I went today for my 4 week follow up appointment with the orthopedic surgeon. As I’ve mentioned before, 4 weeks ago he put me on non-weight bearing use of a walker due to my trabecular bone injury in my leg. It has been a difficult 4 weeks since I wasn’t to use my left leg except for balance. I went to physical therapy a couple of times. This week, I was told that I was doing the non-weight bearing exercises well enough that I could do that home and would come back to physical therapy when the doctor said I could do weight bearing exercises.
The doctor appointment went reasonably well. There were really two topics: my trabecular bone injury and my knee and future exercise.
Trabecular Bone Injury – The bad news is that I’m not entirely finished with the walker.
After some discussion, we ended up with him telling me to transition from the walker to full weight bearing over the next two weeks. I’m allowed now to bear 25% weight on the left leg and will be increasing it periodically over the next two weeks by which time I can go full weight bearing. I would like to have the walker gone entirely, but I’m content enough with being able to use it with some weight bearing. Using the walker while basically hopping, except when I have to balance myself, is just exhausting. It has been so unpleasant that during the past 4 weeks basically the only time I’ve left the house is to go to Weight Watchers or to go to physical therapy. With being able to bear some weight, using the walker is not nearly so unpleasant. It is still slow, but isn’t exhausting to use. That said, while I might be more willing to go to a restaurant or some place that involves a short walk, I’m still not going to want to do things like go to the grocery store.
I’m not convinced that using the walker has really done much to help the situation. It is true that when I don’t bear weight on the left leg I don’t get much pain from the trabecular bone injury. But, that was true before. That is, when I was sitting in a chair I didn’t get much pain from the injury. But, if I pressed on the area of the injury it was painful. Well, that is still true. I’m not sure that this 4 weeks has really changed that. I think my doctor certainly hopes that using the walker has and will help the recovery. But, I suspect that nothing but time — a lot of time — is going to make it really go away.
My Knee and Future Exercise
This was the part of the appointment where I had come up with a lot of questions after my last appointment. Many years ago, I had a tibial transfer to improve the alignment of my kneecap. I knew then that I didn’t have a lot of cartilage under my kneecap, and I’ve been careful since then to baby my knees. I didn’t run and I didn’t do leg extensions and I was just careful with what I did. I noticed in February that I had kneecap pain when I was doing some lunges. The knee MRI revealed grade 4 chondromalacia patella. The doctor told me that I had knee arthritis and the cartilage was bone on bone and that I should pick a cardiovascular exercise that wouldn’t stress the knee as much. He suggested swimming, cycling or an elliptical.
It wasn’t entirely clear to me where the line was drawn and exactly how dangerous he thought it was for me to walk. That is, was he simply saying walking wasn’t an ideal fitness activity for me or was he really telling me I needed to actively avoid walking? I also found this somewhat confusing, since some of what I read seemed to advocate walking for at least some people with arthritis such as here, here, and here. I realize, of course, that this is the type of thing that is individualized. That is, it might be fine for some people with knee arthritis to walk for exercise, while for other people with knee arthritis the doctor would recommend against it. I am a big believer in getting personalized medical advice from your own doctor, since I know that generalities are simply that and may not apply to the individual situation. What was unclear to me was what he was telling me about my individual situation.
I went in with a lot of questions about the limitations he was placing on my walking. He said that while swimming, cycling or using an elliptical would be better choices for cardiovascular fitness, he wasn’t telling me not to walk. What that meant was less than clear. I told him that the reason this is important to me is that I’ve read that even if you exercise, you still shouldn’t sit too much. I live in a one story house and I told him that if I was home all day and didn’t go for a walk or use the treadmill, I would walk about 2000 steps. Therefore, sometimes, I would just hop on the treadmill, not so much to do a big cardio workout, but just to move and get some steps in. The other factor for me is that I wanted to do weight bearing exercise for the sake of my bones.
I finally asked him to imagine two situations: In both situations, I would use an elliptical for an hour a day for my cardio exercise. But, in one situation I would most sit around the house the rest of the day and would have 2000 walking steps for the day. In the other situation, I would use the elliptical for an hour, but would also get on the treadmill and walk on it (flat, no incline) for 3000 steps just to move around some. Which one should I do (given everything he knows about my individual situation)? He told me that, in that situation, walking on the treadmill 3000 steps would be better. I asked him if there was a specific limit on steps that I shouldn’t exceed. That is, was 5000 steps OK, but 10,000 steps was too much? He said there was not a specific limit on number of steps. It depended on how my knee felt. Basically, if I was walking on the treadmill (which he said was better for my knees than walking on pavement), and it didn’t hurt then there was no specific limitation.
I did talk to him about my using my rower, since that was hurting me some when I was using it earlier in the month. He said that if I used it for 30 minutes and my knee hurt the next day then back off and trying using it for 10 or 20 minutes and see if that hurt.
Based upon all this, I think I can keep my treadmill and use it without an incline and walk at a fairly sedate pace just to get in extra steps and movement. I think I’ll probably get an elliptical for the cardiovascular stuff, but will keep the treadmill just to get steps in so I don’t sit too much. I’ll take it carefully and if my knee hurts the next day then I’ll reduce the steps. Of course, if it ends up hurting all the time even when I reduce usage, I would have to look at giving it up.
Before the trabecular bone injury I wasn’t having much pain in my knees when walking. There were a few twinges walking down the hills in my neighborhood, so I think it is pretty clear that that puts enough stress on my knee that I shouldn’t do that any more, at least not at my current weight and fitness level. So, staying on the treadmill seems the way to go, particularly while I’m still overweight.
I’m inclined to go ahead and sell my Concept2 rower. I enjoy the rower, but it seems to bother my knees more than the treadmill and more than the exercise cycle I used at physical therapy. I am leaning to replacing it with an elliptical.
I’ve been looking at elliptical reviews and am horribly confused. Some say having a rear drive is really important. Others, say it doesn’t matter. Some saying it is really important to be able to adjust the stride length. Others say that isn’t that important. I feel about ellipticals much like I felt when I was researching treadmills. When I was looking at treadmills, so many of them fell into the following categories: (1) treadmill had wonderful features and sounded awesome, but the manufacturer had lots of service related complaints, (2) cheap and not very durable, (3) good quality, but often less bells and whistles, good service, but extremely expensive. I also didn’t like ordering something online that I hadn’t been able to try out. I particularly didn’t want to do it since some of the online manufacturers had a lot of service complaints. I had the idea that with some manufacturers if the treadmill you received didn’t have any problems, then everything was golden. You would have gotten a good price, the treadmill was great, and all that. But, if the treadmill broke, some companies had a lot of complaints of poor warranty service. Then, I went to some of the local stores. There were the stores that had the really cheap machines that didn’t seem to have much quality. There were the specialty fitness stores that had really nice machines that had good quality. But, many of those treadmills were over $3000. I didn’t want to pay that much. Finally, we found a local fitness store that sold a variety of different treadmills including Lifespan which I had identified as one that seemed to be good quality, not too expensive and without a lot of service complaints.
Now that I will be looking for ellipticals, the situation for ellipticals seem similar to that for treadmills. The negative is that I haven’t so far found a treadmill that seems to be good quality, but isn’t hugely expensive (I want to spend less than $2500), and is from a company that doesn’t have a lot of service complaints. And, I know stride length is important for an elliptical, so I really would prefer one that I could try out before buying (which knocks out a bunch of online retailers). The problem is that once you knock out the online retailers, most of what is left is either the cheap machines or the really expensive machines. When I look at the brands carried by the stores around here, I’m not all that happy with the choices. Sigh.