All Hands On Deck

[lonewolf]

Considering my dotage, maybe this should be be in Historical but here goes:

I am confident our assembleage of coaches, trainers, therapists, doctors and jacks-of-all-trades will have some comments and suggestions about my dilema.

Many of you may be aware that I had a knee replacement in Nov 2007 at 76 years of age. In view of my residual athleticism, not being (much) overweight and being highly motivated to return to action for the 08 OT, my very experienced and competent surgeon predicted that I would be his star patient in rapidity of recovery. Boy, was he wrong.
I rehabbed for three months, hit a plateau in flexibility of the knee and was sent home to work on it privately or live with it. My surgeon's summed it up, "Well, it worked perfectly in range of motion after surgery when you were out, results vary and you can expect some discomfort with major surgery."
I did the exercises, flexed the knee as much as I could stand and could walk with only mild tightness discomfort in a few months. A year later, I can walk a well enough (still a little tight) but still do not have enough range of motion to ride a bicycle to get in some real exercise.
Earlier attempts to jog were too uncomfortable but about a month ago, I started cautiously jogging/walking alternate 100m for about two miles. The knee seemed to accept it but I was shocked at my loss of aerobic capacity. I have had shorter periods of inactivity due to injury but quickly recovered aerobic capacity, such as it was.
The good news: I was on Motrin and Avandryl for diabetes, my blood sugar immediately dropped from 130 -140 to 90-100 with no change of diet or living habits. I was able to eliminate Avandryl. .
I did not try to run but increased the jogging to about 3/4 of my workout. I got verryy tired after each jogging portion and just didn't seem to be getting much stronger before my knee started bothering me and I had to resorted to "race walking" to keep my breathing and heart rate up.
If I do it as right as I know how it is as exhausting as jogging but I have to concentrate to keep myself swivel-hipping. I have been limited to walking for about a week now and my blood sugar is creeping back up.
Maybe this is just a polite enclave but, so far, I haven't had any cat-calls. The lady at the tag office said she had noticed me walking and was inspired to take up walking.

My knee, apparently, is what it is. My questions are::
Why was/is it so slow and difficult to gain back aerobic capacity?
Does anybody have a tried and true exercise to improve knee flexibility?
Any comments on the anomalous blood sugar drop and resurgence?

Something I discovered: The concrete streets in my neighborhood have regularly spaced joints. I haven't measured the distance but a normal fast walk requires eight of my strides joint to joint. When I swivel hip, it requires only seven strides with little increase effort. If I step it up to my max, only 6.5 strides. Amazingly, if I concentrate and maintain my pace, I can "race walk" in seven minutes the distance I "fast walk" in eleven minutes.

[bambam]

lonewolf - we routinely tell people it takes a full year to recover from a joint replacement. You are, however, now past that window. Full functioning for what we term ADLs (activities of daily living) requires flexion of about 110 degrees. This allows you to get up from a chair without pushing up with your hands, but simply by using your legs. I will assume you don't have this much flexion, as you say you can't ride a bike yet, and 110 is probably enough to ride a bike, although you may need about 120.

As to jogging, if you don't have 110 degrees it will be more difficult, as it will increase the amount of energy you need to spend to run/jog. That may be why running/jogging is helping your blood sugar more, as you are using more energy to do it. Otherwise, I'll defer to DrJay and Pego about your blood sugar.

To get a really good result from a knee replacement you need to get 110 degrees of flexion. If you don't have it, one option is a manipulation of your knee to increase the range-of-motion. You might want to ask your surgeon about the option, in terms of you still not being able to do some of the things you want to do. The other option is to really grit your teeth and push yourself. I would keep trying to ride an exercise bike, adjusting the saddle and pedal height, as its a great way to get back motion, and then gradually bring the saddle back down to more normal height, if you are able to get more flexion.

There are also occasionally some technical issues about the position of the implant that limit the amount of motion you have. You may want to get another surgeon who does a lot of total knees to look at the x-rays, and see if this is limiting your motion.

[Pego]

DrJay obviously knows more about sugar metabolism than I do, but this is my 2-cents worth.
Blood sugar levels vary wildly during the day depending on diet, activities to name just the two most important. I would not sweat a scale 90-140. That, I think, is the least you need to be concerned with.

As far as activities are concerned, do you really have to push yourself that hard? I may get shot at for saying this, but sometimes we have to accept our limitations, even if it's hard. I can't do a lot of things that I could in the past, so I substitute with what I can do.

[lonewolf]

Thanks, bam and Pego.
I have about 90 degrees in the bad knee and 125-130 in the other. I do force it beyond that momentarily and it hurts like hell. I kick that leg up behind me when I jog and feel the stab on every step. But I think that may be helping.
I can get up out of a chair. I can climb stairs, although that leg is weaker and I definitely feel it on every step. I have to be very cautious and hold the hand rail going down stairs. I have difficulty running on grass because of the uneven ground and the uncertaintiy of my foot placement. And, sometimes that foot doesn't come up as high as intended and I scuff the ground.
I take my blood sugar once a day, before breakfast for consistency. I exercise between 6-7pm before supper. I am a late to bed, late to rise person. If I go to bed relatively early and don't eat a banana before going to bed, I may wake up in a few hours with low blood sugar (38-52) nausea.
I realize I am not going to set any more PBs but it would be nice to jog comfortably for a half hour, sweat profusely and have have nice tired but not exhausted feeling. ..
And, be able to button my 34" waist pants... I am 5-9, 43" chest, last winter my weight crept up to 193 and my waist to 36".. I am back to 180 but need to get to 170.
Thanks again for the comments. I will keep on keeping on.

[rasb]

LW.....from a coaching perspective
1) Can you swim?
2) Have you ever tried running in the pool. Once you get the technique down, you can get a hell of a workout that way, because you can learn to move all four limbs, and with the resistance of the water as well. Maybe some pleasant female lifeguards will help
3) The exercise bike with the raised seat is great. Again, you can learn to use your arms as well, and even have wrist weights on, as you get adjusted to the activity. We sometimes also used the "altitude simulator pack with runners coming back from injury, so their workout was done at 7000 feet.
Believe me, you can drive your heart rate up easily doing this. And you can also do a moderate interval type of session, where you can push harder for a minute or so, take a minute easy, and so on.
4) If you can, try and incorporate some hills into your walks. Aggressive walking on a hilly route can be a good workout, and if your knee holds up to it, you will also be stretching and strengthening your quads.
5) Very light weights for some quad extensions and hamstring curls, on a bench will also help your muscles offer some protection for the knee joint.
The quads should be stronger than the hams, in about a 3 to 2 ratio.

Hope these ideas are helpful. Take it easy and enjoy....it has to be fun, not work, at your (and my) age and stage...

[lonewolf]

rasb, thanks for your input.
1.) I can swim, although a torn rotator cuff somewhat hampers my freestyle.
2.) Before my knee replacement, after it became too painful to run, I did run in a pool both with and without a flotation vest. Probably helped maintain my aerobics but boringgg.. Tried it with the new knee, cannot kick enough with that leg... it is like treading water with one leg. and my condo complex pool closed after Labor Day..
3.) I think adjustable exercise bike is probably my best bet. I tried with my road bike.. can't do it. the bikes at the rehab center had the arm function..maybe they will let me come back and try them
4.) No major hills around here.
5.) I guess I will have to re-join the spa down the street. I bought a lifetime membership after arthoscoic surgery on this knee about twenty five ago. Turns out they were talking about their lifetime, not mine. Place went belly up a couple of years later. By then, I did not need the spa and never re-joined after the change in ownership.
All good ideas, thanks again.

[tandfman]

I guess I will have to re-join the spa down the street. I bought a lifetime membership after arthoscoic surgery on this knee about twenty five ago. Turns out they were talking about their lifetime, not mine. Place went belly up a couple of years later.

Off subject, but I must say that buying a lifetime membership, or service contract, or whatever, from a local business is quite risky. I don't know whether this was SOP for this particular operator, but there are guys who do this routinely. They open up a business, raise a lot of money by offering lifetime services of some kind, then fold the business, move on, and do it again somewhere else.

[lonewolf]

I guess I will have to re-join the spa down the street. I bought a lifetime membership after arthoscoic surgery on this knee about twenty five ago. Turns out they were talking about their lifetime, not mine. Place went belly up a couple of years later.

Off subject, but I must say that buying a lifetime membership, or service contract, or whatever, from a local business is quite risky. I don't know whether this was SOP for this particular operator, but there are guys who do this routinely. They open up a business, raise a lot of money by offering lifetime services of some kind, then fold the business, move on, and do it again somewhere else.

You are right, of course, although this was not a strictly local business. This was during the oil boom that preceded the oil bust of the 80s. The facilities were excellent and there was a "chain" of these spas in several states. The principal was being written up favorably in financial publications... seemed ok at the time. was not a big loss..

[ndamix]

I guess I will have to re-join the spa down the street. I bought a lifetime membership after arthoscoic surgery on this knee about twenty five ago. Turns out they were talking about their lifetime, not mine. Place went belly up a couple of years later.

Off subject, but I must say that buying a lifetime membership, or service contract, or whatever, from a local business is quite risky. I don't know whether this was SOP for this particular operator, but there are guys who do this routinely. They open up a business, raise a lot of money by offering lifetime services of some kind, then fold the business, move on, and do it again somewhere else.

Not to mention leaving you (the customer) stuck with the bill. :evil:

Sorry for the rant, just speaking from personal experience.

[rasb]

Also, LW, I meant to mention that we sometimes included a bit of yoga, and found this very helpful, to extend range of motion around gnarly joints

[lonewolf]

Also, LW, I meant to mention that we sometimes included a bit of yoga, and found this very helpful, to extend range of motion around gnarly joints

I don't really know what yoga is but I frequently repeatedly bend the knee to the hurting point while watching TV/reading. Can't tell if it helps.
I guess I am not masochist enough.

[rasb]

Also, LW, I meant to mention that we sometimes included a bit of yoga, and found this very helpful, to extend range of motion around gnarly joints

I don't really know what yoga is but I frequently repeatedly bend the knee to the hurting point while watching TV/reading. Can't tell if it helps.
I guess I am not masochist enough.

Someone will tell us the textbook definition of yoga. But we had a qualified yoga instructor come in....Put on some incredibly relaxing music, dimmed the light, taught us how to deep breathe, and "let go", and gradually led us into deeper and deeper "positions", gently, that we would never have been able to achieve otherwise. In that setting, it became much less masochistic, and
more enjoyable, and that's from a guy whose "natural" flexibility was not good...