Today is two weeks post-ACL reconstruction surgery. I’ve awarded myself a badge. Just like Instagram pics of babies with a three-months sticker, knee surgery people get to use weekly milestones to gauge progress.
Bend my knee to 90 degrees
Crutch to the mailbox
Pedalling 1/4 revolutions
Visiting my physiotherapist
And just like new mothers who hear endless advice about how to raise their children; the internet, surgeons and physios and everyone at the gym have opinions about a recovery timeline after surgery.
Where you at? Ten degrees of extension and 90 degrees of flexion? Hmm. That’s not good enough for two weeks post-op. You should have zero degrees of extension by now.
Do you have a cryocuff? You’ve gotta use the cryocuff to get that swelling down. Fifteen minutes on, 45 minutes off.
Don’t get in the pool until 28 days post-surgery. You’ll get an infection.
But it turns out that mothers throw away the baby books because there isn’t a specific formula for raising a child. And I’m skeptical that surgical recovery adheres to precise numbers. Rehabilitation is the aggregate of rest, patience and hard work, but it’s different for everyone.
In his twelve rules for life, Jordan Peterson is clear that instincts dictate the difference between good habits and bad. Just like constantly scrolling Instagram and eating chips for dinner are bad habits, instincts for knee rehabilitation are accurate as well. Don’t just lie around on the couch, but don’t push the trail running too early either. Pay attention to your instincts and don’t be overly prescriptive in your recovery schedule.
We all want some kind of validation that we’re doing enough. Mothers want to be told that the kid is walking and talking at the appropriate age; post-op patients want to know they’re progressing at the correct pace to get back to sport.
But I wonder if measuring specific targets is overly-prescriptive. I wonder if recovery should be predicated on intuition instead? The medical system is busy. Physiotherapists and physicians hear the same story every day. Oh you were skiing and you blew your knee? Not very original. But here’s a nine-month program to get you from surgery to skis.
It makes sense that there is a rough guideline and one should refrain from “dangerous” activities like skiing, surfing or soccer earlier than nine months (apparently that’s how long it takes the graft to adhere), but milestones along the way are loosely paved.
Abiding by a tyrannical schedule will create anxiety. If you can’t achieve 120 degrees of flexion three weeks after surgery, you’re not doomed to arthritis. Trust your instincts! You know if you’ve done enough squats for the day. You know if you wasted a whole day lounging on the couch. Find the right balance of rest and rehab.
Surgeons and physios do everything they can to help, but they can’t know what you’re feeling and they can’t do the work. If the physiotherapist says to do 30 knee bends once an hour, do it. If the doctor says to elevate and ice, then do that. They offer a prescriptive strategy for recuperating, but it’s individual intuition that asks the right questions and guides the appropriate amount of work.
Mothers know when something “just doesn’t feel right” in their kid’s development. Injured skiers know how much to push and when to back off on the road to recovery. It’s all based on experience and observation.
Judging progress by a weekly schedule is incongruent with skiing. With exception to athletes who are training, skiers don’t mark their progress with checkmarks. Imagine your buddy is just starting out on skis. You aren’t going to give him a schedule that says by day 100 he should be skiing all black runs, by day 200 he should have acquired a backcountry setup and by day 800, he better have ticked off some big ones like Corbets, Cosmiques and Saudan Couloir. This is an arbitrary metric to gauge skiing and fails to account for individual variables. My point is that rehabilitation follows a unique path and is based on athletic ability, personal goals, fitness level, flexibility, strength and appropriate rest.
So with this, I’m going to stop reading the internet in search of validation. I doubt that having my knee pin-straight two weeks after surgery is critical to long term recovery. I’ll weigh advice from gym people against my intuition. In spite of the guy on the bike saying I must have exactly 120 degrees of flexion by now (but no more, lest I cause laxity!), I’m just going to go with my instincts.
Just like ultramarathoners who abandon heart monitors in favour of RPE and refer to it as “training by feel,” I think rehabilitation by instinct is a crucial part of the process. New mothers eventually reject the baby books, developing skiers abide by their own agenda, and post-op patients should go by intuition as well.
This doesn’t mean I’ll stop awarding myself progress badges or start ignoring physio advice. It’s a big deal to pedal a full revolution or finally do a one-legged squat. Those are important milestones and prescribed by professional empirical observation. Intuitive rehabilitation is just relief from the tyranny of the schedule. It’s worth noting weekly milestones, but the rigid prescribed schedule isn’t the only way back up from the operating table.