2 Months, 1 Week

No posts for a whole week (and some change), but, honestly, there wasn't really much to write about. The knee generally feels about the same as it did a week ago, and I haven't been doing anything new or particularly challenging in the mean time that would show improvements or expose weakness. The one somewhat noticeable improvement that comes to mind is that, while the knee still doesn't like it when I stand in place for too long, it doesn't seem to swell up as much when I it happens.

I've been to the PT last Tuesday as usual, but even that was more of the same with just a few updates. I did the longest uninterrupted jog to that point, which would amount to maybe 200 meters or so. Then we did some jumping from one foot to the other, side to side, front to back and diagonally with random interruptions to balance on one foot, plus some throw and catch on top of it to make it even more challenging. Finally, he showed me two new exercises to include in my home or gym sessions. One is one leg deadlifts with dumbbells and the other is squats with a jump at the top where the jump is done into the squat and not out of it, so to say (so I fully stand up before jumping and going straight into a squat upon landing).

I have quite a list of exercises to pick and choose from now. The idea is not to try and jam them all in every session, but to have a variety to keep challenging the body in different ways. These are the exercises so far (in no particular order):

• One leg balancing - combinations with throw and catch, shallow squats, touching the foot with the opposite hand, with and without the balance board).
• Gluteus medius exercises - leg raises on the side, leg abductions, clamshells, side steps all with an elastic band and so on.
• Supermans and one leg deadlifts.
• Glute bridges on an exercise ball, one and two legged.
• Squats - standard squats with weights, squat and shoulder press combination, jump squats, single leg squats while holding an exercise ball against the wall with the opposite knee.
• Knee extensions.
• Leg press.
• Lunges.
• Elliptical trainer (I've replaced this with running intervals).

This week I won'be be having PT sessions and I can say that I am looking forward to it. I will use the opportunity to make a workout program that I will hopefully be able to use in the long term with occasional tweaks, or at least see in general what works best for me, how much rest do I need and how hard should I go on different days. At the moment, the PT sessions always break my weekly rhythm a bit since they are never truly hard sessions, but at the same time they tend to be hard enough to require some recovery afterwards. Next week I'll go to the physio with any conclusions and see what he thinks about it.

I have had one gym session so far this week. To begin with, I did 30 minutes of 4+1 walking/running intervals (4 minutes walking, 1 minute running) where I tried to do actual running instead of jogging once I warmed up. There are various theories about whether cardio should be done before or after weight lifting workouts, or in the same session at all, but seeing as I can't really run hard enough or long enough yet to significantly tax the cardiovascular system, I think this is a good general warm up.

After the running I did squats to shoulder press combinations, two sets, then a set on the leg adductor trainer as a sort of a break for the hams and glutes. This I followed with four sets of barbell deadlifts with progressively increasing weights. To finish it off, I did three sets of knee extensions and then two sets of bicep curls just to give the arms some work as well.

The idea was to focus more on deadlifts in this session, while doing some squat-based exercises as well. Since I'm limited by shoulder strength in the squat to shoulder press, this exercise served more to warm up the posterior chain muscles, while deadlifts really worked them. For the next session the focus will be on squats, so I will start with single leg deadlifts and then do proper barbell squats. I will also alternate leg press and knee extension workouts. In the days between the two gym sessions I will do some of the exercises that don't use weights, plus at least one or two full rest days.

Other than that, I will try to bump up the cycling distance a little. I've been commuting by bike almost every day, but I haven't really been cycling other than that. The longest ride so far is still the 8.5 km or so from a week ago. It's time to get into the double digits finally.

2 Months

It's exactly two months today since the operation. Looking back, I was hoping that by today I would be close to 100% by today, though I was ready to take it as slowly as necessary to make sure the recovery complete and permanent. Yet, when I look back where I was even weeks ago and compare it to where I am now, I really am pleased with how it's going. I think the biggest unexpected thing is the discrepancy with what I can actually do - cycling, running, gym workouts - and the little aches and pains that still happen on the first few steps after I've been sitting for a while, or the way the incision site gets swollen after standing in one place for too long. I guess I wasn't expecting those little things to persist the longest.

In the last few days I've done all the three main activity toes: cycling, running and gym work, and are improving. I've increased the weight for the squats up to 25 kg (I didn't plan to, but the previous weight really felt to easy), I expect to increase the weight of squat to shoulder press from 8 to 9 kg dumbbells next week, and I've done the first few sets of deadlifts. In cycling, I'm pushing harder and harder as well, though I'm keeping the distances low for the moment. I've done the same 7.5 km loop as last weekend, but my average sorted has increased from around 18.5 to around 23.5 km/h.

I've made the least obvious improvements in running, but that's hardly surprising; I was never a runner, so I'd be staying at zero even if it wasn't for the knee surgery. I've done one session of walk/run intervals, purely by feel. The running intervals were around 200 paces each (this is still jogging pace, so I guess 150-200 meters), at which point the muscles in front of my shins would start complaining. If then switch to walking for about as  the same distance as the running part, but I want really trying to be too precise with it. I've no idea how far in total I went, but I was out for maybe 30-40 minutes I guess. I was surprised by the shin pain appearing so quickly, but at yhe same time I was pleased that there were no major complaints from the knee, just a vague feeling of tension from time to time.

I've done only one session of balance and elastic band exercises, but this is according to plan since a lot of the same muscles are now being targeted in the gym. This combination of harder exercises with more rest in-between send to be producing very good results so far, and the lighter exercises are just there to improve balance and coordination further.

1 Month, 27 Days

I had physiotherapy this Tuesday. We did some jogging again, but this time going for some 50-60 meters at a time. We also did some hopping from one foot to the other, side to side and forward and backward. Finally we did some reverse lunges, before going back inside. Back in the studio we did some squats to shoulder presses, then some deadlifts, both with 8 kg dumbbells. To finish, he had me do shallow single legged squats while holding an exercise ball between the knee of the opposite leg and the wall - quite difficult to coordinate everything while keeping the proper form.

He instructed me to include deadlifts in my gym work plus well as leg presses and leg extensions at the end of training sessions to really work the muscles and stimulate strengthening and growth. He also gave me a green light to increase the distances in my run/walk intervals and to adjust the dynamics as I feel suits me the best. In general, we are moving more and more toward self-guided training where he will just provide advice as an outside observer.

Yesterday I commuted to work by bike. It's very short, just 3 km one way, but it provided a more challenging dynamic than the previous weekend rides since I had to focus on the interaction with the traffic rather than on my interaction with the bike. Nevertheless, it felt good; I was able to relax and pedal without thinking with no complaints from the knee whatsoever. I was pushing harder than on the previous rides, naturally getting into a stronger rhythm. Judging from the sensations from the legs, I would have been able to forget I'm still in the very early stages of regaining my strength and endurance, but a quick check of the speedometer was quick to break that illusion. All in all, cycling feels good and I'm looking forward to increasing the mileage. I guess it's lucky the weather will be getting worse in the next months, so hopefully I won't be able to go too far too quickly.

Today I went to the gym. I warmed up for 12 minutes on the elliptical trainer, then did squats, leg press, leg extensions and some leg abductions, just to give those muscles some attention since all the others have been working a lot lately. I left deadlifts for the next session since the hamstrings still feel a bit fatigued from the PT session. Squats felt very good though, I was able to increase the weight to 25 kg.

I think I've approached the limit of how much the knee can take at this time. It feels a little sore now, the way it didn't last week. I'm icing it regularly and keeping an eye on it. Since the exercises are getting harder, I will be making longer rest breaks in between, and that will hopefully help to find the balance again.

1 Month, 23 Days

Time for another weekly update. I have been doing the jogging intervals daily and it's been going quite well. I've been able to slowly increase the internal distance while keeping the number of intervals at ten. I increase the distance based on feel for each interval - I start with a few 20-pace ones to warm up, and then I start extending them little by little. The longest one I've done so far has been full 40 paces.

I rode my own bike yesterday, for the first time since the surgery, and then once more today. It felt a bit strange for the first few minutes, but very good overall. I've had no pain from the left knee, riding both in and out of the saddle (very careful and deliberate in the second position though). Nevertheless, I'm keeping it short and easy at the moment: it's been a while and it's not just the legs that need to get used to cycling again, but the back, neck, shoulders, and the rest of the body. I did 4.5 km on the first ride and 7.5 km on the second, 17-18 km/h average.

First ride on my bike since the operation

Other than that, I'm also working harder in the gym. I'm increasing time on the elliptical trainer in the gym slowly, up to 10 minutes now, and I've added 2.5 kg to the bar for squats. It's not much, but I'm making progress.

Overall, the knee is proving to be functional, but I still feel occasional aches and pains. Standing in one spot or walking too slowly is the worst as the knee swells up noticeably, but ice and some rest helps in those cases. It sometimes complains on the first few steps after sitting for a while, buy it settles down when it warms up a little. I do still have to remind myself from time to time to keep pushing it out of the comfort zone, but so far it has taken everything I throw at it with few complaints.

1 Month, 20 Days

PT session was Tuesday. Since I'm able to do short distances in a full run without pain or significant discomfort, we decided to start including some light jogging into the daily exercises. The program for this week is once a day, ten intervals of light jogging with normal walking in between; start with around ten meters for each interval, increase by feel. Other than that, he corrected my stretching technique to target rectus femoris muscles more, and introduced a quad stretch to add to the daily routine. He also gave me a new exercise for the gym, a composite squat plus shoulder press with dumbbells.

Since the exercises are getting harder, the muscles are needing more recovery now. I will be going to the gym three times a week to do exercises on the elliptical trainer, stationary bike, squats (two days normal barbell squats, one day the dumbbell shoulder press combination) and bridges on the exercise ball. In between I'll be doing the balance board and leg abduction exercises. Only stretches and jogging will be done daily.

1 Month, 16 Days

The idea to push the knee out of its comfort zone is working well so far. I went to the gym twice since the last post. The first time was more of a learning experience, while the one today was a harder workout (compared to how hard I was able to work as little as a week ago):

1. Warm up on the stationary bike, 5 minutes.
2. Elliptical trainer, ~75 RPM, ~155 BPM, 6 minutes (+ 1:30 cooldown).
3. Stationary bike, ~100 RMP, ~140 BMP, 8 minutes (+1:30 cooldown).
4. Squats, 3 x 6 repetitions with a 20 kg bar.

The knee is feeling better daily. I am now able to run with a normal gait with just a little tension and pain - about how walking felt like in the second week after the surgery. As usual, I just ran some fifteen-twenty meters as a test, but it was especially encouraging that the pain stopped immediately when I stopped running. I expect I'll start doing some actual running training with the physio the week after the next at the latest.

1 Month, 13 Days

I went to my standard physiotherapist yesterday. He put me through a set of exercises and he was quite pleased with my current condition. He suggested to start putting the left knee under more stress - not enough to feel sharp or burning pain, but enough to feel the load - this is something that I avoided so far, preferring to have a slower recovery rather than pushing too hard and causing new injury. Now that the knee is mostly healed, it's time to get it out of the comfort zone, and train it back to full strength.

We will be having one PT session per week, with exercises to do at home or gym in the mean time. He gave me the following set of exercises to begin with (to be done daily unless marked otherwise):

1. Balancing on the balance board or a BOSU with throw and catch. If I don't have anyone at hand, I throw and catch a throw pillow - the size, weight and shape make it more challenging than a ball from the balancing standpoint.
2. Leg abductions/raises laying on the side with an elastic band or ankle weights (we used 2 kg weights in the session).
3. Single legged supermans.
4. Hip bridges with feet on an exercise ball and an elastic band around the thighs.
5. Single legged bridges with the foot on an exercise ball.
6. Squats, five times a week. When possible, do them at the gym with a 20 kg bar, go for around 6 repetitions.
7. Elliptical trainer as often as I have the time to go to the gym. Build up the time, start with 5-10 minutes.
8. Cycling (normal and/or stationary bike) and swimming fit cardio when I have the time.

All exercises are to be done at a level that's challenging, but not all out painful. Along with the exercises, I am to continue the hamstring and glute stretching routine, plus a lighter hip flexor and TFL stretch, about as hard as I can stand for 20 seconds at a time, a few times during the exercise session.

Today I went for the second follow-up with the doctor. Regarding the hard bump around the incision site, he thinks it may be a combination of residual swelling and some scar tissue growth, but he is not sure about. He prescribed ultrasound to be done in about a month, to give it some more time to settle down and stabilise. In any case, he doesn't think it is something to be overly concerned about.

Other than that, he also recommended starting to push the knee harder, looking for that balance between a bad pain and a good strain. This pretty much settles the course for the following month or more, and I can say I'm looking forward to it.

Finally, this is what the operated area looks like now:

This is the hard bump, there is no swelling of the skin in these pictures

The scar is getting thicker and paler; I don't think it will be very noticeable in the long term