadily. The strength in the leg is improving and I can apply more power before it starts hurting. A lot of everyday activities still cause some pain, but that's because I naturally push to the limit where it starts to hurt. For example, going down stairs yesterday hurt the same as the days before, except that this time I was able to go straight and with no hop-skip for the first time - yay!

The scar from the incision is also looking better and better. There's still some scabbing, so I won't be going to the swimming pool just yet, but I expect it to be fine by the end of the week.

All in all, I'm happy with where I am at the moment and I'm looking forward to starting active rehabilitation on Friday. I hope I'll get an exercise program to do at home as well, but even if I don't, the three sessions a week will provide a very welcome change indeed.

Day 14 (2 Weeks)

Still improving, but still very slowly. It goes up and down during the day, so at times it feels like there hasn't been a change in a few days, and later it feels massively better. I guess it's also easy to forget that a particular move or position used to hurt before, once it no longer does. There are definitely no leaps and bounds though; it still hurts a little to go up stairs for example, and I still do the little hop-skip when descending them. The strange pulling feeling comes and goes too, so sometimes the most sensitive spot is there, while other times it's around the actual incision site.

Speaking of the incision site, the one thing that really hasn't changed much is the swelling/hematoma. It decreases a little with icing, but it comes back if I spend too much time on my feet, whether walking or standing in one place. I'm still icing it daily as it does feel better.

Physiotherapy starts Wednesday. The physiotherapist I planned to go to will be on vacation until the end of August, so I had to make an appointment with another physio I found at the same hospital where I did the surgery. My idea is to work on basic strength and coordination of the muscles around the knee in the following month, and then start the specific cycling and running work with the original physio once he comes back from vacation.