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.

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 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.