I WILL Keep Getting Better, Right?
May 4, 2021 7:23 AM   Subscribe

I'm recovering from a broken knee. I've come a long way, but I'm not all the way there - and I'm getting impatient and paranoid that I won't keep recovering. Can anyone talk sense into me?

So here's the activity level I was at before: walked almost everywhere, did some biking now and then just for fun. I live a half-mile from work and would always walk or ride my bike there. I'm 3/4 of a mile from the local supermarket and thought nothing of walking there. I live in a 4th floor apartment and there's no elevator, so leaving the house calls for a 4-flight stair climb when I come home. At the time of the break, I had JUST started getting into the habit of a weekly 8-mile bike ride, and about once a month would go on a long urban walk or hike (like 7 miles).

I broke my knee in early October (a slip and fall on the sidewalk). I had surgery to repair it; it was apparently pretty gnarly, but my surgeon wrapped all the pieces of bone back together with a wire cage to hold everything in place and the recovery from the surgery went well. On the last x-ray I saw (back in January) there was just one crack that had to fill in, but my surgeon was confident it would still do so (it was the biggest crack so it wasn't surprising it wasn't all the way grown in, the bones had separated entirely and had a ways to go). The wire did occasionally bother me if I put pressure on the knee early on, but....that stopped, so I think it was just some swelling that went down.

I started physical therapy on Halloween. At that time I had only 25 degrees of mobility in the knee and almost no strength, and was still walking on crutches. I had just come out of the cast and was using a brace. Since then I've hit the following landmarks:

* I ditched the brace in January and switched to using a cane.
* I ditched the cane in March.
* I hit full mobility in my knee about 2 weeks ago.
* I started walking up stairs normally - yes, even at home - about a month ago.
* I started gradually walking to work again a month ago - first a couple days a week, then 3, then 4. I am now walking to work every day again - although it takes me about twice as long.

But, here's what I still CAN'T do.

* I can't walk DOWN stairs. My bad knee is still too weak for that; I try to bend it with control but it gives out at a certain point. (I've tried walking downstairs normally a couple times, but after one step I can tell I'm not there yet.)
* I still feel a little wobbly some days.
* About once a week my bad knee will start to buckle.
* I'm SUPER scared about crossing streets - I suspect this is mostly mental, as I am afraid that I'll fall and the light will change and I wouldn't be able to get out of the way in time.

I think I am just psyching myself out because Dr. Google says recovery typically takes 3 to 6 months, and it's been 6 months and there's still stuff I can't do and I"m starting to ask "is this just my life now or am I on the slow end of the curve or what". Any insight?
posted by EmpressCallipygos to Health & Fitness (21 answers total) 1 user marked this as a favorite
Are you still in PT? They're probably the best people to talk to about your progress. You might need to switch up exercises/intensity/reps/whatever. What you're describing sounds like you might have some muscle weakness (might be something else, knees suck) and if it's the muscles that's totally fixable, but exactly how is best for a professional to figure out.
posted by restless_nomad at 7:43 AM on May 4 [9 favorites]

What Dr. Google says may be true for a 20 yr old athlete, which you're not. It sounds like you're doing great except the stairs. Are you still doing physical therapy? Your physical therapist should be able to help with the stairs thing. So, are you just going down the stairs lowering both feet sequentially to the same tread like little kids do, or like I do when I'm carrying something heavy?

As for crossing the street could you just carry a cane, a security blanket cane?
posted by mareli at 7:45 AM on May 4

Response by poster: I am still doing physical therapy, but only once a week. I am indeed doing the stairs like little kids do. And I THINK that actually may explain why my left knee may be starting to feel a little stiff now as well - it's been doing all of the going-down-stairs heavy lifting for six months now.

And PT has indeed told me that I still have muscle weakness. So even just hearing that "oh yeah, muscle weakness is totally fixable, and don't forget you're not 20" is helping even right there.
posted by EmpressCallipygos at 7:54 AM on May 4 [3 favorites]

I would definitely get back to PT if you can. A sports therapist might help you fine tune your recovery at the 'recovery' end - my first PT was really great but used to kind of rehabbing seniors and so she was happy with progress at a point I wasn't done.

Anecdata: I broke my fibula in two places, one quite close to the ankle, in Dec 2017. I was doing 4-6 hours of martial arts a week at that time and running 10km races.

Long story short, I kept reinjuring myself on both sides of my body, not because my *bone* wasn't healing but because I wasn't building up muscles equally on both sides, especially the muscles that kind of stabilize you for balance. I had to be really diligent. I'm afraid I did a lot of stunt exercising on my good leg while I was in a cast and then a boot and I managed to wreck my gait so one leg was carrying more of the load.

I'm 50. I had to recover s.l.o.w.l.y. but also smartly. I'm still a bit reluctant to kick hard on that side but at least I can pivot now, am running, walking 15km a day, etc. It took quite a while.
posted by warriorqueen at 7:57 AM on May 4 [3 favorites]

You and I had surgery right about the same time. Mine was for my shoulder and I’m sure was an easier surgery than yours. I just in the last two weeks got full use of it again. Right up until the very end, there was still some swelling inside (my supposition, that’s exactly how it felt) that kept it very stiff and painful despite that my range of motion and strength were improving. Then suddenly I turned a corner. And in fact for every surgery I’ve ever had, that’s how it’s been—just as I’m resigning myself to a life of disability, I turn a corner. Hang in there.
posted by HotToddy at 8:12 AM on May 4 [1 favorite]

I was also going to say that your PT needs to give you some strengthening exercises for your weaker leg. If they know you're physically healed but also weak I don't know why they would not be prescribing single-leg recovery exercises to address the imbalance. I have a bad knee and I've been working on recovery for a long time, and some of the things my PT and coach have assigned (just to give you an idea of what could be on offer, not advice!):
  • Single leg kettlebell Romanian deadlifts (RDLs)
  • Single-side farmer carries (also with KB or carry handles)
  • Side planks
  • Bicycling your knee with a resistance band around your foot (hard to explain)
This is a short list but is what I can remember right off hand. But it definitely sounds to me like you've got range of motion (yay!) so now you need to work on muscular strength. It is, unfortunately, just work. But you can get stronger and you can get better!
posted by Medieval Maven at 8:15 AM on May 4

I don't have any sort of medical knowledge, but what I do have is a lifetime of watching sports, and from that, I've learned that knee injuries are about as difficult as it gets. It's only fairly recently that professional athletes (i.e., people in peak physical condition whose entire existence revolves around physical rehabilitation of injuries) are able to resume playing again at all. As recently as the late 90s or early 2000s, a knee injury was generally considered career-ending. Even today, when that's not the case anymore, it still generally takes a year or so to rehab. And yeah, a pro athlete's rehab is going to be different than yours, but they're also starting from a better place in terms of base strength and resources.

In terms of practical advice, I'm not sure how much I can offer. If your knee feels like buckling, I'd maybe suggest revisiting the brace for a little while longer, but it's presumptuous of me to think I know better than your doctors and PTs. Psychologically, though, yeah, your experience scans with what little I know about knee injuries. I'd be surprised if you were at 100% already - I would expect several more months before you'd be close to normal. That may not actually be comforting, but I also know that nearly all knee injuries do heal, eventually, and that you're unlikely to be "this way" forever.

If you'd find the sports analogy thing comforting, knee injuries are common enough among athletes that there's a whole subgenre of longform sports journalism about knee injury recovery. You might try reading some of those. They generally follow a similar pattern: good initial progress, a plateau that leads to a period of hopelessness (similar to where you're at now), ending with a full recovery and a happy ending.
posted by kevinbelt at 8:27 AM on May 4

It me! The also fucked my knee around then but not as badly as you (I had keyhole surgery to wiggle a meniscus, I was talking about wet-fart-noises). I am now 8 months post op, finished at PT a few months back and training regularly, BUT I still get more tired in that knee, it's feeling the workout I had yesterday, and I am still building back muscle-mass and strength. Talk to your PT, if they're giving you exercises to do at home, do them, I know it's shit, but it makes a difference. One of the exercises I had to do at home was explicitly lowering myself from one step of the stairs to the next, so "negative" steps. It's sounding kinda unanimous here on preview.
posted by Iteki at 8:29 AM on May 4

I had a major knee injury a while back (but not as bad as yours) and it took FOREVER for my muscles to get strong enough again to walk normally. It’s fine now but I’d say it took the better part of a year, much of which was getting over the very last period of slight limping, which seemed to take months. Hang in there! It’s really frustrating but sticking with the PT exercises really helps. Eventually. I think those muscles atrophy really fast, like by the time I was healed enough to start my PT exercises, the muscles around my thigh and knee wouldn’t even contract and I needed help from one of those electro pad stimulator things.
posted by music for skeletons at 8:30 AM on May 4

orthopedic injury / PT vet here. Yes, you will keep getting better for a long time, for years if you keep working at it. Hang in there. And keep working at it.
posted by Dashy at 8:38 AM on May 4 [1 favorite]

Response by poster: Sorry I wasn't clear - I am still doing physical therapy, and have been consistently since Halloween. I only just last week switched down from twice a week to once a week. They are indeed doing strengthening exercises as part of the therapy, and I'm doing the exercises at home that they've given me consistently.
posted by EmpressCallipygos at 8:39 AM on May 4 [1 favorite]

Response by poster: And y'all are giving me a great reality check, thank you! (Kevinbelt, if you have links to any of those "I thought I was done for but then suddenly one day...." articles, please share!)
posted by EmpressCallipygos at 8:43 AM on May 4 [1 favorite]

My minor knee injury (a meniscal tear with no broken bones) took me six or eight months of regular PT, although I'll admit some of the end of that was more core strengthening and injury prevention on the other side because I'd been compensating for a while. It seems very much like you're on the right track. Make sure you let your therapist know about the increased pain in your other leg and they'll probably add some symmetrical or full body work to help you gain equal strength on both sides.
posted by fedward at 9:44 AM on May 4 [1 favorite]

Oh man, I remember those feels so well. (ACL surgery here.) I think I was at the TWO YEAR mark when my surgeon/hospital sent me another annual outcomes survey and I was SO MAD because yes I could do day to day life just fine but still didn't feel super comfortable with a lot of more adventurous jumpy side-to-side stuff and was really wondering if I would ever, EVER be back to fully normal. It was like I was hovering at 90% for so long.

Good news is I am back to what I would call fully normal, though my right leg is still ever so slightly less strong/stable than my left, in that when I do single leg RDLs with heavy weights I notice the right leg is shakier. But I'm not scared of movement anymore and I do all the things I used to do - run, bike, walk crazy long distances, etc. etc. I even trained for and ran a half marathon at around the 2-3 year mark, and I am middle aged and not particularly athletically skilled.

I don't want the long timelines in my story to scare you, but instead to reassure you. It takes like 6 months to a year to recover the first 90% and then the remaining percents just tick by so slowly that you don't even notice until one day you realize "huh, my knee hasn't done that locking/buckling thing in ages!" or "wow I leapt over that puddle without even a second thought!" That's normal, especially if you're not a pro athlete used to pushing your body to the limit all the time. Some of it is as much mental as physical.

If you're doing the home PT exercises consistently you're ahead of most, including me. You'll get there.
posted by misskaz at 10:18 AM on May 4 [2 favorites]

I had ACL surgery almost exactly five years ago, and I REALLY relate to this. I clearly remember the surgeon telling me that it would take two years before I trusted my knee again, and I was very like "ugh god seriously?" about it, but... he was more or less right. When you're in the thick of it, every milestone feels so slow and fraught. I did PT weekly for about 9 months, and I swear it was the longest 9 months of my life. I remember getting cleared for running and going outside and being like, literally how did I ever do this, there are POTHOLES and CARS and my knee will NEVER BE THE SAME etc etc. Some time later I got cleared for soccer (which is how I tore my ACL), and it was similar -- just constant obsessing about movements I'd never given a second thought to, constant hyperawareness of my knee, constant frustration about how [some professional athlete I read about on the internet] was back to playing in 6 months and so what was wrong with ME that everything still felt so weird. And then one day it just... stopped. It's really anticlimactic actually, you do all this work and spend all this time obsessing about it, and the reward for all that is that one day you're halfway through a run or hiking straight up a mountain or something and you're like, "huh, I haven't thought about my knee in months."

I don't know about you, but I am highly, HIGHLY anxious about health stuff, and that was like 75% of what made recovery difficult. If you're doing PT and progressing (which it sounds like you are), you will eventually be fine. It's just slow and boring and stupid, unfortunately. It takes a weirdly long time to build back all those tiny muscles around the knee, but it'll happen. I basically don't think about my knee at all anymore, and I do a lot of workouts that involve like 8 billion squats and run 4-5 times a week and hike and pretty much do whatever I want.
posted by catoclock at 11:23 AM on May 4

Best answer: Something that might temporarily help with the stairs, is try to go down them facing backwards (I.E. face the highest point of the stairs). If you have the strength to go up stairs normally, you should be able to go down using the same movements in reverse to descend. Descending stairs while facing the low point requires more flexibility and a lot of eccentric strength/loading.

If you can do so, this will likely be both faster than doing two foot falls per stair, while not unbalancing one side of your body.
posted by nobeagle at 11:50 AM on May 4

Response by poster: Thanks, guys - I also literally just came back from PT, where I also discussed things with my therapist. She agreed that I had no cause to worry about "have I stopped" or anything - she pointed out some progress she's seen me make in the past few weeks, and reassured me that yeah, this just takes a while. She added that we had already been discussing phasing me over into more strength training going forward on top of what we were doing, and that would help. She also pointed out that I wasn't gunning to run marathons or anything, so what I am hoping for is VERY achievable.

Marking nobeagle's thing as "best answer" because walking downstairs backwards is a BRILLIANT idea, which may spare my good knee - it's been feeling tight, and my therapist agreed that the fact that it's been doing all the work on stairs for the past six months probably isn't helping, so a more even way to handle stairs will likely help a lot.
posted by EmpressCallipygos at 11:58 AM on May 4 [1 favorite]

You've gotten good advice but I just want to chip in and say that I had a bad RSI with bonus nerve damage (years of ignoring pain until I literally couldn't grip with enough force to brush my teeth) that I didn't plateau on for a year, and even after the residual was declared "permanent and stationary" I am still noticing improvement year after year. You haven't even plateaued yet! Keep at it.
posted by Lady Li at 12:39 PM on May 4

I broke my knee in my early 30s. I was a regular cyclist. It took me about a year to fully recover extension — early attempts at peddling involved getting up and down in the saddle — and probably another year after that to get full strength back. Just a point of anecdata that your frustration is familiar, and that it took me a while to get back to normal. Keep at it, and it is likely there will be a day not long from now when it all feels right again.
posted by They sucked his brains out! at 2:16 PM on May 4

Best answer: It's important to remember that surgeons are delusional liars about recovery time, because to them you're officially recovered once you are no longer in their office asking when you can walk without crutches. Not all recovery is recovery. Taking surgeon recovery time and multiplying it by 2-4 is reasonable.

I know a lot of skiers who have had ACL surgery, and it's usually 1-2 years to really recover. Your injury sounds much more serious, so I think your progress is amazing. Still I think having in your mind 1-2 years to really be back to 100% might help you set expectations.
posted by medusa at 8:34 PM on May 4 [1 favorite]

Give it time. My knee surgery recovery ebbed and flowed for a good long while. It will eventually get better.
posted by tarvuz at 4:15 AM on May 5

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