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.