Brace free lessons: Recovery steps
In each stage of recovery from injury, one learns to accommodate the conditions that are necessary for healing. Casts, splints, braces, crutches, canes, stitches, medications and more may all be part of the return journey to mobility and health. Hopefully, one has intelligent co-ordination of self and expert guidance so that the temporary necessity of artificial support does not mutate to a creation of ongoing need.
Since February 18 (10 weeks, 70 days), my left leg has been confined in either a post-surgery full leg splint, or in a Bledsoe Simple leg brace. I have used a cane for balance, as well as a signal to people about my injured status.
I accustomed myself to full leg extension, then learned that my skills no longer applied once I had been allowed partial flexion. Then I learned to move with allowed partial flexion in the brace. I adapted my life (with generous human help) to both the splint and the brace so that I could continue to function as well as possible, within a specific set of activity limitations.
After the previously mentioned 10 weeks, I removed the brace, on recommendation of my surgeon, and according to recovery protocol. Fear and relief held a continuing discussion. Relief in sleep quality, overall physical comfort, clothing choices confronted large anxieties about falling down, severe muscle atrophy, and new demands on the injured knee. All the sensory signals for safety that I had developed had become associated with the weight, feel, and constriction of the leg brace. Without the leg brace, my vulnerability seemed overwhelming.
But, as any Alexander student (and since I am an Alexander teacher, I am always a student), I learned through experience. After sleeping without the brace (and being unnecessarily fearful about bending my knee in the night), I bravely dared to stand up in the morning. Nothing terrible happened. The knee was as stiff as ever, but I didn’t fall down. I walked up the stairs to my office with two legs (both hands on the railings) almost like a normally mobile person, just with a wince and a lurch. It was scary and my knee ached, but I could do it. (I still can’t descend stairs like a normally mobile person, as my knee won’t yet bend enough.)
And the cane? I remain uneasy about going outdoors without it, but I see now how I have been delaying a level of recovery of balance and confidence by relying on my lovely cane. We need assistance, then continue the assistance even when the need has changed. This seems the essence of habit as related to injury recovery.
I am not mobile in any larger way. I am slow and often scared of falling. I walk with a very noticeable limp. My knee aches more and differently now that the demands upon my knee have changed. The knee ache doesn’t alarm me, but it does remind me that I can’t end-gain this recovery nor speed it with my will.
I still can’t just “run” to the store, “jump” on a bus, board a flight, squat to pick up dropped keys. “Walk” signs remain far too briefly timed for my street crossing pace. I can sleep more comfortably, bathe easily, wear my regular clothes (not just brace-adaptive pants) and get to know my leg again with continuously changing use.
Hope and Participation: Continued Recovery
After 9 weeks (but who’s counting?) of recovery from patella fracture, my hopes of resuming strength and function any time soon had been dimming. Recovery from injury is an endurance test for anyone. For someone as addicted to, and identified with, a high level of daily activity as I am, a long term recovery is torture on numerous levels.
My very skilled and smart Physical Therapist, Heather, provided renewed hope and some psychic endorphins when I saw her today. Firstly, she had viewed my website, and had a fairly clear concept of what I do daily. Secondly, and very importantly, she gave me an increased demand in rehab activities so that I can apply the use of myself in an increasingly dynamic manner.
An activity enthusiast such as myself wants deeply to participate in my healing and recovery. This differs from the end-gaining urge in the sense that I want to attend to HOW I participate. (Nevertheless, end-gaining can sneak stealthily into nearly any activity one considers “important”!)
Heather gave me an intelligent series of strengthening and re-balancing exercises to address the dismaying atrophy of my left leg. She advised me to see myself as a student and take my own direction. Humbly, I accept: teacher, teach thyself.
Thus, I am re-learning to walk in a very basic fashion. I am renewing my monkey with an entirely fresh perspective. I am doing squats to the degree that my brace will allow, as well as numerous leg lifts to rebuild muscle fiber and nerve responses.
I remain confused in my newly faulty sensory appreciation, but trust in direction, inhibition, expert guidance, non-end gaining determination to see me through to the next level of recovery.
Non-linear Recovery
Recovery progress is not linear. In the same way that improved use through lessons will typically reveal long held and previously invisible habits of use, and thus require a newly dedicated conscious response that may “feel” like going backwards, so the changing structural conditions and shifting mobility of injury recovery requires time, endless patience, and a trust in Alexander principles. Progress is a spiral, not a line.
I managed to figure out how to use myself as well as possible in teaching with a fully extended, then a minimally flexed, knee. The solutions I found on a daily basis were evidenced in my overall elastic response, despite a condition of self that was dramatically limited. Now, my injured knee conceptually can bend much more, but the challenges have increased. I would have believed that an increase in allowed flexion would equal more ease, but that is not my experience yet.
The injured knee is both stiff and wobbly, which sounds contradictory. The muscles, tendons and ligaments have been in only one length and use for 8 weeks. Elastic response in the knee area has yet to resume. Although the knee doesn’t hurt actively (except at night, when it really aches), the sensations are distractingly strange. My knee doesn’t operate in any recognizable way.
The distraction of the odd sensations brings a huge demand to inhibit focussing on the injured knee. I can’t claim to have yet succeeded in keeping my picture big and attending to the whole self, even in teaching. I struggle, and the struggle is challenging in a way that is different from the stimulus of pain.
Still, the daily, constant activities of monkey and lunge while teaching must help not only with my overall response, but with the knee’s recovery, weird as the sensations might be.
Walking on the street is a whole new challenge also. Although I can move somewhat more easily, balance is constantly changing. Even a slight breeze seems to throw me off balance, and I must use my cane to steady myself. I am both more and less confident. My stamina has improved, but sudden wobbly knee sensations scare me. My attention gets drawn downward, and I have to use all my resources to go up again, to use the whole of myself in a balanced manner.
A favorite local dog, Oliver, was tied outside the coffee shop a few days ago. I was a block away when he spotted me, and he wagged and wiggled and smiled all during my slow and wobbly progress until I could greet him appreciatively. His patience, and his joy in my arrival, remains as a metaphor for my eventual progress. Grimacing and despairing won’t help me now. Patience and daily joys will.
Faulty Sensory Awareness
After a far more optimistic visit with my knee surgeon today, my leg brace was adjusted to allow 60 degrees of knee flexion. Now, this does not mean that I can immediately bend my knee to 60 degrees! The muscles, tendons and ligaments have been in forced full flexion or near full flexion for two months. The nerves to these areas are barely firing from non-use. However, even after even a few hours with increased flexion, neural-muscular connections are being made, more bend is occurring and an increased awareness of my knee in motion is registering on my overall awareness.
It is a huge relief to have a more moveable leg. I do notice that I have to very consciously direct my left knee to move forward to its fully allowed flexion, as full extension has become a strongly held habit after 8 weeks. The previous pain of even slight flexion haunts me, so that I am still reacting as though my knee hurts when it bends even though it is not truly currently hurting. This is an excellent experiential example of faulty sensory awareness. Over and over, I have to direct the knee forward and then inhibit reacting as though pain is the result. In essence, I refuse to pull down to send my knee forward.
I will have two weeks to renew my use of self with this amount of flexion (I have time to send my knee forward without pulling down), then the brace goes away (gasp!!!) and my strength in good use becomes my overall support, as it has been even with the brace. As stabilization (the brace) decreases, my intent is that my elastic response increases, so that I am supported, even as I recover, with a balance of tone that yields an integrity of form.
Continuing Recovery with Physical Therapy
After the discouraging and dire predictions from my surgeon, it was a great relief to meet my Physical Therapist, Heather, today. She began our meeting by asking, “What activities do you want to resume?”.”Running!!” I answered with great enthusiasm. Heather didn’t see a problem with this goal, as long as I wasn’t thinking of marathons or running down hills, neither of which I was even vaguely considering.
Heather was impressed with the activity level I have resumed since injury/surgery. I showed her my Gyrokinesis daily routine, which she found quite consistent with the exercises she has designed for me to pursue. Her only caution, seeing my high level of motivation, is not to push too hard. If my knee gets sore, taper off a bit. (I think my dancing has not been the best thing for my knee, but it has made me feel more alive and engaged)
I can perform the assigned exercises, which are various leg lifts from lying down and standing, with good use of myself. Nothing she suggested seemed inconsistent with Alexander principles of attending to the whole self.
Having a means to participate more fully in recovery, and interacting with a health care professional who sees me beyond being an injured person, gives me renewed hope! Guidance in resuming an overall elastic strength is just what I needed to continue optimistically and fully toward resuming my preferred active life. It will take time, of course, but it is entirely possible for me to be active in all the ways I had enjoyed prior to injury.
Questions I wish my surgeon had asked
I know surgeons focus upon the repair and the mechanics. In an ideal world of health care, my surgeon would have asked the following:
How is your non-injured leg holding up with increased weight bearing and mobility demands?
How are the hip flexor and ankle joint on the knee injured leg?
Does your back hurt from necessary compensating use?
You look much thinner, and you were already thin when you were injured. How is your appetite?
I understand that you are normally very active. How are you coping with being inactive? Has depression become an issue?
What necessary daily activities are most challenging for you?
Is your brace/cast/splint as comfortable as it can be? Is there a way to adjust it for further comfort?
How are you sleeping? Is the pain or brace/cast/splint interfering with much needed rest?
What concerns do you have about your return to full mobility, and how can we assist you in your full recovery?
The Dance Solution
The slow dance with self pity is unappealing and does not involve the preferred response of being on the ground and springing up. So, my current procedure for overall recovery is to put on dance music and dance like crazy with my challenged leg and all the rest of me. Use what I’ve got and dance!
Take that, Doctor “you won’t walk normally for 6 months”!
Experiment
Ok, imagine and experience this:One of your legs is in total extension. No knee bend whatsoever is allowed. Now, add extreme pain, which increases if any knee flexion occurs even slightly.So, with full leg extension and pain added, attempt the following:*walking*going up or down stairs*getting into or out of a car*cooking a meal*sitting on a toilet/getting up from a toilet*dressing yourself
How did you do with the experiment? These are just a few of the challenges I have managed in the past 6 weeks. Thanks to my Alexander skills, I figured our coordination for all of the above. My point is that injury takes a toll that you can barely imagine until you are in the experience. Without good use, a person would be utterly devastated by the sort of injury I have experienced. Even with good use, it is devastating. Life shrinks in possibilities. A sense of self in the world diminishes. Dependency becomes a daily reality. All the emotional relief of activity is no longer available. Sleep becomes a huge challenge as pain becomes a constant interruption.
How to continue with optimism, how to hope for eventual recovery becomes a constant question. My surgeon, who has a limited viewpoint, says it will be 6 months until I will walk normally. My stubborn refusal to agree to this prediction, and my insistence that my Alexander skills will speed my progress, are all I have to support optimism and hope.
I am already walking, with my very slightly increased flexion, with greater steadiness. I can direct the injured knee out of my back more effectively with the slightly increased flexion, and I know that the nerve connections are operating well. My lower back is far less distressed, and I don’t have to catch myself from falling with the same frequency. I am not as anxious about walking on the streets.
However, a long term recovery demands every ounce of personal resilience and Alexander skills that I can muster. The road ahead is long, but I am determined to do my very best, as well as to continue to make discoveries that will hopefully be of use for others.
Flexion change/New Use
I admit that every Alexander skill and personal ounce of resilience has been faltering after 6 weeks in full legextension. Depression, despair and that old slow dance with self -pity have been haunting my peripheral view.The “big picture” was beginning to shrink and fray into daily frustrations, many discomforts, and multi-layered distress.Today, I returned to the surgeon 6 weeks after the injury. My challenged leg looks like an alien limb, and my fractured/repaired knee is swollen like a grapefruit. The muscles, especially the quadriceps, are atrophied to near invisibility.
Dr. Mohammed thought it all looked great, except he wants me to do leg lifts to slow the muscle atrophy. I will pursue this assignment with dedication and good use.I was given, and indeed it seems like a gift, 30 degrees flexion in the knee brace. This flexion does not change my mobility much. I will still need my cane for balance on the street, and face the same challenges in car-loading, stair walking and just plain old walking. However, the slight flexion does shift discomfort to a more tolerable level. And, most importantly, the change gives me hope that recovery is progressing. I can begin to apply Alexander principles more effectively with the confidence that I am indeed getting better.
I do notice that I continue to use myself as though my leg is still fully extended. How quickly habits take hold! I will be observing the shift in my use to this new flexion over the next few weeks.