6 Months

Now this was a long gap in posting. I just never felt like updating when I didn't really have anything new to post. My progress has been really slow recently due to the medial knee pain, and after a visit to the orthopedist this morning, I at least have the name for this new game: it's called synovial plica syndrome. The treatment is no different from what I've been doing so far, just keep working with the physiotherapist, doing the exercises at home and slowly be increasing the load all the time listening to the knee and how it feels. The long term plan is familiar too: if it doesn't improve, steroid shots are next, then arthroscopy as a worst case scenario.

On the bright side, the ortho has spent some time studying the old MRI scans of both of my knees, and he thinks the original diagnoses were a bit too eager to proclaim structural problems that would match the symptoms. In his opinion, there is no damage to the cartilage or the menisci in either of my knees, so that's a relief.

When it comes to cycling, as I said the progress has been slow lately. After several weeks of sporadic activity due to going on vacation etc, in the last month and a half I've been working on building a solid base of regular workouts and rides with intensity and volume that doesn't trigger pain in the knee. This means one solid gym or physio workout, including 25 minutes of run/walk intervals (still at 3:2 minute ratio), and one 20 km bike ride per week. At the moment this seems to be functioning well, with no pain in the knee, though I can still feel some irritation when cycling before it gets warmed up. The goal for the next few weeks is to introduce another, shorter ride in the week, and then work on bringing it up to the same distance as the longer one. If that works out well, I'll have built up a base of regular 40 km per week that I can then hopefully start extending into more serious distances.

Regarding the IT band, it is doing well, no complaints. The ligaments in the lateral knee area do feel bit strained and sore from time to time, but that's a sign that they are still adapting to the increased loads after the IT band release. I haven't had any pain from the IT band itself during cycling, running or walking (and I've had some long walks on consecutive days during the vacation a couple of months ago). It could be said that the focus of my recovery work in the last three months has shifted from the IT band to what I now know is the plica syndrome, so I consider the surgery to have been a success so far. There might be some doubt that the new issue is somehow related, but I have had some pain in the area even before the surgery. I'm thinking that it's just a combination of anatomical predisposition plus overuse, as is usually the case, and is something that would have probably happened anyway.

3 Months, 10 Days

Tuesday was PT day. I told the physio about the medial patello-femoral pain but he couldn't find anything wrong that would stand out on manual investigation. He approved of my plan to keep cycling with decreased intensity and on platform pedals and see if it improves. After that we did a quite intensive exercise session, the theme being balance and coordination taken up a level. This means all the one-legged exercises (touch the opposite leg, extend the opposite leg in different directions, supermans...) but done on a BOSU and with addition of light dumbbells just to make it even harder. Finally he had me balance on one leg, side jump onto a step on the other leg and jump off back into starting position. The physio was positively impressed with my ability to do all the exercises he came up with, and with very good form too. However, we came to the conclusion that I have noticeably better coordination on my right leg, while the left leg is stronger and has more stamina.

Even though I've been regular with gym work and it has shown during this PT session, I have been lagging on these exercises hitting the side glutes and other hip musculature. I know this because for good two days after the session all those muscles were really fatigued and sore. Luckily I will be away for the next three weeks, so I'll have to do more of these types of exercises instead of gym work anyway.

I went for a short and easy ride this Saturday, around 15 km at an easy tempo. The knee still felt a little strange, almost like there's something in between the patella and the femur head that gets irritated on every flexion and extension. I feel this only on the bike, and even then it's not a constant feeling but sort of comes and goes. Not really stressing about it yet, I will monitor it further and only think about going to the ortho if it doesn't improve by the end of next month or so.

It's funny that the IT band is almost being forgotten, even though that's what I'm supposed to be recovering from. It's doing fine, but still letting itself be heard from time to time. At the moment, some of the ligaments toward the front of the IT band and toward the outside edge of the patella are feeling a little sore, like they are now learning to take the increased loads after the band itself was released. It's a new sensation, unrelated to the tension I used to feel in the same general area - the tension has been gone for at least a couple of weeks now. It doesn't feel worrying, I won't be surprised to still be getting phantom aches in the area months from now.

3 Months

It's been two weeks and then some of the new regime with one gym session per week. It's all good so far, seems like a programme that will be sustainable in the long term, providing the benefits but at the same time not too taxing. I've expanded the gym sessions into more of a full body workout with dumbbell shoulser presses, bench presses, bicep curls and one-arm rows in addition to the leg exercises and treadmill work.

Speaking of the treadmill, running is improving nicely. I've come up with a combination that seems to work well for my current ability: 2 min walking, 1 min jogging, 2 min light to medium speed running, repeat 5-6 times. No knee pain, no shin splints any more, cardio seems to be the limit to going much harder at the moment. I'll be slowly increasing the run-to-walk ratio, but there's no hurry.

Cycling is not going as well unfortunately. I've kept the rides to around 20 km, but it seems I've been riding a little too often, not giving the body enough time to adjust and re-adapt after the long break I had before and right after the surgery. As a result, I've developed some knee pain - not around the IT band, but the inside (medial) side of the patellas, both knees but more on the left one. Pain in this area is not new to me, and I've had MRI done on both knees at different times to see what's going on inside: meniscus damage in the right knee and some lesions in the cartilage of the left knee.

The damage on both sides wasn't deemed bad enough to warrant anything more drastic than some rest and rehabilitation at the time, and I'm hoping to get away with same now. The pain only appears when cycling, so I'm taking a week off and I'm switching to platform pedals for a while to let my legs re-discover the most comfortable position for pedalling after the break. Of course, I'll also ask the PT about it the next session.

The IT band itself is doing fine, further along the way back to full strength. As usual, there are occasional aches and pains, tension, or just feeling of something being not quite right, but it's getting less intense and less frequent all the time. There hasn't been any swelling that I could detect at any time in a few weeks now, and it just gets a little more sensitive to pressure if I've been working it a bit too much. No surprises overall, it's right about where I'd expect it to be at this time.

2 Months, 3 Weeks

It was good having the two weeks to settle into a workout schedule and really see what the effects would be. I did gym sessions every three days on average, alternating the focus between squats and deadlifts, with leg press and knee extension added at the end of each session plus the full complement of stretches. As a warm-up, I'd spend 20-30 minutes on the treadmill doing walk-jog-run combinations. In between the gym days I did some home exercises, mainly elastic band work for the gluteus medius and some balance work, but not frequently. These were the results.

The good:

• I improved noticeably at doing squats and deadlifts.
• I improved a little at running.
• I no longer get the feeling of tension and pulling in the area halfway between the kneecap and the incision site - I used to get it while walking at first, and later while running ever since the surgery.

The not so good:

• It takes me time to recover properly from the gym workouts, three to four days at least. In the days between sessions the muscles would feel tight and a little sore and the legs would feel heavy. I wasn't able to push myself on the bicycle and I never really felt like running or doing any exercises other than on gym days.
• The muscles improve faster than the joints. I started feeling some soreness under the kneecaps when crouching or kneeling if I wasn't warmed up. It wasn't a major pain, just a warning that I was starting to work them more than they could recover from.
• The area around where the IT band inserts into the top of the tibia started feeling sensitive under my fingers (I got into the habit to poke and prod the area every morning to see how it's doing, if there's any swelling etc.).

The obvious conclusion was that I should ease off on the gym work and replace it with more exercise for balance, coordination and proper muscle activation. The PT agreed with my conclusions and additionally suggested to decrease the loads on all exercises that strain the knees, so squats, leg press and knee extensions. 

The PT recently started training as an ultrasound technician and he acquired a machine for the office, so we used the opportunity to take a look under the skin during this week's session. Everything looks like it has healed up fine and there seem to be no residual swelling in the tissues. He noticed that the surgery was done very cleanly and neatly without any unnecessary damage. The hard bump looks like normal bone under ultrasound. The PT thinks it's most likely the normal epicondyle being more prominent since it's no longer being hidden by the IT band, but to me it still seems like it's slightly enlarged compared to how it was before the surgery. I still need to make an appointment at the hospital for the ultrasound that my doctor prescribed, so we'll see if they have anything interesting to add.

The bump is definitely smaller than before, but is nevertheless still prominent

The next PT appointment is in three weeks from now, so I'll have plenty of time to develop a new exercise routine. So far I've been a bit lazy this week - I've done just one workout session at home, but I did ride the bike more. I've upped the ride distance to over 20 km and so far all is good. I won't be increasing the distance next week since I've made quite a jump, but I will try to do some running outside. That't the plan at least, we'll see how it goes.

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, 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

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.

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 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.

Day 12

I've removed the final bandage today. The incision hasn't healed completely yet, there's some scabbing and light bruising there. The picture is here for those interested, but I don't think it's presentable enough to be displayed directly in the post just yet.

I've been icing twice a day since the sutures were removed. The swelling/hematoma decreases noticeably after icing. It would probably have been a good idea to use the ice during the time the old thick bandage was off for showers.

There is a new sensation from the knee. I feel a distinctive longitudinal line of tension midway between the lateral epicondyle and the patella, like there is a thin band stretched there that gets tight when I bend the knee under load. Could be that they had cut the IT band away from the fascia along that line during the operation, or it could be some scar tissue. We'll see how it develops.

The functionality is still slowly improving, though maybe not as quickly as in the first week. It's good that I'm about to start physiotherapy soon, it should help to kick start the recovery and keep it on the right track so I don't develop bad patterns of movement.

Day 10

The stitches are finally out! That feels a bit better. I can't really tell what the scar looks like yet as I have a new adhesive bandage over it, not to be removed for two more days; luckily, I can shower with this one on.

In other news, the swelling around the incision is actually the hematoma doctor told me to expect - I thought a hematoma would include more visible bruising for some reason. I told the doctor I wasn't really icing it so far since the thick adhesive bandage on it make it really hard for the cold to actually reach the site. He urged me to start using ice regularly now. Other things to look forward to are:

• Start physiotherapy next week to rebuild the quads.
• Free to start swimming next Wednesday.
• Free to start cycling and/or running in six weeks, so beginning of September. I can do very short runs or rides before, but nothing longer than 20 minutes.

Otherwise, the knee is improving slowly. I'm walking up stairs almost normally now, though it still hurts a little. I'm also going down stairs facing forward (no longer sideways), but with a sort of a hop-skip on the left leg to avoid the painful eccentric contraction. Still doing glute and hamstring stretches daily, but I've given up on hip flexors and TFL, it seems to hurt more than it helps at this time.