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

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

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 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.