I recently underwent arthroscopic knee surgery for CCK–chronic crappy knee (that is not the official diagnosis, nor does CCK have an ICD-10 code). The surgery went well and the next day I was out and about without crutches or even a cane. I took my prescribed meds but opted out of the heavy-duty pain medication. I had my post-op visit a few days later and the doctor gave me 2 things: a prescription for physical therapy and a copy of a home exercise program with a list of approximately 10 very simple exercises.
I was feeling so good and so optimistic after the surgery that I put both papers on my desk and ignored them for a few days. But then 1) my husband starting nagging me and 2) I realized I was being the non-compliant patient that drives me crazy. So I packed my gym bag and made an appointment for a physical therapy evaluation.
At the gym, I made my way through the 10 very simple and easy exercises. They seemed so simple and easy that it was difficult to stay in the zone. It was my version of thumb rotations. I kept losing track of the repetitions… was that 8 or 9? But I knew I had to commit and get it done, so I did. The next day my knee was sore, so I guess my knee needed easy simplicity. I’ve been back to the gym, still completing the simple easy exercises, but now adding some complexity to some of the movements or making them more difficult by adding ankle weights. I am making progress!
Then I had my physical therapy evaluation. Before I saw the doctor, I completed all the requisite paperwork. That included a survey that immediately reminded me of the CISS (Convergence Insufficiency Symptom Survey). Using a scale of 0-4, I was asked to identify my degree of difficulty with activities that are essential to independent daily life, such as walking up and down stairs, lifting groceries, getting in and out of cars or chairs, walking short distances, etc. The doctor reviewed this when taking my history, and then we talked about my goals. Yes, I want to be able to walk up and down stairs pain free, but I also want to be able to hike.
My evaluation started at my left knee, but very soon it was about my right knee as well, and then my ankles and my hips (all I could think about was the children’s song “Head, Shoulders Knees and Toes”). It was about standing, sitting, balancing on one foot and moving. It didn’t take long for him to detect the asymmetries in my body, not only from compensating for my CCK, but from spending so many hours riding a bicycle. I have very tight hip flexors! It was a mighty lesson on how function changes structure. Then he began treatment which focused on relaxing the muscles above and below my knee. Once he got things loosened up, I completed several exercises. These were different from the ones my surgeon had prescribed but still simple and easy. At one point he remarked, “I can tell you are doing it right because your leg is shaking. You’re fighting through it instead of letting your asymmetries win the battle.” Yay me!
Today was a beautiful day and I was tempted to go out for a bike ride, something simple and easy (no hills). Then I thought about a patient of mine. Mr. T is a 30-year-old attorney who spends a minimum of 12 hours per day reading, writing and staring at screens. He is being treated for a convergence excess. I sent him home with a 6^ prism and a Brock String. He reasoned that if doing prism jumps for 5-10 minutes a day was a good thing then taping the prism to his glasses to practice diverging all his waking hours would be a great thing. It was not a great thing. It took him a full week to recover from this “overtraining.” Remembering this, I rethought my plans. I went to the gym and rode a bit on an exercise bike where I had control over the degree of difficulty and time.
Let’s summarize! I found these 7 principles of rehabilitation; although these principles refer to Core Concepts in Athletic Training and Therapy, I think you will agree that the principles are universal. They are applicable to any type of rehabilitative therapy.
- Avoid aggravation: advance gradually and steadily to keep setbacks to a minimum.
- Compliance: Patients are more compliant when they are better aware of the program they will be following, the work they will have to do, and the components of the rehabilitation process.
- Timing: The sooner patients can begin the exercise portion of the rehabilitation program, the sooner they can return to full activity.
- Individualization: Each person responds differently to an injury and to the subsequent rehabilitation program.
- Specific sequencing: A therapeutic exercise program should follow a specific sequence of events. This specific sequence is determined by the body’s physiological healing response.
- Intensity: The intensity level of the therapeutic exercise program must challenge the patient and the injured area but at the same time must not cause aggravation.
- Total patient: The whole body must be the focus of the rehabilitation program, not just the injured area. Remember that the total patient must be ready for return to normal activity.
I am doing very well. The surgery seems to have been successful at reducing if not eliminating some of the mechanical issues. My knee is no longer swollen and stiff. If I may use an analogy, my left knee has 20/30 acuity! Translating my own recovery to the world of amblyopia, I’ve started with some patching plus active therapy. Now, I need to get my left knee to work with the rest of my leg and the rest of my body. I want “binocular knees”! I am starting with simple and easy activities. I will be compliant (I won’t do anything stupid). I will have patience. I will do other things to support my recovery. And in the spring I will buy a new bicycle.