Yesterday was an important milestone. Fourteen weeks since surgery but, more importantly, two months since weight-bearing and the start of real rehabilitation and genuine regenerative exercise. I had a lazy Friday today. End of the working week and decided that there would be no gym and no bike today. I think the blood thinners are making me tired and I slept in till 6 AM. Leisurely stroll down to Manly. A huge surf boomed into Queenscliff and I stopped for awhile and watched surfers getting some perfect tube rides on a 2 m swell held up by a strong offshore wind. Manly wasn’t too bad, pretty glassy with the occasional big set pounding through. I waited for the lulls and didn’t have any trouble getting out. Quiet swim over to Shelly Beach and back with the 7 AM Bold and Beautiful group. Caught the Jet cat into work with daughter Catherine.
At this stage, after eight weeks of rehab exercise, it’s worth trying to determine what someone with a tibial plateau fracture should be able to do and should not attempt to do. Most importantly, by this stage you should not have any residual pain other than an ache and some stiffness when you wake up in the morning or when you have been seated for some time. This should pass quickly with movement. The list below is prepared using the experiences of a 62 year old male as a guide. If you are younger you may have a faster recovery; if you are older it may be slower. If you are a woman it may be different again. I don’t smoke or drink so that will also have an impact. The timeline below is the result of a very structured exercise program supervised by a physiotherapist and a personal trainer who is experienced in post-surgical rehabilitation for sporting people. She is a genius and has been a major factor in my recovery. I am not a doctor nor am I a health care professional. These are my personal experiences. None of the following exercises should be attempted without clearance from your surgeon and physiotherapist.
WHAT YOU SHOULD BE ABLE TO DO
1) Walk with a natural gait without limping
2) Stand with the injured leg straight and able to support the entire weight of the body. At eight weeks I have not quite got hyperextension of the injured knee but I’m almost there
3) Lying on your back you should be able to draw the heel of your injured leg towards your buttocks with the flexion measured from the hip, through the knee joint and down to your ankle at 135°
4) You should be able to walk 4km on level ground, without stopping and without any pain around the surgical incision or in the tendons around the knee or in the leg muscles
5) While there may be some residual swelling in the calf, foot and around the knee area, there should be marked improvement over the situation when you began weight-bearing. I can wear joggers, hiking boots and boat shoes but at this stage still cannot wear some tight leather business shoes due to residual swelling in my foot. This may be a residual impact of the DVT.
6) Despite some residual swelling, emerging muscle definition in the quadriceps and calf muscles should be evident
7) You should be able to bench press 10 kg with the injured leg five times. This should be capable of repetition at least three times without pain. This should not be done except under close supervision from an experienced personal trainer or physiotherapist. It should not be attempted without a month of buildup exercises to stabilise the injured knee joint. This should not be attempted if it causes any pain
8) You should be able to flex 5 kg with the injured leg at least five times. This should be capable of repetition three times.
9) Static lunges with injured leg both forwards and backwards in the lunge should be possible with a hold counting to 5 on each one
10) Sets of five sitting squats, with weight equally divided on each leg and back supported by a gym ball against the wall should be possible without pain
11) Step ups onto a bench with the injured leg both forwards and sideways should be possible in repetitions of 10 step ups and five sets. This should be done on benches both 20 cm high and 30 cm high.
12) Walking up stairs without discomfit and without hanging onto the handrail
13) Thirty minutes on a stationary bike, with the chain on the big ring at the front and on the middle cogs on the back of a ten speed bike i.e. the fifth and sixth cog. This should be done with a cadence between 70 and 80rpm. This should not cause any pain or resistance in the injured knee. Care should be taken that power is imparted to both pedals equally and the exercise is not done just with the uninjured leg.
14) Swimming, both with and without flippers, both in the pool and in moderate surf, is possible if this is part of the program. Great care should be taken in getting in and out of the water if any reasonable surf is running. The possibility for a sheer fracture of the knee from a twisting or rotational movement in the water is very real.
WHAT I CANT DO
1) I can’t walk down stairs without holding onto the handrail. I also cant walk down steps leading with my bad leg. I go down one step at a time leading with good leg.
2) I can’t step onto a downward escalator without hanging onto the rail. ie I cant use an down escalator with something in both hands. I stepped onto one the other day with my gym bag in one hand and drink bottler in the other and nearly fell down the escalator. It’s too early and my bad leg doesn’t yet have the strength, to be this cavalier. Always keep one hand free
3) I cant do one legged squats on my bad leg. Too much pain in the kneecap. Tried. Cant do them.
WHAT YOU MUST NOT DO:
1) Attempt snow skiing I have heard numerous stories about people back on the slopes four months after tibial plateau surgery. I have heard of people skiing one legged three months after surgery. Don’t even think about it. Even though your bones may have healed, there is no way that the muscle and tendon structures around your knee and in your injured leg are strong enough to safely attempt snow skiing. It should be off the agenda for 12 months following your injury. Do not even think about it.
2) Running and jogging. I inadvertently broke into a jog trying to get to the ferry this week. Not good. Don’t think about running at this stage. It puts impact pressure on the top of your tibia. If you want some aerobic exercise try swimming
3) Golf Too much twisting and lateral pressure on the knee
4) Field sports such as cricket, baseball, hockey and tennis
5) Body contact sports such as AFL, Rugby League or Rugby Union where lateral force can be applied to your knee in a tackle, should be right off the agenda.
6) Sports involving sudden stops, twists and turns particularly basketball and netball
7) Anything involving high-impact downward force to the tibia. Gymnastics of any form should be right off the agenda.
8) Road Cycling. While a stationary bike in your home or at a gym is a vital part of your recovery, riding a bike on the road with fixed cleats is an absolute
no-no. When using the stationary bike at home, I leave the right shoe, ie the broken leg side, permanently cleated to the pedal. I mount the bike with the left shoe on and laced up, the right barefoot. Once in the saddle, I put my right foot in the right shoe and close the shoe straps, while sitting on the bike. To get off the bike I do the opposite —Undo the right shoe straps and remove my foot leaving the shoe cleated to the pedal. If you were on the road and had to suddenly uncleat using the broken leg, it’s unlikely that, at 12 weeks, you would have the strength and may seriously damage your knee with the rotational force necessary to get the shoe out of the cleats. Don’t be tempted at this stage.
Hey, the great news………It’s 14 weeks since surgery and if you haven’t, by now, had an infection, rejection of the plate and screws, a deep vein thrombosis or compartment syndrome you’re not going to have them. If you haven’t had a fall you are probably not going to. Congratulations give yourself a pat on the back.