Jo's injury update - stage 2!

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Diagnosis, Return to Work & Prehab
 
Now to get down to the more technical stuff and really where the journey properly starts. So, the initial injury happened on the 19th of November as I said in the previous instalment. I went straight to A&E after I had finally started feeling normal again from my feeling dizzy/sick episode. After all the assessments etc I was kind of left to my own devices to a point, told to just wait for this follow up phone call. I got the phone call on the Tuesday (21st Nov) and was told that I wouldn’t get to see the consultant until the 6th of December. Their reasoning for this was “my knee would be too painful to assess until then”. What a load of rubbish, I fought back on the phone explaining what I do for a job but it didn’t help, the appointment stayed at 6th December. I then thought no I’m not waiting that long to find out what’s wrong with it. I messaged Sam (our Senior Therapist) to ask if she would be happy to assess my knee at the next possible date I could get there. Of course, she was more than happy to, luckily my partner had that Friday booked off work as we were going to a spa for the day (I’ll give you the full funny details about this a bit later on). I jumped straight on the booking system and Sam had a bright and early 8am hour slot available on the 24th of November.
 
Between the 19th to the 24th I did all I could at home to manage the pain, which to be totally honest with you, wasn’t as horrendous as I thought it was going to be. I took paracetamol or co-codamol for the first couple of days, mainly to get me off to sleep and then I switched over to ibuprofen. Just on a side note here I might as well make this educational as well as telling you my story… In the initial 48 hours of an injury ideally you do not want to be taking any anti-inflammatory drugs such as Ibuprofen or Naproxen. Inflammation is actually really important in those early stages to start the healing process. I was still on crutches and spending most of my time in that lovely black brace you saw in the last post. I took it off whenever I was trying to do some gentle exercises, or I was icing the knee.
 
Some of you might be thinking what sort of exercises could I be possibly doing in that stage when it’s so early on. Well, there are ALWAYS things you can be doing right from the start to reduce pain and give your body the best chance of a smooth recovery. The exercises I was doing included putting a pillow under my foot/ankle and allowing my knee to relax into a fully straight position - this is very important to restore full extension of the knee. I was also using a towel whilst sitting on the floor to help get my knee bending more. Then because one of the biggest issues in these injuries is loss of muscle mass, particularly in quads, I also did some isometric squeezes. It’s also important to remember not to neglect your non-injured leg in all stages too so anything you can do at home single leg that doesn’t hurt the injured leg make sure you do it!
 
 
Time to talk about how the assessment of an injury only 5 days in can feel, what you get out of it and where you go from there. I’m up nice and early on the 24th of November for us to get over to the clinic. Once I’m there just like any of our initial appointments go Sam asked what happened. I explained and then she started a physical assessment, first looking at the amount of swelling, how warm the knee was which is another sign of inflammation, and then what sort of range of motion I could get my knee to go into. I won’t lie to anyone, the assessment is uncomfortable, of course it is my knee is swollen and I can’t get it to bend past 90 degrees yet. But after some fiddling about with it and time, Sam managed to get it to go to about 110/115 degrees of bend before it hurt too much. She then went on to see what special tests she could do on me knee. For anyone who doesn’t know what these are, they are tests that allow us to challenge the structures within the joint. In the case of a knee there are many ligaments, two bone surfaces, the meniscus (cartilage), tendons and so on. If any of the structures are damaged there is likely to be some pain/discomfort when they are tested. The therapist will also be looking for excess movement within the joint or your reaction to the test being actioned. I’m not going to bore you with any more of the technical details here I’ll jump straight to the conclusion of the assessment. Unfortunately, due to many areas being tender to touch, a few tests being painful to perform as well as laxity (excess movement) during some of the tests, Sam couldn’t rule out worse case scenarios. These are: a ruptured Anterior Cruciate Ligament (ACL), damage to the meniscus, damage to the Medial Collateral Ligament (MCL) and she also mentioned potential of a fracture. As a result of all these findings she highly recommended an MRI, said if I could afford it that it would probably be beneficial to go privately.
 
My worst fears are becoming more and more likely to be true, but we’ve got a spa day booked so lets try and enjoy it! Me and my partner go to the spa day, I’m stubborn and love the gym so couldn’t pass up and opportunity to use a different gym, only upper body obviously. That is harder than you may think when you only have one good working leg, but I did it anyway. Then swimming cozzies on and off to the pool and sauna we go. I have never been so scared of a wet floor in my life! It took about 10 minutes to move about 10 meters from the sauna to the pool, and then hopping into the pool down the steps well I’m sure you can only imagine the scenes! However, it was good for me to get in the pool and move about a bit. I managed to stretch with the help of my partner and do a little bit of gentle swimming. We also had afternoon tea in our lovely white dressing gowns, but I’m there with my leg propped up on a chair and a big bag of ice on it too. It was a lovely day nether the less. On the way home I decided to have a proper look into the process of going privately for a scan and I came across a website called scan.com. It was reasonably priced and had appointments in a number of different clinics semi-locally to me within the week. I thought why not, the quicker I get the diagnosis the quicker I know what needs to be done.
 
With scan.com you provisionally book an appointment with a clinic of your choice and then wait for a couple of phone calls. Call number one is from a consultant radiographer who asks the reason for your scan, and if they agree you have chosen the right thing, they then send a referral letter to the clinic you chose. I booked it at 4pm on a Friday afternoon and it said expect to wait 2-3 working days for this call, fine by me. My phone went off at 7pm that same day and it was the radiographer! A 5-minute phone call later I received an email confirming that the referral had been sent and I would hear from the clinic within 3-4 working days. Monday morning 9am my phone goes off again, it’s the clinic I chose, and the appointment is confirmed Thursday 30th of November at 5pm. I honestly cannot fault any of that and I paid £350 for it. I don’t personally feel that is a big amount for how quickly it’s all been sorted. The 30th comes around and we go to Stockport where the clinic is, I fill out a form, take off all my jewellery (my piercings took longer to take out than the scan!). No longer than 30 minutes later we were back in the car driving home. The best part about all of it is how quickly I got the results, 9am the next morning I receive an email with all the images and a written report. 10am the radiologist rings me back to discuss the findings. The final step was getting those images sent to the consultant at Leighton hospital which was as simple as an email to the team at scan.com with some information about where it needed to go, and they sort the rest.
 
The results were as bad as to be expected really, ruptured ACL (completely torn), a longitudinal tear of the medial meniscus (a lengthways tear to the inside part of the cartilage), a fracture to the tibial plateau (there is a small part of your tibia that comes to a point in the knee and it was cracked) and some damage to the soft tissue on the outside of the knee too. Ouch! - that is a lot and a lot to take in/process. Inevitably it’s going to need surgery and it’s going to mean a lot of rehab if I want to play football again. A quick bit of information about the recovery time-lines for ACL based injuries. A lot of the internet says you can be back within 9 months playing again, realistically this isn’t true. Think about how long you may have to wait for the surgery, then post surgery it often takes an amateur sports person who must still work full time alongside the rehab around 12-15 months to fully return to their sport. All together I’d say from start to finish you are looking about at least 18 months if you can’t have your surgery done privately, which I certainly couldn’t afford!
 
And so, my journey to recovery, playing football again and everything else I want to do begins. By now I have sourced myself an ACL brace which is sturdier than the cricket splint and has two dials at the knee joint allowing you to bend your knee. I’m walking now without crutches and I’m slowly able to return to work. Across a 3-week period I had nearly two full weeks off work and then phased my return by having a much quieter diary than I usually have, and doing bits of treatment sat down where I could. Jeni and Sam were great with me, they were really helpful and did everything they could to help me get back ASAP. I also had the benefit of treatment by them for tight muscles or any other issues that occurred should I need it, more on this a bit later!
 
When I went to see the consultant at the hospital in December my scans were up on his computer when I went in. He initially thought he had forgotten who I was before I explained they had been done elsewhere. But the outcome was the obvious one, I needed surgery and the waiting list was at least 6 months. I won’t lie that was hard to hear. It was made harder by being given false hope three times during those 6 months by nurses and PAs telling me it could be March, it could be April, blah blah blah. It wasn’t any of these months and it felt on many occasions that I was never getting this operation at all.
 
By New Year I was walking without the brace, in the gym four times a week and smashing pre-op rehab every day. I was feeling as normal as you possibly could, given the circumstances and I was happy with how I was getting on. I was back working full time now with a normal diary and my knee seemed to cope with the stress of being on my feet most of the day. I also started to see the physio at the hospital and we were working on some more strength in the knee, initially I thought it was ok the service that I got until we started working on the leg press before I could even do a body-weight squat properly… Queue a knee flare up which resulted in swelling again and a very annoying clunk in the left knee for the foreseeable, just what I wanted! Luckily being a sports therapist and working at Maximise meant I could talk about what had happened with my knee again and both Jeni, Sam and Hannah were on hand to help. I had a number of massages to help with tightness in muscles. Sam and Jeni had a good go at figuring out what was making my knee clunk and it always felt better after each treatment. It also helped to be able to bounce ideas off everyone for new exercises and they were very good at telling me off and reigning me back in when I got a bit ahead of myself in the gym!
 
So generally, by this phase as long as the knee has settled from inflammation and doesn’t become inflamed again from standing for too long you should be looking at building the strength back up as much as possible before the surgery. The stronger you are heading into surgery the better your recovery should be. It’s very easy to just give up and think there’s no point until it’s fixed but this isn’t the right way to approach it. Get in the gym, get back to doing some light activity you enjoy and try to live a normal life as much as possible. I got myself into a position where I could cycle, I could do about 15 minutes of slow jogging on the treadmill, I was on my feet all day for work, I was coaching at football and I could go on 5-6K walks on flattish ground with absolutely no problems at all. To do this it took a lot of work and being disciplined to do rehab exercises every day. But that didn’t mean going to the gym 7 days a week. I made myself a plan which included 3-4 days in the gym where I always did some work around the knee and the other days, I did bodyweight exercises at home/work.
 
Naturally, I had the odd time where my knee went a little swollen again after I had tried something new or over done it a little bit. I just tried to be as sensible as possible and allow my body to rest for a few days whenever this happened. All in all, I was really happy with my progress going into the surgery. I did however have a slight hiccup, three days before where for the first time I felt the instability of my knee and actually fell, which caused a lot of swelling and discomfort. But honestly in the full 6 months that was the only time I really felt I was injured, and my knee was unstable. Obviously, I was pretty annoyed at the fact this had happened, but I just tried to get the swelling down as much as possible before I went in for the surgery again.
 

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