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Quadriceps Tendon Rupture, Repair and Rehab - Page 45

post #1321 of 10802
wanasail, dbrow,fall guy,
Thanks for the responses !  dbrow and fall guy, your right I am expecting to much to soon.
(although I did cut the grass with the brace this morning)... I'll wait until
the OS assigns PT before I do more.  Right now I just wanna drive
Thanks for the encouragement everyone.This is frustrating and its good to have others who know what you are goung thru.
Wannasail, my "painkiller" of choice was Cruzan and diet coke or rum runners on Tortola.
Did you go to a doctor on St.Thomas?   I chose not to.... no cane or crutches, just ice and ibupoferen for a week
until we returned to the US.  The airport in Puerto Rico was tough, a lot of walking and no carts
(tried an up escalator and barely escaped).
Luckily I had little pain just bruising and swelling.
I arrived back in Chicago 7/9, saw the OS 7/10 and had surgery 7/14.
Wanasail how did you manage in the Caribbean?
I see the OS Monday and hope for the smaller, hinged brace all of you describe.
post #1322 of 10802
Hi kamikazee99, my story is on post #1003 on page 34 -- wow its been a long time!  Like you, I toughed it out until I got back home before seeing a doctor.  I was the skipper for the bareboat, a 40' cruising catamaran and didn't want to wreck the vacation for everyone.   On the boat I was taking perscription strength Aleve during the day, Tylenol with codeine at night and Dark and Stormies (dark rum and ginger beer) as often as I could.   I kept the knee iced as much as possible and used an ace bandage we found on the boat for compression.  I honestly didn't think it was as serious as it turned out to be.  I still tease my wife about telling me to "Suck it up - its only a sprain" when we were climbing the steps to Blackbeard's Castle.  My icon for the forum is a photo of one of the pirate statues overlooking the harbor on St. Thomas outside of the Castle.  It sounds like you live somewhere around Chicago - I'm in Madison, WI and sail out of Milwaukee. 
post #1323 of 10802
Hi kamikazee99,

I'll throw yet another voice into the fray counseling patience. This will heal. 100% doesn't sound like an unreasonable goal. The thing is that it's going to take 12 months (give or take a couple) to get there. As wannasail said, you'll need to know yourself well enough to know what your goals are in rehabbing the knee. I found the rehab process to be a very pleasant challenge. My PT constantly reminded me that you have to be patient with this injury. It will heal pretty well almost regardless of methodology, but it does take a long time. The first few weeks are sort of excruciating to move from being active to immobile with utter suddenness. Then, you can sort of start to do things after 4-6 weeks. Just be really, really careful about walking without the brace -- the hinged brace was a great thing (even though I was desperate to get rid of it by the end of my time in it).

I'm at 6 months post-surgery today. I couldn't have imagined being where I'm at now when I was back on my couch in March. Right now, I'm biking 3 days each week, working out in the gym 2 days, and trying to play tennis once each week. It's nice to be active again. There's still a noticeable strength difference between the legs, though the muscle mass differential is diminishing. I'd say it's about 75% of the uninjured leg. A lot of the exercises are now easier on my left leg than my right.

This is just a long way of saying to work hard at what they'll let you do but be careful about pushing the envelope too far. Wait a few weeks until the healing has had a bit more time.
post #1324 of 10802

I am up to 170lb leg sled press with the injured leg.  Another 25 lb.  Did two sets of 20 reps but boy were the leg muscles twitching after that.  Then did two miles on the bike.

My injury was April 9th.  I drove a little bit in Hawaii around May 24th and it was a bit tough.  It still is not right with the clutch, tough still to lift the leg but not impossible. So use that as a guide for driving. Automatic would work OK after a month and a half, but not clutch.  I mowed the grass after a month or so also, but it was tough.  You really do not know how much muscle tone you loose until you start trying to do straight leg lifts.  I got the mini hinged brace with the knee hole after about 2 1/2 months.  You  are correct, that first ride on an escalator or moving walk is a real trip "Ah what do I do now that the end is coming...."

Remember, you need to heal the tendon joint first, then comes the muscle.

To all, one thing I have noticed.  The skin on the good knee is real tight.  The skin on the bad knee seems flabby and about twice the volume if you can know what I mean?  Whats up with that?!?! Also, I get a bit of tendon popping when I do the leg presses.  Does not hurt but can feel it...

post #1325 of 10802
Hi Kamikazee99,
Sorry to hear about your troubles, and welcome.  This thread has been my third partner in recovery with my OS and PT.  Lots of good information in all of the posts.

I am jealous of your story and your recovery to date!  I think you are ahead of the curve. My injury was while walking on a gravel pathway with a grade of a whopping 20 degrees.  You and Wanasail have great stories, but I can’t imagine doing this out of country. I was post surgical about 12 hours after my injury; injury 6/14, surgery 6/15.

My recovery story is a lot like Fallguy’s, and at the risk of piling on, I would say tendon repair needs to heal, then you go after the range of motion, and reforming and rehabbing the muscle groups.   In my case, both were at ground zero. I was in decent shape when it happened, but after the immobilization period I had to start from scratch. 

I am nine weeks tomorrow, and have completed two weeks of PT.   I went in there 12 days ago with 33 degrees in the left and 31 in the right.  Last night I checked out at 63 and 62 degrees. Look out Fallguy, I am catching up with you! Our race is like the tortoise and the tortoise. 
Kamikazee99, I know you posted the question how to speed up the recovery, and I don’t know if you can. My body is in charge and has dictated the rate of recovery despite my desire to put mind over matter.  Muscle fatigue plays a big part here too.  I would love to do two four hour sessions a week and be done, but for me it has been three half hour sessions a day, plus three one hour PT appointments a week. Dbrow says it best in the previous post; ANOTHER STEP FORWARD!!! Recovery is a lot of little milestones.
But I have found my new medicine, and it isn’t dark and stormies!  I went walking and swimming in the pool this week and it was fantastic. Lots of relief, but I think it is going to speed recovery along a bit.  Hey Xerxers, hopefully you are getting back in the water as well. 
post #1326 of 10802
RCM - I am now post surgery 5 wks.  I have an appointment with the surgeon this upcoming Thursday and hopefully he will provide me with a hinged brace and the go-ahead to use the "continuous motion machine" that was delivered to my house.  The machine bends your knee, passively, a fixed number of degrees, i.e., on the first day the range is 0 to 30 degrees.  I am instructed to add five degrees per day.  Once I get the hinged brace, I will go into the swimming pool, using the old straight leg brace to enter.  I have rigged a rope in my back yard that I tied to a tree, such that, when I get out of the pool, I can pull on the rope to help me get up the pool stairs.  I cannot describe how much I yearn for the soothing cool waters.
If anyone has a specific suggestion of things to do to speed recover, which soon will be devoted to increasing my range of motion, I would love to hear from you.  A few days ago I invented an exercise to help strengthen my leg.  I stand with my good foot on a book, such that, my bad leg is dangling two inches above ground.  I support the bad side with a crutch.  I then move the leg in a kicking direction, keeping it straight.  At first, I could only move it an inch.  Now I can move it 5 inches.  When I do this, I experience an odd twitching near my knew, without any pain.
post #1327 of 10802
Hi Xerxers - I hear you wanting to get past his thing as soon as possible.  Rigging up the rope to get in and out of the pool is a great idea.  But - listen to your OS and PT.  Push as fast and hard as they let you - but no more.  You'll get there only as fast as your body will heal. You are healing and vulnerable to injury that can set you back.   To speed your recovery make sure to exercise the rest of your body - especially your core.  Work on exercises that you can do that don't put stress on your injured quad or knee.   This will pay big dividends for you down the road as you start working to regain your motion and get back to your favorite activities.  Good luck, you're going to get there! 
post #1328 of 10802
Thank you.  I take your cautionary advice seriously.  Actually, however, I don't have a PT at this juncture.  As of 5 weeks post-op, I've only seen the OS once.  I do have an appointment this Thursday when I think I will received an adjustable hinged brace and the go-ahead to use the continuous motion maching at home (which will slowly bend my leg adding 5 degrees per day).
post #1329 of 10802
Thanks for responding wanasail,xerxers, and garland.
5 weeks post op tomarrow and saw the OS today.  He gave me clearence to start PT
and surprisingly suggested I not wear a brace at all.  I was shocked.... after reading your posts
I thought for sure he was going to recommend a hinged brace.  After seeing me walk without it,
he told me to bring a crutch with because he doesn't believe I will get much use from a hinged brace.  Without PT I am at at least 50 degrees(except for flexing I have done nothing).  I am
not sure if I am lucky or the OS is just making me do what he thinks I can handle.
The bad news is he doesn't want me to drive until I am at 90 degrees, so if I drive it won't be
very far.
Wanasail, a dark and stormy sounds great...where do you get ginger beer?  Have you ever been to Tortola?
I split my time between Elmhurst, IL outside Chicago and Burlington WI outside Lake Geneva
RCM we have almost the same scenario at 5 weeks each... good luck to you too.
D Brow, you are right about muscle tone... it sure feels wierd without the full brace.
The ride on the up escalator at San Juan Airport was scary... I flung my luggage onto the
platform near the top so I had two hands getting off... not fun
Garland, sound after a lot of work you are doing well.  Hopefully I can be there after I go
thru PT.
Good Luck all,
post #1330 of 10802
Tom - remember me?  I'm a BQTR like you.  Accident on Feb. 23.  At the end of this month, it'll be six months post surgery.  I wanted to see how you were doing - and hope you are still recovering (unless you're FULLY recovered!).  I'm doing very well!  Finally, no more problems walking downhill.  The only issues I have are walking downstairs (upstairs is fine) - in which case I have to really take it easy.  Although I just finished my prescribed PT last week, I've got work to do on my own now.  I've been working my quads and knees pretty hard with squats, leg extensions on a nautilus type machine, cardio on a stationary bike, and on an elliptical - and also some speed walking.  I attained full knee movement about a month ago.  I'm quite happy with everything.  For the first time, I'm actually hopeful that I'll someday (maybe in the next couple months) be able to do light jogging again.  I bet that after ALL this is over - my legs will be stronger than they were before the surgery!  My quads are as hard as a rock. 

I really want to thank you for your words of advice.  You're the only other BQTR I've communicated with (albeit briefly) - and your email was very important to me - and gave me hope.  Thanks!  Hope you're doing well.  Since I have your email, I'm going to send this to it - in case you're no longer on this forum.
post #1331 of 10802
Kamikazee99 - a Dark and Stormy is worth taking a quick break from work. Here is a link to the Barritts website http://www.barrittsgingerbeer.bm/index.html    If you can't find it locally, here is link for buying it over the web http://www.beveragesdirect.com/products/barritts/  My wife and I have done several "bareboat" sail charters starting from the Moorings base in Roadtown, Tortola.  It's one of our favorite vacations and we go back every 5 years or so..   Where were you staying? 

You guys with the bilateral ruptures are nothing short of amazing.  Xerxers, good luck with your OS appointment --  hopefully you'll get a referral to a PT familiar with the injury.   All the best!
post #1332 of 10802
Hey all, I would like to second all of the advice to be cautious with rehab.  You do have to take things slow but at the same time you have to embrace the small steps you have made.  I can remember laying in bed feeling pretty depressed because I couldn't go to my daughter's soccer games and the next thing I knew I was back to work and getting around relatively well under my own power.  And now I am four months post op and I can not believe how well I am doing.  I am able to keep up with my kids, can't jog yet, but steps are getting a little easier. 

So keep up the hard work and things will get easier, just don't push too hard, too fast! 

post #1333 of 10802

Hi AdrianC,

Thanks for the update and the encouragement.  I am also BQTR, and that is just what I needed today.  I had another great PT session today, and am really improving.  But I was discussing with my guy about the lack of progress walking. Not having a good leg to rely on definately slows that portion of recovery.  Just when I asked "will this ever end?",  I see your post and find some assurance that it will get better.  Will have to go back and find Tom's and your original posts. 

post #1334 of 10802
Hey All,
  rcm 111  sounds like you're making good progress... thats great !!    last wednesday (8/12) at pt i reached 78 degrees, on friday  i got to 84 degrees and   today , monday ( 8/17 )  i actually hit 91 degrees !!   It wasn't easy but  i think it did get a little easier once i got past the 70 degree marks.     Walking is easier but  I often tend to  limp..and my daughter reminds me    " dad, bend it "  !!   I seem to have more  "small pains  and sensations  " around the knee and i think this might be because the swelling is going down very little, but  my knee is still swollen and hard.
post #1335 of 10802
The OS said after 4-5 weeks the sewing and tendon/bone knitting should not come apart.  The caution I got from my PT is that if  you tear it again, the Ortho Dr would have to trim the tendon again (if your rupture is complete detachment) then do the sugary again.  With the shorter tendon, full ROM would be in doubt.  Just a caution that you really do not want to over do things!

You can try this.  My PT had me stand on a box with the bad leg, lifting up the good leg.  Then bend the knee on the bad leg to lower and touch the toe of the good leg.  Similar to your setup.  I just took some old 2X4s a small sheet of 3/4 plywood and fired up the compressor and nail gun and built one.  Take it slow and easy to start, to get the burn in the tendon which adds to the strength of the knit.

I have an L shaped counter.  I grab the counter, and do squats stretching the tendons.  I started with a chair under my butt in case of a fall, but do not need that now.

I think a lot of getting back the ROM in the leg is stretching those tendons. Stable walking is the muscle tone. 

I am now using the injured leg to lift going up the stairs.  I can do the full 13 in my house.  I can go down the stairs for the last couple of stairs using the injured leg to support.  Another step forward!  I am really feeling good with the leg tonight after doing two sets of 10 squats.

4 Months, one week since the sugary and moving on forward.
post #1336 of 10802
Hi everyone,(5 weeks today)
Just did my 1st PT session yesterday.... started with a 47 degrees rom and went to 74
at the end.  The leg is a little sore today, but it is good.  Can't wait to go to the local pool tonight as it is very humid in the midwest.
The OS still has me wear the brace when I walk the 3 blocks to the train, but otherwise I am now free of the brace.
xerxers how are you doing we had our surgeries at about the same time?
RCM ...both quads?  how did you do it?
as you said I'm just taking it one step at a time... hopefully driving again soon
dbrow, any recommendations on core exercises?
you've been right on with your advice, thanks
wanasail, In Tortola I stayed in Long Bay(West End) twice.  Once at Long Bay Resort
this time we rented a villa called the Sterling House.  Google it... it was well worth it.
post #1337 of 10802

Kamakazee: I am exactly five weeks post-op.  My leg is still in a straight leg brace, not hinged.  I walk around the house using one crutch for balance -- just in case.  I go down stairs using two crutches.  I have no significant pain or discomport.  I will see the OS in two days, and, hopefully I will get a hinged brace and the go ahead to use the continuous motion machine that was delivered to my house.  (This machine bends the knee passively a pre-set number of degrees.)  My OS wanted me to wait to the 6 week mark.  I get the sense that my tear must have been quite severe because his usual protocol is much quicker.

dbrow: Thanks for the advice.  I had a little trouble picturing how you do the box exercise.

post #1338 of 10802
dbrow, any recommendations on core exercises

Stretch the tendons doing knee bends, flex the leg or squats and when your able use leg press sleds at the rec center to build up the quad. I started at 80 lb about a month ago, three months after the repair.

Feel the burn but be prepared to catch your butt if you fall.

I am really starting to believe I am over the hill.  Only complaint is a bit sore after a day at work which could be because the left quad is still not 100%.  The leg feels perfect sitting here bent normally at the computer.  Actually, the right good leg knee aches more than the left!
post #1339 of 10802
Today, I went to OS and got hinged brace to replace the immobilizer.  Initial setting is for 30 degrees.  WOW!  This little bit of flex makes a big difference.  Two days ago, I started using the continuous passive motion machine at home.  I am now at 45 degrees flex.  Given the material I have read on this site, I am surprised that I did not have any pain getting there after 5.5 weeks in a straight leg immobilizer.  I did modify the regime by simply adding one degree per ten minutes to the flex, such that, I went up in flex very gradually.  (Possibly, I will experience pain after I get a little farther in the protocol.  I did read my surgical report and discovered that during the surgery, after the repair, they test the knee to 30 degrees, i.e., you leave surgery with this much room to flex.
post #1340 of 10802

Congrats on getting the hinged brace.  It is so nice to be able to move your leg a bit isn't it? 
The machine you have at home sounds like the "bioflex" machine I used at PT.  I sat on the seat, my leg was strapped to another piece that bent my leg to whatever degree the PT set it for.  While this did hurt a little bit, It was the kind of hurt that also felt good, because it was so good to get some motion.  I was actually disappointed when I stopped using that.  It helped me really get some ROM very quickly. 

So all along, I have been reading on this forum how many people, months out of surgery continue to have swelling and stiffness in the knee and I always thought I was lucky because I never experienced that... until last night.  Not sure what was going on, buy my knee was sore much of the day and very swollen and uncomfortable last night.  I just laid down and iced my knee and this helped some.  Today, no problems at all, except a little feeling of being stiff, more trouble on steps today and transitioning from sitting to standing. 
post #1341 of 10802
Hi Graceella,  I've wondered if it was my imagination, but the left surgical knee seems to feel differently from one day to the next.  Sometimes it feels close to normal, sometimes tight, sometimes I get a little clicking sensation, sometimes sore, sometimes weak.  I haven't really been able to see a pattern to it - it just seems random.   I had two operations on my right foot last winter before I injured the knee and that also feels differently each day.  Maybe its just part of having surgery.  I have a theory that I may be pushing the knee harder as I feel stronger - maybe overdoing it a bit.  Interesting, but a bit disturbing. 
post #1342 of 10802
I call those my good and bad hours.
In general my knee still swells at end of work.   I take an ibuprofen and it goes down.

I am now up to 185lb  on the leg sled with the repaired leg.  Was trying two sets of 20, but only got to 12 on the second set.  Went back down to 165lb to finish the set. 

The knee always feels better after the workout.  But I still get kind of a saggy but tight feeling if I have not used the sled in three or so days.  I think you have to have a full rupture to relate to that feeling.

Also have an annoying pop or snap of a tendon, not the main one that ruptured, outside upper portion of the left knee, right above the cap but down inside.  I can feel it too when I press and put my fingers on the area.  Will consult the doctor on that next month.

It general the knee is doing real well.  Again sitting here at the computer after the workout it feels normal.  I am using the repaired leg to lift climbing stairs and now am using the repaired leg to lead walking down stairs.  It is not gracefull but I am doing it.

Was your injury a compete rupture or partial?  With your progress it sounds like a partial tear but I could be wrong.
BTW  about the box, just think of building the 2X4 box maybe 18 inches square, 2X4 on side and slap on some 3/4 plywood.  Then stand, lifting the good leg up and back, drop the repaired knee forward and down so the toe of the good leg touches the ground then come back up using the repaired leg to lift.  It is a weight support, and tendon muscle stretch exercise.
post #1343 of 10802
Howdy folks,

I'll third the day to day differential in my knee. Actually, I can see a pattern for my knee. Every time I have played tennis so far, my knee swells and gets stiff for the next day. It's the nature and intensity of the activity when I hit tennis balls, I think. I don't think I'm playing very intensely yet, but it pushes the knee harder and more consistently than any other activity that I take part in right now. It's a combination of bending, lunging, and light running in addition to coordinating it with some level of hand-eye. I haven't found an exercise yet that emulates the motion of hitting a tennis ball :). Overall, I think it's how hard the knee has been pushed beyond its comfort zone. The first time I felt that way was the first weekend post-brace when I moved two truckloads of topsoil into my back yard -- yeah, I'll admit that proves that I'm an idiot.

Just to make it complicated, I think the other variable for me is that tennis involves moving my leg and knee in 3 dimensions. All of the exercises that I have been doing in PT and post-PT are 2D exercises that move the leg in the same, single plane of movement. I've started stretching my hip flexors more to get loose in that other plane that I didn't used to need to think about.

I will say that playing tennis and jogging both leave my knee feeling so much looser than anything else that I've done post-surgery. It feels like a normal knee when the muscles are warm and loose. I have illusions that it will someday feel like this all of the time. Even cycling doesn't get everything as loosey-goosey unless I do a 30 mile + ride and really exhaust the quads.

On a sort of related note, I ended up playing a set of doubles last night by accident. I was hitting with one of my regular partners before the Wed. night doubles group that I used to be part of. We did groundstrokes for a while until the group showed up. One of the guys was late, so I subbed in for a set until he got there. I suspect they were taking it easy on me, as a lot of shots headed closer to me than I would have expected. Serving was a tough and not utterly pleasant experience when I came down on the left leg. The first service game hurt, but the second wasn't bad at all. Still, we did win the set -- even if they were being nice to me.
post #1344 of 10802
Hello Garland and everyone else (with sympathy).
I had the surgery for total rupture to my left leg quads on the 4th June this year. I had the 2 part cast and brace removed 2 weeks ago and PT going well so far. Seeing as you seem to be through the re-hab more than anyone else, I was wondering if you can tell me about your recovery progress. I can walk with a limp and drive for about 20 mins until the pain becomes too much and I have to stop and get some movement before starting again. I can get about 115 degrees movement so far. PT's have told me that I will regain approximately 85%  of full movement. Is this the case with you? I was hoping to go on a skiing holiday early next year. Given that I havent done it in years do you think I should forget about it? I also experience similar issues with my knee to those that you and wanasail have discussed. I have been told that this is due to the erosion of internal scar tissue. Therefore, if I continue to moving my leg, does this grinding effect reduce over time. Also, how far into the re-hab was it until you started 3D movement and how far back can you now bend your leg? Please tell me anything else that you think I should know about. 
post #1345 of 10802
Hi Westlakes,

Sorry to hear that you've joined the club. That being said, this injury does heal at different rates and with different methods for almost everyone. If you look at the medical literature on the surgery and various PT methodologies, they all seem to work. As my OS said, this is the tendon repair tends to come closest to normal function at the end. You're in the same time frame of recovery as Fallguy and many others on the forum. It'll come together despite feeling god-awfully slow at times. A positive attitude is the key. For 8-9 weeks post-surgery, it sounds like you're in the same place as most other folks on the forum. You're doing better than I was on ROM at that time, but my OS wouldn't let me go beyond 90 degrees until 12 weeks (which is not to say that I didn't). I can't say on the ski trip. It could be an awfully nice carrot to dangle out there if you're a goal-oriented person.

It's really worth reading the history on the forum. There are a lot of records about what folks have gone through. Right now, I'm 6 months and 8 days post-surgery. There are a lot of folks who've had faster, more complete recoveries. I think they tend to stop posting as they get more and more active. Also remember, every case is different. Your OS is probably the only person who knows the true extent of your injury. He/she is the one who's seen it first-hand. Their recommendation has to carry a lot of weight.

My models for how to approach recovery were some of the early posters like IdahoGuy, who started the forum. As I waited for surgery, I read about what they went through and made the plans to work that hard to come back to doing what I did before. I think that's a pretty common resolve. We want to get back to normal--whatever we perceive that to be. That's not a goal for everyone, though. If you look at the therapy articles out there, something like only 50% of the folks with this injury return to their previous activities. Then again, there are also a vastly different set of expectations. Being able to walk comfortably and do stairs normally is a huge accomplishment. I could be at peace with that as the extent of my recovery -- esp. after those first few weeks on the sofa at full extension.

A couple of things I need to add as a disclaimer: I'm 42 years old (so a bit younger than is really common for this injury), I have two young boys (4 yo and 1 yo) and the desire to play with them as they grow up was a HUGE motivating factor for me, I'm a decreasingly big guy (289lbs in Nov. 08, 254 when injury occurred, 229 as I type, shooting for 200 by the end of the year to keep a promise to my wife before I can play competitively again) despite being active so weight loss has been a constant factor in this for me, and the tear was a clean one right at the patella.

To the best of my recollection, this was the schedule:

Weeks 1-4: Sitting on the sofa, reading a novel per day, playing the PS3 and PS2, getting my wife to drive me around. Tried to do leg raises at 3-4 days, finally accomplished this about 3 weeks post-surgery (or 2 days after being told that was the requirement for getting to bend my knee in the hinged brace). Partial weight bearing on day 2, full weight bearing around day 12-14, using one crutch for most of this period. Starting doing stairs toward the end of this time. Went back to work at 2.5 weeks post-surgery. Leg at full extension. Early PT to get muscles to fire and to work on stretching achilles and calf to alleviate discomfort. No bending at all. Drove for first time 3 weeks and 2 days post-surgery.

Weeks 4-6: Back at work, more swelling from sitting up, icing regularly, limping around with one crutch, 30 degrees ROM, I remember being really excited to hit the 30 degree stop on the way to my car and not using the crutch anymore, lots of leg raises with the brace on, at first I locked it back at full extension and then started to have the confidence to leave it unlocked, side leg raises, toe raises/achilles extensions, hamstring stretches. the quad muscles were concave during this period. Russian stim at PT to build muscle tissue.

Weeks 6-8: 70 degrees ROM, took longer to get there -- about 2 days to do it comfortably and consistently, lots more leg raises, side leg raises, Russian stim, stretching hamstring and achilles, limp diminishing, more Russian stim through this period, lots of ice. PT was only once per week through here as I could do all of the work at home. We started to save visits at this point for when I was more active. Started doing some yard work to get ready for spring. Raked the yard, seeded/fertilized the necessary area, started to mow weekly.

Weeks 8-10: 90 degrees ROM, still in the brace. Limp still diminishing. Stopped the Russian stim. PT now once every 2 weeks to save visits.Leg raises with 2 lb weights, stretching hamstring and achilles, lots of ice, started on the bicycle -- couldn't do a full rotation, so 10 minute sessions of back and forth to ROM limit (about 3/4 pedal turn)--this helped to break up scar tissue but I was very careful not to push it too far/hard.

Weeks 10-12: >90 degrees ROM, still in the brace to complete the treatment, limp still diminishing, trying to do stairs normally -- takes about 110 degrees of ROM, made first full rotation on my bicycle -- scariest part of the whole rehab process was going over the top of the pedal stroke for the first timeand the most liberating moment to have actually done it, switched from mountain bike to road bike in week 11, hating the brace--want to burn it, leg raises (2 lb), side leg raises (now 5 lb), cross leg raises to build VMO, step ups on low step at PT, marching in place, leg curl with no weight, insanely bored with what I am allowed to be doing, walking around the house/work without the brace, left leg is tiny and very weak without the brace.

Weeks 12-16: I feel like my real rehab started in week 10. At week 12, I was given the go-ahead for aggressive PT. This added more weight to the leg raises (3-4-5 lb progression), more weight to all other exercises, started to do squats and leg extensions -- weight increased weekly on most exercises. PT was twice weekly. The big at-home addition was biking. I rode my bike 30 min 4x weekly on my trainer in addition to the nightly PT regimen. I did the full range of exercises daily at this point. Took a lot of time. About week 14, I took my road bike out for the first time for gentle, flat rides. Noticeable lack of strength in left leg. Kept riding -- felt active again for doing that. ROM was around 115 at middle of this period.

Month 4-5: Added lunges into the routine, doing more intense stairs at PT (higher steps, then the escalator-type machine), walking with no limp, doing stairs normally if slowly with a muscular hitch while descending, moved out to the gym for weights on leg extensions and leg curls (increased weight pretty much weekly, started out really low), PT 2x weekly but starting to run out of sessions, started working on side to side movements (this felt like a major accomplishment), I'm around 120 degrees of ROM at this point. Longer bike rides at higher pace -- changed riding style during the rehab to do higher rpms in lower gear to take stress off the knee, added some mild to moderate hills.

Month 5: Released by the OS, who seemed happy with his work. Still need to build muscle mass in left quads. Flexibility is coming along slowly -- working to increase ROM in the evenings with my wife helping, pushed the PT to let me start to jog, doing 5 then 7-8 minute sessions on the treadmill, continued side to side movement drills at higher pace/intensity, leg raises boosted to 8lbs, leg extensions and leg curls at higher weights, Released from PT in mid-month, longer bike rides, hit tennis balls at the end of this month, added leg press in my last 2 PT sessions. My VMO still needs work.

Right now, I'd say my strength in the left leg is about 70-75% of my right leg. It's getting stronger, and I feel less difference on the hills when biking. I'll keep pushing it, and I hope to get it into the 95-100% range. Gotta have a goal. The hard part is being able to devote the time required to do all of the workouts to really get the strength back. It's a balancing act between working, being a dad, doing the house work, etc.

Sorry this was so long. Garland
post #1346 of 10802
Terrific post. I am at 5 1/2 weeks post op and enjoyed seeing what is in store for the next few weeks.
I started PT this week(3rd session this morning)  ROM was 70 degrees going in and after
a long session I hit 90 degrees.  Russian stims sure got my attention.   This is my 1st week  without the brace.
Starting to get concerned that maybe I'm going too fast from a complete QTR.
I'm 51 and my 10 year old daughter asked if I would again be able to out run her.... almost
broke my heart to tell her probably not.  (Time is not on my side)
Also really enjoyed driving for the 1st time today since  the Caribbean injury 6/30.
Watch out Wisconsin and Illinois I'm back....
xerxer's it is so strange that our OS's have given us such different recovery methods.
I am only wearing a brace(straight leg) when riding the train.  I am doing it for protection mostly.
and because I walk about 1/2 mile in downtown Chicago, otherwise no brace or crutches
at work or home.  Also no motion manipulation machine.
Are you driving?
dbrow thanks for the exercise tips at what point were you able to sit down normally?
This question is for everyone at what point could you go up stairs normally?
Are there exercises to practice?
My biggest problem is stairs (especially down).  I 've read where others with QTR''s have problems going downstairs for a long period of time so I am not expecting much.
Have a great weekend all.
post #1347 of 10802
In answer to the question: My rupture was complete.
I am able to drive without much problem because the injured leg is the left leg.
I am not in any form of PT.  However, I have been given a Millenium Continuous Motion Machine which bends my knee through a fix angle which I set (e.g., 0-30 degrees on day 1).  I have found this very useful and urge others to try to get this.  It was delivered to my home and it allows me to set the angle of flexing to the exact degree.  This allows you to create a routine, for example, where you add 1 degree each five minutes, thereby slowly and comfortably increasing the range of motion.  Today, day 4 with the machine, I am up the 50 degrees (6 weeks post surgery).
post #1348 of 10802
Thanks Garland, that is a great summary. 
I have had 8 PT sessions in three weeks, and am 10 weeks post injury today.  Will go to PT one more week @3 times, and then back it down to twice a week. My insurance gives me 30 visits per procedure. I bet my OS billed the insurance company for each leg separately, so perhaps I can get 60 visits out of the deal!
I think this may be where the BQTR veers a bit from the rest in terms of rehab. I am at 10 weeks, where Garland was at 8 weeks. My ROM improvements and ability to do things (stairs, driving) are progressing bit slower in this week 6 to week 8 period.   I can’t quite cover the distances, number of reps, and other physical activities like yard work that help move things along.
Started PT with 35/33 degrees, and checked out last night at 75/72.   I am walking a little bit solo here at home, and spent two days this week with one brace on and one brace off (alternating legs). Also have both braces open to 60% and walking that way, concentrating on a “normal” gait, heel toe, etc. Otherwise, if one buckles, there is nothing to catch me from ending up in the weeds.  Trying to cover more ground, and spending more and more time on my feet everyday.
I figure that I will be walking sans braces in about 10-14 days and driving shortly thereafter.  Like many people here, I am eyeballing 90 degrees so I can start the stationary bike.  Trying to walk in the pool on the off days to practice walking. 
My man at PT commented about this slightly slower rate of recovery. Said the fluidity in the ROM from 0 to 60 degrees is fantastic, and the muscle recovery is also good in that range. Smooth.  When it goes from 60-70+, there is no muscle control and it isn’t very smooth.   So when I make a gain in ROM, the Quad and other muscles take some time to catch up, and it is kind of a ping pong game. Improvement in one area requires follow up improvement in the other.
I don’t have the crunchy or grinding feeling that some of you have expressed, and I haven’t had too much swelling, so that part of my recovery is a bit different.  One thing is for sure; after a day of heavy activity and or PT, I can barely sleep at night. I ache from my ankles to my waist.  It isn’t swollen or tender, but it aches like I went on too long of a hike, or like a long day doing something really physical.
post #1349 of 10802
A Little Discovery For All
     1)  When I originally sustain my complete quad rupture, I purchased from Walgreens one of those walkers that older people use.  It has three sides, no wheels, place for your hands to hold, and four rubber tipped supports.  I bought this so that I could place it in the bathroom, around the toilet (backward), to help lower myself keeping my injured leg straight.  My discovery has been, now that I don't need this device for the toilet, is that it can be used anywhere as the perfect parrallel bars to practice knee bends and leg raises.  Because you have support on three sides, and side bars to hold onto, you have great security in case the knees fail.  The item, which folds up for storage, cost less that $170.00.  I find it very useful and recommend you give this a try.
     2)  I have been able to prevent my brace from slipping (a real problem) by placing a belt tight around my waste and then using a strap (from luggage) to attach the belt taught to the brace.  This is quite effective.
    Today, after six days on the continuous motion machine, I am up to 60 degrees, and today I set my brace for 60 degrees.  What a liberation to be able to start walk with a bend at the knee.  For the last few days I have swam, wearing the old immobilizer in the pool, five laps a day in my 70 foot pool.  Heaven!
     I do wish you all well.
post #1350 of 10802
Thanks for the reply and thanks for taking the time. At least now I can get a feel for what I am up against over the next few months. I have been treated by the NHS as I live in the UK. The problem I find is that, although the surgeons, doctors, PT's etc have been great so far, I am yet to see the same doctor on a regular basis and often the doctors have given me recommendations and information on recovery that contradicts what the PT's say. For example, I had the cast and brace replaced as it was absolutely filthy. On removal of the cast, the doctor noted the amount of muscle depletion and insisted that I did 4 hrs per day exercise on the bad leg (at the time, I couldn't do this with the good leg). In contrast to this, the PT said no more than 1 hr. Because the fracture clinic is at the opposite end of the hospital to the PT dep't, I couldn't get the 2 together at any one time to find out who I should be listening to.

Also, pre-op, the surgeon informed me that he would make a 4" incision into my left leg and that the op' would take around 40 minutes. The incision turned out to be 10" in length and the op' took nearly 3 hours. The surgeon did tell me what had been done but only briefly and straight after being transferred back onto the ward whilst I was still under the effects of the anaesthetic so my recolection of this is somewhat scathy. I have since been told that the reason for this is that the ultrasound did not indicate the full extent of the injury and that it was a total rupture to 2 of the main tendons and partial tears to the remaining. Apparently the quad muscles of total rupture had retracted, hence the large incision.

Now I would like to know exactly what surgery has been carried out as I have since discovered that steel rivets are used to hold the damaged tendon into the patella. Does this sound about right to you? (You would think that medical staff would explain this in detail to the patient). I dont understand why the medical staff are so reluctant to divulge this information. Our National Health Service is notorious for being at a financial stretch, so maybe they just dont have the time and resources. What is the Health Service like in the States?

The biggest discomfort I have at the moment is the pain after 20-30 mins driving. From this, I get sharp pains from the knee upwards. Then I have to get out of the car and move my lower leg in a cyclic motion where I experience a 'crunchy grinding' sensation (unlike Rcm111 I notice). Does this ever go away?

Anyway, its good to be in touch with you guys. Please keep me updated on your progress.

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