9th Update – Pressing On.

22 Aug, Wed – 28 Aug 07, Tue. D85 – D91. The 13th week.

At the 10th physiotherapy session at NUH, I worked on the exercise routine for almost 2 hrs, and with increased intensity. The Leg Press load was increased from 4 kg to 5 kg. I also ‘walked’ for almost 30 mins on the platform with parallel handrail, although limping along with an unsteady gait. Physio said I should press on to increase the partial load bearing of the right leg and where possible, try to wean off one crutch, so that more load would be taken by the right leg. I’ve also measured the max load bearing that the right leg could bear – it has now progressed to 75%. The physio asked me to be patient, in order not to injure the knee during the physiotherapy and exercise session. I would be able to work out on other gym machines, once I could achieve almost full load bearing on my right leg.

Meanwhile, I’ve raised the resistance on the cycle machine to Level 6, but not increasing the cycling time and distance (as advised by the physio). The unassisted knee flexion improved from 117° to 120° this week. The forced bending of the knee has also improved to 135°. My good (left) knee can easily bend to 147° unassisted - so, I still have a long way to work on my range of motion on the right knee.

Both my knees do hurt somewhat from all the exercises and the limping around, but I’m careful to keep all the workouts up to the pain limit, and numbing the aches with the help of glucosamine capsaicin cream and muscular analgesic balm. Although my appetite has been good, I’m still able to maintain my post-ops weight, which is some 3.5 kg lower than before the operation. This lower weight is good for the knee as less stress is placed on the legs.

8th Update – The 12th Week, Good Progress.

13 Aug 07, Mon – 21 Aug, Tue. D76 – D84. The 12th week.

Time flies - today is already the 12th week since I underwent the ACI operation. I’ve also started to partially wean off the knee brace, which I’ve been wearing almost 24 hr a day. I now wear it only when I’m sleeping and when I need strenuous effort to move around, such as, climbing stair and going to hospital for appointment. This is to prevent the knee from buckling. The wound is also healing well, although with some pain from time to time, probably caused by the various daily exercises and partial load bearing. The “pins and needles” feeling (paraesthesia) on my foot has also gradually faded away. There is still some swelling on the knee, but you can make out the profile of the kneecap now.

At the 9th Physiotherapy session, I tried walking with one crutch. I initially thought I needed the right crutch to support the right knee, but I was wrong. Using the left crutch to move in synchronization with the right leg actually helped to support 50% of the walking load. I also tested how much partial load my right leg can bear currently, by setting up 2 weighing scales and gradually shifting the load to the right leg – it had improved from 59% two weeks ago to 70% currently. To be able to walk with some limping, the right leg must bear at least 90% of the body weight - so I still have to work on it. My unassisted knee flexion had also improved from last week’s 105° to 117° now. When forced, the knee can now bend about 130°. The physio said I’ve made good progress.

Right leg can now bear 70% partial load

I have stepped up my cycling workout to reach 15 km (340 calories) daily and also raised the resistance to Level 5. However, my physio advised against over stressing the knee on any one particular exercise. Too much cycling can actually put localized stress on the knee. It would be preferable to work on a wide variety of muscle exercises progressively, so that the strengthened muscles can together support the knee. Another exercise introduced was to lean against a large inflated ball at the back against a vertical wall, while I rolled up and down, bending the knee slightly, a variation of the back wall-slide introduced in the previous week. To date, I’m now doing some 22 different types of exercises.

My car battery went totally dead, even though my brother has helped to start the engine once a week to charge the battery. Anyway, it was time for a replacement as my present battery lasted about 3 years. AA Singapore responded within 1 hr, even though I told them I’m not in any hurry to fix it. A new “Zero Maintenance Battery” was fitted, costing $94.

7th Update – Learning to Walk

3 Aug 07 Fri – 12 Aug Sun. D66 – D75. The 10th week.

Went to the 8th physiotherapy session at NUH yesterday. The physio said I could start learning to walk. However, I walked with great difficulty and efforts using the four-leg walker. To strengthen the walking muscles, he made me lean backward against a flat wall and slide slightly up and down, loading and bending the knees in the process. Later, on a platform with parallel bar handrail, I made tentative attempts at walking without crutches, between the parallel railings. I was happy that I could walk, albeit supported by the two railings and made several rounds, until stopped by the physio, as he did not want me to overwork the knee at this stage. The physio wanted me to continue with all the isometric exercises, as well as my twice-a-day cycling sessions at home. I’m now pedaling a total of some 50 mins a day at level 4, equivalent to cycling 13 km with 300 calories expended. My flexion angle however, has not improved. Unassisted it was only 105°, but could reach 125° when forced. The physio, however, was not worried, as he said it would improve with time, since my knee still had swelling, which restricted the bending in any case.

During last week’s 7th PT session, the physio introduced another 3 exercises. The first was the inclined cycle, pedaling horizontally instead of the normal cycle, which is vertical. This required more efforts. Lying on my right, I also did the inward leg raising with weights. With this, I’m now doing leg raising in all four directions. To strengthen my knee stability, an elastic band was looped over the knee while standing and by moving away from the anchoring point, increased the resistance. I also increased the leg press load to 4 kg.

With the new added routines, there are now some 20 exercises which I’m doing, summarized into the following categories – 7 in the lying position; 3 in the sitting position; 3 standing; 4 active motion / walking exercises and 3 on exercise machines.

6th Update – Active Motion

27Jul, Thu – 2 Aug 07, Thu. D59 – D65. The 9th week.

I finally weaned off the Continuous Passive Motion (CPM) machine as I have reached the machine’s max limit of 120°. I’ve rented the machine for 7 weeks or 49 days to be exact, costing me some $818 (inclusive of delivery cost and GST). Reflecting back, my daily routine for the past 7 weeks had been quite regimented, faithfully performing the trice-a-day CPM sessions. From now on, I’ll be doing more active motion of the leg.

At the 6th physiotherapy session, the physio started on a series of active motion exercises. He introduced me to the leg press machine, pushing a 3 kg starting weight. He asked me to stand and tiptoe repeatedly on both legs, supported by the hands, effectively putting almost 50% load on my right leg. Another exercise added to my daily routine was to stretch the leg forward, backward and sideward while standing on my left leg. Ironically, as the right leg is slowly taking over the partial weight of the body, the left knee has taken its toll and started to ache. During one of the stretching session at home yesterday, my right leg suddenly cramped up painfully, thus serving me a warning, that I should not push the rehabilitation process too fast and too hard.

I’ve also been increasing the resistance level of the cycle machine to Level 3 (out of a max of 9 levels) and cycling twice a day. To keep track of my daily exercise output, I would be totaling up the distance and calories equivalent of the workout, starting a few days ago at Level 1, 3 km & 80 calories, and gradually progressed to 7 km & 160 cal yesterday. Cycling also helps to maintain the flexion of my knee. I fixed up a device to measure the progress of increasing the flexion angle, which is currently at about 125°.

Measuring the flexion angle after exercising with weights

Saw the Prof this morning - he was satisfied with my progress and asked me to persevere with the physiotherapy treatment, both at NUH and at home. He noted my determination and said most physiotherapists would be happy to have a patient like me. He asked me to gradually learn to walk with the aid of the crutches and avoid over straining either of the legs. He extended my medical leaves to 9 Sep 07. He said to try to return to work after that and let him know if I encounter any problem during the next appointment on 13 Sep 07.