The Dynamic DynaSplint

Last Friday (a week ago) I got my DynaSplint. The rep came to the physical therapy office to fit it on me and show me how it works. It didn't take long to get a good fit and I picked up how to put it on and adjust it quickly.

The splint is held in place by four velcro tabs, two above the knee and two below. There is a set of two cams, one on each side of the knee, that assist in applying pressure to the leg, from two linear adjustment pipes below the cams. The rep started my splint out at level 3. She said she starts everyone there. It gives a lot of wiggle room. I am supposed to work up to wearing the splint from six to eight hours a day, preferably while I sleep. With my sleep problems I am not seeing this happen particularly easily. After taking off the splint, my knee is expected to feel stiff for a while. If it is stiff for less than an hour it is time to increase the tension. If it is stiff much longer than an hour or if it causes pain it is time to reduce the tension by a half-step. The goal is to get my knee straight! Zero degrees.

I have been wearing the splint for more than one session per day, and have worked up to about 3-1/2 hours total. Today the level is at six.

Unfortunately, the splint seems to encourage that "restless leg" feeling, so I tend to take it off often. However, I have had some longer stretches of time, asleep, no discomfort. As with everything else, I think the key is to get myself into a good solid sleep, which is much harder than it sounds.

Meanwhile, I continue with therapy as usual, no change. The various machines, then step-ups, maybe some rubber-band sideways steps, some "mobes" to help straighten the knee, then finally the infamous stim machine for fifteen minutes, both legs. All of these activities together, added to the work I do at the gym, should be helping with the straightening as well as the strengthening of the thigh muscles.

I have added a few more exercises to the gym routine after meeting again with Clara last week: rolling my thighs on a foam roll, to massage the soft tissue (pain!) and pressing a 12-lb medicine ball between my legs (quite effective).  I find that I enjoy hanging out on the mat after doing the bike and other machines at the gym. I feel like I can take my time there and get it all done.

I just read the title of an article that says you can do your exercises at home, you don't need a gym. I know that I don't need a gym but I find it much easier to get the work done there than I do at home. It is well worth it to me and I get the added benefit of having others around me encouraging me or offering additional examples of what I might achieve over time. If I devoted as much energy to keeping my house clean it would be some kind of miracle.

My right leg continues to cause me problems, although not all the time. I try not to let it discourage me.

Eight and a Half Weeks

I'm feeling a little tired right now, a little headachey. I cut out all meds four nights in a row, to see if there was a difference. By the fourth night I realized that the meds probably were helping a little. I had so little sleep that I was up in the middle of the night watching television and still I could not sleep in later. And I had crying jags. So last night I did not forego meds. I took three tylenol pms. That actually did not help much either, to get me to sleep. It was hours of adjusting and stretching and taking showers and sitting on the side of the bed with my head in my hands. Finally, after I dropped off I was up a few more times to go to the bathroom, and once again I awoke with a spasm in my leg. I still feel vaguely hungover.

I am a bit at a loss here as to what to do. I really want to be off the drugs at night, and I figure time has got to help. I don't want magic meds. Well, yes, I'd like that, but more than that I want this to be over, no more need for meds.

At the therapist's office I talked to another knee patient a few days ago and he said that he too still has difficulty at night, has spasms and that he has more trouble sleeping now than he did right after surgery. I am not alone, and that actually is a kind of comfort.

So that's my primary complaint at this stage, at eight and a half weeks. The secondary complaint is that I find it painful to walk, or at least uncomfortable. Third, when I get out of my car I find it painful to stand up again.

The walking is a bit of a mystery to me. A few weeks ago I was walking somewhat stiffly but there wasn't much pain. It may be that I am not allowing my muscles enough rest. It does not seem to me that I am overworking anything but I am working the same muscles in the gym T Th S that I work in the therapy sessions M W F - so I am working them six days in a row. That may not be the wisest course. It may be smarter for me to do my gym routines on the same days as I do therapy.  I hope to get this straight when I start working with Clara, the trainer at the gym. Another component of the walking problem is, of course, my right leg. There are times that it feels incredibly weak, like it's going to cave in, and it hurts to put my weight on it. I do use my cane at these times, to take some of the load off it, but that is not any kind of long-term solution. Today at the gym I found it really hard on that knee to climb the stairs to the second floor, so I took the elevator down when I was done with my workout.

As to what I am doing at the gym. Very similar to what I was doing before surgery, but I have cut some things out and added one machine, and modified some settings:

Bike: I now set the seat at 8, whereas before it was at 9. This is a triumph of sorts. I can bend my knees better now. I bike at level 9 (before I went to 10) for twenty minutes (before I did fifteen) and I work up to my training heart rate and stay there every time (I did not get there before). So when I get off the bike I am sweating.

Leg Press: The goal here now is simply to strengthen my thighs. Previously a big part of the goal was to straighten my legs. I do two sets of ten (same as before) at 120 pounds (previously 140).

Leg Extension: The difference on this one is that I don't go all the way up to a straight-leg position, based on what Paul said he'd learned about using the machines for this purpose. I go about 80% of the way and then back again. I think I'm at just 30 pounds - I don't remember! Two sets of ten.

Seated Leg Curl: I had not been doing this before so I had to figure out how to set the machine. I'm not at all sure I am doing it entirely correctly. I do one set of fifteen at ...what?? I think 65 pounds.

Hip Abductor: I am using this a little differently. When I do "clamshells" on my bed at home I am supposed to lift my leg and hold it for ten seconds. So now when I push open the machine I hold it for a few seconds at the outer limit, then return it to the start. Two sets of fifteen, I think 65 pounds.

Lat pulldowns or row or both: same as before, two sets of ten, 95 pounds.

Sometimes I stand at the railing and do some leg pushbacks (I do not know the correct term) but mostly I do not.

So that's the T Th S routine. I hope it changes after I meet with Clara. Change is good.

Overall I know my progress is good. I am doing well enough to expect a good recovery at the end of this road. I need to be more patient than I am. I look forward to rereading this post some weeks hence and thinking, wow, things have changed...

On the Right Leg and Work at the Gym

Yesterday afternoon I had another appointment with Paul, the physical therapist. Almost immediately I asked him about the difficulties I am having in my right leg. He said it may be because I am not putting my full weight on the left leg, so the right is picking up too much. I said no, I am not skimping on using my full weight on the left. So he suggested that I try using my cane in the other hand for a few days to see if the legs can even out the load. I'm trying that.

He worked on pressing the knee down more, then flexing it, then pressing, then flexing. Most of the work initially was on straightening the knee. At the end of this part of the session he measured the range of motion and the extension - I am up to about 122 degrees flex and down to -5 degrees extension. That last five degrees reminds me of "that last five pounds". The hardest to get rid of.

The rest of the workout involved machines: the Total Gym, which allows me to do a modified squat, without putting my full weight on my legs, first. I found it harder to do for some reason, than last time. But certainly easier to get to a lower squat than I can do on the leg press at the gym. Following the squats I did leg curls, then leg extensions. And here a difference: Paul went to a class within the last six months and learned that doing a full extension (pushing all the way up and forcing it) on the leg extension machine is not advisable. Because the feet are not grounded, not carrying weight, there is a chance of damaging other parts of the leg, as I understand it. So he said to go about 3/4 - maybe 7/8 - of the way up, do not extend fully using that machine.

Then the bike, ten minutes at level 5 as compared to fifteen at level 4, which I did handily, again, averaging probably 65 rotations per minute. I guess that's hardly fast, is it?? But good enough. Lastly I got the stim machine again, this time both legs, ten minutes of straightening both for ten seconds on, ten seconds off. I'm glad we're paying some extra attention to the right leg too now.

I told Paul I'd be meeting with trainer Clara soon and what might I tell her about what I can work on. He said the extension (as explained), the bike of course, the leg press - but ask if there is another piece of equipment similar to the Total Gym for that. And he said she can call him. I felt like he was more open to my using the gym this time than the last time I asked, probably because I said the name Clara. She can make sure I don't hurt myself.

I made my way home stiffly, as usual. What will I do when I no longer have a physical therapist to look forward to? Honestly, it's going to be hard!  I am so glad that I have managed to stretch it out as long as I have.

Up From Pain and Slipping at Times

After my few days of unusually bad pain  I went back to a "normal" that isn't so bad. I have managed to get around without a whole lot of pain, my times on the treadmill have generally not included pain, I have felt well enough to get up and do some cleaning and shopping. Not all wonderful but better.

There are times that I do slip from the path. Last night, for example, I just watched television and did not do my nighttime exercises. If I do not get them done earlier in the evening chances are I will not do them at all. I forgive myself. I am human. It doesn't happen often.

Also, yesterday morning I got started later than usual and skipped the resistance band exercises at the gym, along with the left arm stretches with the wooden stick. These are all exercises that I could skip one day a week, really, considering that I do similar moves in Aqua and that my arms and shoulders are doing much better than my knees and hip. I planned to pull out the bands at home and do them after sewing class anyway, but I didn't do it.

This blog is as much a confessional as a record of pain and progress. I am not looking for advice unless it relates to what I am doing. I am not looking for cheerleaders or coaches, telling me to buck up, get going, don't ever skip an exercise. I know what I need to do and I am doing it. If sometimes I slip that does not mean I need anyone standing over me reminding me that I need to keep this up. Do I not know that?

A Fourth Meeting with Clara

On Thursday, October 7, I met with Clara again. Clara is the trainer at the gym who has been helping me build my strength where I need it to counteract the effects of arthritis. I showed her the new exercises given me by Paul, the physical therapist, and I told her that overall I felt I was at a higher level, experiencing less pain in general, than I was when we first met in April of this year.  We went upstairs to the weight room area.

She showed me a machine where I could the new hip exercises, using a band around my ankle and weights.

We discussed the sitting and standing routine, and decided I could do that on the high box that sits in the weight room area. I can also sit on that box to do the raising and lowering of my leg, with ankle weights.  Unfortunately, the gym does not have ankle weights so I will need to find mine and bring them with me.

Finally, I asked her about alternative ways to do some of the things I am doing already. She showed me a new way to do lat pulldowns, sitting on a large ball, thus efficiently working the sitting and standing muscles as well. I also learned how to do the compound row using a different machine.

I will continue to do the remaining exercises as before, except that I will alternate using the different machines for lat pulldowns and compound rows.

In the last few weeks I have lowered the weight on some things and raised it on others. I felt I needed to keep it down more on the leg press so that I could focus more on keeping my knees apart.

Since meeting with Clara I have done the new routine a few times. I found I rather enjoy using the new machines. They are a little different in how they work so they probably work my body a little differently, but also just manipulating different machines gives me more a feeling of mastery, and I am more likely to find machines I can use when I travel.

At this time I am doing the rising and lowering to a seat rather sporadically. I think I need to work in at least one time a day when I do that consciously, regularly. Similarly, I haven't gotten the sitting leg raises and curls with ankle weights in at all, because I haven't found my weights.

The visit with Clara took only a half-hour. We will meet again if I feel the need or after my next visit with Paul. So far this way of adjusting the routine is not turning out to be costly for me, which I appreciate. I don't need anyone holding my hand or walking me through the routines regularly, as I can pick up and do them myself. I can also adjust as recommended.

Second Time with the Physical Therapist

This morning I met with Paul, the physical therapist, for the second time. It has been about two and a half months since we last met. I hoped to see clear positive changes from the work I've been doing.

There were some, but they are small. I should have expected that because Paul said it would take a long time for changes to be measurable. The positive changes were in the range of motion for my knees. They have both increased. There may have been improvement in other areas as well, but not as measurable. The alignment of my knees is just about the same. As Paul said, "It's not worse!", which is true.

I felt a little deflated that there wasn't some huge improvement that was magically measurable. But we moved into additional areas and I see some real potential for improvement here:

* Paul showed me how I should be walking on my feet. I told him my feet felt off-balance and he watched me walk and showed me what I need to emphasize. I need to start with my heel and then move to my big toe and the "knuckle" of the foot. I have been walking more on the outside of my foot for so many years I can't remember any other way. As soon as I tried walking the right way it seemed that walking was less painful. It takes a bit more effort so I don't see this changing overnight. But now I am aware of specifically how to place my feet and this will make a difference.

* He showed me a "test" for rising from a chair. It involves rising from an 18"-high chair with arms crossed in front, continuously for 30 seconds. That is, seeing how many times one can rise from the chair in 30 seconds. I did it six times. The average for my age is about 12 - 15 times. So that's my goal, get to average. And to get there I will start out with higher seats and rise very slowly and lower very slowly. Honestly, I was surprised that I could get up that way at all! I think some of the exercises I have been doing have started to give me enough strength to do so, and I am very encouraged and even excited about this. Getting up from a seat without using my arms is something I have wanted to be able to do for a very long time.

He gave me more hip exercises that I can do with resistance bands, and something for my knee - unfortunately, we forgot to get me copies of that exercise. I will have to ask. Let me see if I can remember, though:

Sit on a high surface and place a weight on my ankle. Let it swing comfortably for a bit, then raise up and hold, then bend inward and hold. I think this one is to extend the range of motion of the knee.

My next step, then, is to make another appointment with Clara and discuss these new exercises with her so we can work out changes to the gym routine.

Adding to the routine

Yesterday I met with trainer Clara. I showed her the exercises given me by the physical therapist and asked if she might be able to come up with machines that I could use for some of them, when I am at the gym. She said yes, for two of the five. I told her about the pain in my right foot and how it feels and she suggested that we try some feet stretching exercises. And I asked if she could recommend a few things I can do in the pool when I am there. We then went upstairs to the weight room areas.

She showed me the leg extension and hip adduction machines, and I tried both of those. I then tried different ways to do both the calf stretches and the squats, because neither were working very well for me.  By the end of my trials and Clara's observations, I had an expanded routine (including minor changes I have added over time):

machines:
15 minutes on upright bike at level 10
5 minutes on treadmill - walk normally, focusing on feet, knees, posture. Could go longer if it weren't for my hip pain. I now have added 30 - 60 seconds of walking with my toes pointed up as part of the five minutes. This is one of the foot stretches.
1 set of 15 reps on row machine at 95 lbs
1 set of 15 reps on lat pulldown machine at 95 lbs
1 set of 20 reps on leg press at 180 lbs
2 sets of 10, increasing to 15, on hip abduction machine at 80 lbs
2 sets of 10, increasing to 15, on leg extension machine at 35 lbs, focusing on VMO

rubber band exercises:
compound row, red and green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

chest stretch, 30 sec each side

calf stretch, 30 sec each foot: changed to one foot behind the other

squats at rail - put feet toes right at the wall, hold on for support, dip, do not hold
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of fifteen seconds each
Foot - sit and point and flex for 30 - 60 seconds total each foot (also when foot pain flares up)

When I said this might take me to an hour total, Clara suggested alternatives: doing upper body one day, lower another, for four days total, or stay with three days and have the upper body the middle day. I did the whole thing today and it did not go a full hour. I think I will stay with three days a week doing it all.

In addition to the gym routine, I am doing the PT exercises every day, trying for twice a day (sometimes I just forget or am too tired for the second set). And of course I continue to do Aqua three days a week. I may exchange one of those days for swimming. I haven't decided yet. The PT exercises are:

quadriceps muscle set
short arc quad
hip and knee flexion
clamshell
bridge
All twice a day, most held for 10 seconds, total 10-15 times

When two months has passed from the PT appt I will have another PT appt. After that, I will get together with Clara again and we'll see if changes need to be made.

Lately I seem to be having less pain overall. Still hard to walk at time, hip pain at times, but less often. I am having more better times.

Some kind of progress

As promised, I do not write in here every single day, I do not report on every single workout now. I have settled into a routine where there are not significant changes, or even small changes, every day.

I had a few nights of cramps in my inner thighs and in my feet. These may have corresponded to a change in the Monday instructor of Aqua. I am not sure I did everything correctly and I know we did not do great stretches at the end. Another possibility is my use of arch supports. After I started wearing them I started having pain in my right foot, right around where the support is. So yesterday I pulled them out and I am going without for a few days to see if there are changes. It appears that the pain is going away so that part I may have guessed right.

Otherwise, not a whole lot has changed. I still have significant pain in my right leg-hip area. When I wake in the morning I limp, bent over, to the kitchen to feed the cats. Gradually I get myself straightened up and can limp, not quite so bent over. I continue to remind myself to stand and walk as straight as I can and to pull in my stomach. Usually, after a workout, I feel a bit more loose and am able to walk a little more easily.

The past few days I have noticed that I am a little more active in the afternoons. I work on something, perhaps just making dinner, and when there is a lull I clean something up or organize something. It smacks of having a little more energy. Could be. Energy, though, is such a fickle thing. It seems to depend more on my state of mind than on my state of body.

As to my regular workouts. I have upped the weights on the rowing and pulldown machines to 85 pounds and the leg press to 180 pounds. The rest is about the same. I do 15 minutes on the upright bike and five minutes on the treadmill. I could do more if it weren't for the pain. Damned pain. More pain on the treadmill than on the bike, as a rule. I used to love walking. I want to again.

It seems time to schedule another appointment with Clara. I think, though, that I should get an appointment with my doc first. I want to confirm arthritis in my hip and shoulder and ask about physical therapy. Maybe I can get a physical therapist who can test where I am more specifically.

Baby steps

Over the past few workouts I have made some minor changes to my routine. So now it is:

13 .5 minutes on upright bike at level 9
1 set of 15 reps on row machine at 80 lbs
1 set of 15 reps on lat pulldown machine at 80 lbs
1 set of 20 reps on leg press at 180 lbs
chest stretch, 30 sec each side
calf stretch, 30 sec each foot

rubber band exercises:
compound row, red & green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

squats on ball on wall - I put large ball in small of my back, put weight in heels, do squats - I'm doing five, sometimes six
squats at rail - weight in heels too, I'm doing five, carefully, sometimes two sets of five
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of ten seconds each
treadmill - walk normally, focusing on feet, knees, posture - I am up to 5.5 minutes. Could go longer if it weren't for my hip pain.

Lately I have been a little discouraged by the hip pain. It makes it hard to get around and I am disappointed in myself when my daughters visit - or I visit them - and I am unable to do the things they want to do. No hiking, no walking around malls, no strolling near the ocean.  I am considering making another appointment with a doctor to consider two things: possibly get corticosteroid injection in hip, if that's a reasonable pain relief alternative, and possibly referral to physical therapist.

upping it

Today, as I promised myself, I increased weights on the machines. So as of today, this is my routine:

12 minutes on upright bike at level 9
1 set of 15 reps on row machine at 80 lbs
1 set of 15 reps on lat pulldown machine at 80 lbs
1 set of 20 reps on leg press at 160 lbs
chest stretch, 30 sec each side
calf stretch, 30 sec each foot

rubber band exercises:
compound row, red & green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15 - I often don't do this because it's hard to find a door or other place in the gym that I can use.

squats on ball on wall - I put large ball in small of my back, put weight in heels, do squats - I'm doing five, sometimes six
squats at rail - weight in heels too, I'm doing five, carefully, sometimes two sets of five
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of ten seconds each
treadmill - walk normally, focusing on feet, knees, posture - I have managed all of four minutes

Today the gym was crowded when I came and I did not get on the treadmill and I did not get to a weight bench with the stick. On my way home I purchased a rake handle to use as a stick at home and I did the stick stretches at home. I am thinking that I will go on the treadmill twice the next time. Four minutes isn't much but it hurts and I don't want to keep doing things when they hurt, so that's where I end it for now.

pain again

Back to the gym for my expanded routine today. I got through it, glad that it is getting more comfortable for me, but I noticed that doing the three band routines was hard on my legs. They require that I stand and standing just seems so hard right now. It has been for a while, of course, but it seems worse somehow.

Again, I lay down for a while when I got home. But I didn't stay as long as I have lately. I got up to make myself some tea, to move around, and pains in my right hip came searing at me. I don't know what is happening here but it isn't making me happy. I am wondering if the "walking" book might help with some of this. Stay tuned for that.

For the record, my present routine:

11 minutes on bike (I am using upright bike now but not the "spinning" type yet) at level 8
1 set of 15 reps on row machine at 65 lbs
1 set of 15 reps on lat pulldown machine at 65 lbs
1 set of 20 reps on leg press at 140 lbs
chest stretch, 30 sec each side
calf stretch, 30 sec each foot

rubber band exercises:
compound row, red & green bands, 3 sets of 15
shoulder external rotation, red, 3 sets of 15
empty can, green, 3 sets of 15
lat pulldown, red, 3 sets of 15

squats on ball on wall - I put large ball in small of my back, put weight in heels, do squats - I'm doing five
squats at rail - weight in heels too, I'm doing five
stick stretch - I'm doing two stretches where my right arm helps stretch my left (the problem arm). Right now I am stretching three sets of ten seconds each
treadmill - walk normally, focusing on feet, knees, posture - I have managed all of three minutes

It takes me about 45 minutes, maybe a little more. As I get more comfortable on the treadmill and with the squats I figure it will take a little longer.

My goal is to do the chest and calf stretches every day, plus I figure I'll get in the stick stretches too once I get me a stick. Also, I am doing the lat pulldowns at home because I don't want to use a door at the gym.