Post Surgery Week 13: Every Step You Take

Saturday, August 17

One of the most amazing things about my post-surgery experience was the fact that a mere three hours after my surgery ended, I was up and walking in the hospital.  Sure, I was still under the influence of the good drugs.  Sure, the parts of my leg that had been ravaged were still mostly numb from the nerve block.  Sure, I was holding on to a walker, and I had a physical therapist helping to hold me up.

But still, just three hours later, I was walking.

I didn’t really understand in those early days that in the coming months, I would need to completely relearn how to walk.

I remember talking with the surgeon in the pre-op appointment about this;  if you totally rebuild my knee, how will it affect how I walk?  Well, sure, but I didn’t fully get the impact of it.  Then when I had tendonitis, and went to see my chiropractor Karin, trying anything - everything - to deal with the pain, she brought up the topic of relearning how to walk.  “Isn’t your PT teaching you how to walk again?” asked Karin.  She was pretty much aghast that it wasn’t the number one focus of every PT session.

That’s all changed now that I’m working with Blue Sky Karen, both in PT and in Pilates.

My valgus deformity, pre-surgery.
My left knee is on the right of the image,
and you can see how slanted inwards it is
in relation to the right one.

I have, as long as I can remember, been terribly knock-kneed.  The medical term for this is a “valgus deformity”.  I may have had a bad case of arthritis in my knee in any case, but the valgus deformity was the thing that caused my left knee to get to bone-on-bone on the outer surface, with all the nasty pain that goes with the whole bone-on-bone thing.  This was something that every ortho and every PT I’ve seen since my knee first started hurting told me.  It was always something that the PTs - and the Pilates teachers - pointed out that I could fix - at least in some degree - by paying attention to how my knees move in relation to my hips and ankles and feet.  They would point out to me - more often than I liked - how my knees would collapse inward in almost any exercise we did.  Too bad for me that I didn’t pay nearly enough attention to fixing this.

But now, it’s a requirement.  Dr. Miner and his team changed the entire geometry of my left leg.  Is it 100% straight?  I don’t know, but I do know that it’s a heckuva lot straighter than it was pre-surgery.  (I wonder if perhaps I have grown taller as a result?  Wouldn’t that be nice? I must measure my height one of these days.)

And my right leg?  Well, so far (knock on wood), I’ve had no issues with arthritis in that knee like I had in my left knee.  (Full disclosure:  I banged my right knee up about six or so years ago when I fell while out for a run, and had it scoped to fix the torn meniscus.  But it’s never hurt outside that experience.)  But the reality is that both knees suffered from the valgus deformity;  it was just that the left one was worse.

So one of the things that I am paying very close attention to now is making sure that neither of my knees turns in when they are supposed to point straightforward.  This is maddeningly difficult.  Oddly enough, it’s tougher for my right knee;  I guess the rearchitecting of my left knee has made it easier for that one to behave.  It is amazing how that reflex for my knees to both turn inwards at every movement is deeply ingrained.  60+ years of walking, standing, sitting, standing up from sitting, going upstairs, going downstairs while not paying attention to this one seemingly little thing:  well, there are some bad habits that stubbornly hang on, and resist breaking.

Which means that I am, every day, every movement of every day, relearning all those movements.  I stand up slowly to make sure my knees don’t collapse inwards.  I walk down stairs very, very slowly, because if I go any faster than turtle speed, my knees turn inward.  I go upstairs slowly for the same reason.

Working at having straight,
non-knock-kneed knees.

The other day at PT, Karen had me stand up from a sitting position on a bench - with no help from my hands and arms. It was harder than I thought it would be, and boing! There went my right knee, collapsing like a cheap cardboard box.  She had me repeat this multiple times, and then she lowered the bench, making it that much harder, and it was back to the drawing board.

Likewise, Ed is on board with the vigilance to make sure my knees don’t drift in towards each other, and now he’ll watch me coming down the stairs.  Just when I think I’m nailing it, he’ll start shaking his head, and then demonstrate back to me exactly how poorly I’m doing at this exercise.  This walking business is much harder than I ever expected it to be.

Late yesterday afternoon, I went for a walk by myself, just a mile and a half on the local bike path.  I wore running shoes because I’m learning that they offer the best support.  Flip flops are not part of the equation for me this summer:  I tried them weeks ago, and it just didn’t work very well.  My extension is still not up to 0 degrees  - I did hit 1 degree with Karen in my PT appointment earlier Friday - so I keep my mind on extending my leg and exaggerating the heel-toe motion.  And then I concentrate on making sure that my knees stay over the second toe, working hard  not to let those knees kiss each other like they have done since I don’t know how long ago.

One day I’ll worry about walking without pain;  this poor knee that was badly abused over so many years, and then seriously set upon almost three months ago still likes to hurt much - well, no - most of the time.  Right now, though, the pain is in the back seat, mostly under control.  But the instinct for both my knees to go all knock-kneed on me is the biggie.  It’s a bear to break. With every step I take, I’m working to break bad old habits.  With every step I take, I’m learning to walk again.