Monthly Archives: July 2017

Sometimes, less is more

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“Just a little more. Push it further. Go on. A little more…” This is the refrain from the physical therapist as I work on bending my knee. One more degree of bend, and another, and another as I work toward a magical goal of 120 degrees.goniometer

“You’ll need to work hard at PT,” were the words spoken by just about everyone I told about my pending knee replacement operation. And the expectation is that this will hurt. In the hospital I was offered extra pain meds before PT. When I told the in-home PT that pushing for more flexion was making my pain spike into the 7 to 8 range on that 10 point scale where 10 = intolerable pain, her response was “Good, that’s what should be happening.” Say what??? Her goal is severe pain???

The day after surgery I was strapped into a passive motion machine for an hour which repeatedly bent my newly operated knee to 60 degrees then to 90 degrees, flex and straighten, flex and straighten, over and over. That same day I was wheeled down to the therapy room and put through my paces—ankle pumps, quad sets, and bending. “We want you at 110 degrees of bend before you leave tomorrow,” the therapist said. “And you’re going to lock me up and make me stay if I don’t achieve that?” I thought.

“No pain, no gain.” The warrior’s approach to recovery. This is a very American approach. Push through pain to achieve your goals.

I take part in an international online forum for people who have had knee and hip replacements and from reading other participants’ posts, I’ve discovered a different perspective on recovery.

Yes, keeping the new knee joint moving is essential for a good recovery. But this can be done gently. In the first weeks of recovery, the focus can be on letting traumatized soft tissue heal and moving just enough to keep things from freezing up—bend to the point of pain and slightly beyond then stop.

This seems like such a sensible approach but when I mentioned it to the PT she looked horrified. “You’ll never get flexibility back unless you push hard!” she said.

I’m in my fifth week of recovery. On the days that the PT is here to measure me I push a bit—it’s hard to resist those cries of “just a little more”—but on other days, I follow the gentle approach. I spend a lot of time with my leg elevated and an ice pack on. I stroll around the house and take short walks outside. Every time I get up I spend a few minutes gently bending my leg but never to the point of extreme pain. And with this approach, right on schedule, I reached that magic goal of 120 degrees of bend.

Seems like there’s a life lesson in all of this. I’m reminded of my forays into floor waxing. My house has oak floors and when I first moved in they needed to be waxed regularly (I’ve since had them refinished). I rented a power floor buffer and had to learn just the right amount of pressure to apply to control the machine—too much pressure and it took off across the room at warp speed, dragging me behind and gouging the floor.

Sometimes less is more. Sometimes the motto should be “No pain, more gain.” The trick is knowing when to push through and when to back off and let healing happen.

Recovery land

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I’m sitting on the back porch, with my right leg elevated on cushions and an ice pack draped across my newly replaced knee. I’m beginning week four of recovery and hitting all the milestones. Straighten leg—check. Activate quadriceps muscles—check. Bend beyond 90 degrees—check. Walk with a cane and a normal gait—check. Walk without a cane—check. Wean off pain pills so I can drive again—in process.

I tell friends that I’m an impatient patient. But “patient” is the wrong term. We were told in the pre-op class that we should not view ourselves as ill and were encouraged to bring street clothes to wear on the hospital unit. I was up and walking a few steps on day 1, walking up and down the hall on day 2, climbing stairs on day 3, and then sent home to recover.

I don’t feel ill—it’s more a feeling of being suspended in time. This is partly due to pain meds, which make me sleepy, content to mindlessly surf around the Internet and let time drift by.

Or at least that was the case in the first couple of weeks. Now that I’m reducing the pain meds and regaining energy, restlessness has sidled in.

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I’ve been nesting on my back porch daybed, which gives me a limited view of the world—the rhododendrons that flank the east and north side of the porch, an occasional bird that lights there, preens, sings, and flies off. If I turn my head to the left, I see the pink bloom of filipendula, grass, evergreens. Occasionally a critter of some sort scampers through—squirrels, groundhogs, rabbits, one day a spotted fawn. My gardens are blooming and thriving but seen for now from a distance. Soon I’ll venture out for a closer look but that feels like a next week activity.

My days have a rhythm. Morning means coffee and toast, the welcome coolness of morning air, easy contentment as I slowly wake up, maybe write a little, check Twitter, look at an online newspaper, ease into the day.

Afternoons stretch longer and desire clashes with reality. Mind and spirit want to go and do—body is not quite ready.

I pace around my small house. I might venture out for a walk down the driveway, across the street and down a ways, mindful that however far I go, I need to do the same distance on return.

Now, the sun is out and the air is steamy. Ten minutes ago, a thunderstorm raced through, a few loud claps of thunder, brief torrential rain. Another storm is on its way—I hear thunder in the distance. There are lessons to learn about accepting the present moment, whatever that moment brings.

I hear myself thinking, ah, I’m missing out on summer but of course I’m not—I’m just having a different summer than usual. A porch summer, a recovery summer, a summer to ease back into my busy life, slowly, one degree of bend, one step at a time.

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My cruising around the Internet sometimes takes me to delightful places, such as this clip of Natalie Merchant and the Kronos Quartet. Enjoy! https://www.youtube.com/watch?v=Qbxwa_ie3dQ