How your physiotherapist can turn things around

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I have been athletic my whole life. While running 5k in February 2017 I felt a pain in my knee, and I knew it was significant...

Years of track, tennis, and many other sports had me quite attuned to my body. I iced it for a few days, hoping it would get better, but it didn’t. I was diagnosed with a bucket handle meniscus tear in my right knee. In April 2017 I had an unsuccessful surgery that resulted in a full meniscectomy. We knew that I’d had an issue from the initial surgery, and my prior surgeon had advised me that I would likely develop osteoarthritis and need a knee transplant in the not too distant future.

I continued with physiotherapy but my rehab was not going that well. When seeing the physiotherapist the hospital had assigned, she advised in that session that we had tried everything and that there was clearly still something mechanically wrong with my knee. Her recommendation and that of the senior physiotherapist was to find a new surgeon. I mentioned I had previously met with Professor Wilson and really liked him, and already had a follow-up meeting booked, and they both were glowing and said he was the best. 

Meniscal Transplant - and then a fall!

Professor Wilson advised meniscus transplant. I also needed to continue physiotherapy to get me to the best place possible so the surgery could be done - most people think physio starts after surgery, but that isn’t always the case. I met Phil Harris who is my current physiotherapist.

By the time we found a meniscus that was a match as a transplant, it had been 10 months, and incredibly painful ones from commuting to work, or being able to do anything at all. I was glued (virtually) to my crutches. Then six weeks after my meniscal transplant, I had a nasty fall down a huge flight of stairs and had also been concussed. It was such a shame - I had taken off really well with my physio, and then after the fall I started to slide backwards. My rehab seemed to be ‘stuck’ and needed a kick start. We had a meeting to discuss needing to potentially open my knee again as the MRI wasn’t fully clear in the field of interest, and at the end of the meeting I asked about an injection - Prof Wilson had done a Cingal injection before. We did schedule surgery twice, once in late March, then we moved it to 11 April based on how I was progressing in physio. In our meeting we decided we’d re-asses surgery after 3 weeks of an all out physio assault, and I was progressing so well, we moved it out to that 11 April. Reopening my knee for the 3rd time in a year isn’t an ideal option for anyone, and Prof Wilson wanted to avoid it too if we could.


Working closely with my physiotherapist

Enjoying physiotherapy

A physio and a patient have to have an ability to click, because as a patient you have to do what they want, and hope they are right, so there is a lot of trust in there. At the same time, you need to keep positive, so Phil ensured we were always laughing or sharing stories - he probably kept me from going mental, as I was staring at the same walls for so long.

At 3 weeks after the Cingal injection my flexion range had dramatically changed: My ‘flat’ was 3, and my bend was 119. Only 4.5 weeks later, on Monday, 9 April, after those 10 sessions/4.5 weeks I started walking unaided. No brace, crutches, etc. It wasn’t graceful, but I could walk, and without pain! I have kept going, and can now ride my bike outside instead of a stationary bike, and keep working with my physio & Prof Wilson on what’s best, and my range is now 0-136. It was at 0 3 days after I started walking, and doing the exercises right so I don’t get my form wrong & reinjure myself is key, so I see Phil once or twice a week.

Those ten sessions happened in 4.5 weeks, and the first week of April I started walking! I have kept going, and can now ride my bike outside instead of a stationary bike. I am now at 0 degrees flat flexion and 129 bend, so there is work to do, but I learned the flat measurement is more important so your physio can get you to weight bearing, which is needed to get to walking. I had a session with Phil on the 11th, and I’d been walking about 4 days then, and I said to him - "today was meant to be my surgery day".  I didn’t think I’d ever walk. We were all a bit euphoric and teary when I did walk - from me, to my partner Simon, to Phil and Prof Wilson. Phil said days like that was why he loved his job. I just loved him pushing me and pushing my naturally competitive buttons, but I don’t think any of us thought I’d walk so fast.

Do your research

Research, talk to people, don’t always take the ‘obvious route’. This is life-altering surgery, and there are only a few people globally that do it well, and Prof Wilson is the only person I would have used. But I still did my research, met him, had a think, met him again, but he clearly knew what I could do based on his large, successful body of work, so just as with my physio, you put more trust than you can imagine in the surgeon, but you almost don’t realise it until afterwards. There isn’t enough I can say about Prof Wilson and how brilliant he is, but you need to make sure everyone knows you are more than just a knee - you are a person too. Prof Wilson does acknowledge that and others follow his lead.

Principles Phil and I developed together -

1. Educate the patient on the process, and the pace of recovery, and continually explain how - with my knee, for example, why other parts of your body become key to focus on, such as building up my quads so they could do some of the work the knee would normally do alone.

2. It is key to have a rapport, so that physio, even when hard, is fun, so you if you can both have a laugh together, it makes it easier.

3. Listen to the patient - this gives him a sense of the pace of rehab based on that and what he can feel when working on the leg.

4. Explain what each exercise does, why you are doing it, and for what reason

5. A physio is almost like a version of a 'seeing eye dog', ensuring they guide someone through rehab, especially transplant in the knee.

6. Figure out the patient's triggers (I’m competitive and love sports) and try to introduce an element of that into the work that needs to be done to rehab, it makes someone feel more normal and they tend to respond better. 

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