Session One

I wasn't exactly sure what to expect out of my first appointment.  I knew from googling whatever I might be able to find, and from friends' experience with Graston, as well as my own experiences even from massage, that it was going to be uncomfortable.  But other than that, I wasn't too sure where he was going to be working or how long it may last.

Answer was about 15-20 minutes.  The first session focused on two locations - my ankle to try and regain some dorsiflexion, and my knee, trying to regain some flexion.

Ankle:

Focus was on the lateral (fibial) side.  This is the side where I had my plate and seven screws (thankfully removed last October).  Overall it was not super pleasant, but the discomfort level wasn't off the charts.

Knee:

Whereas my ankle was all manual release, for my knee he brought in the instrument adhesion release.  Essentially, a piece of metal stripped away at the lateral side of my knee which was way more uncomfortable than anything on the ankle had been.  He moved a bit across the joint line and did a bit of work on the medial side as well and then proceeded to above my patella and hammered away at my quad tendon/vastus medialis.  The last thing he did was a bit of work on my lateral quad - he said the two quads (so I'm assuming vastus lateralis and intermedius) were stuck together.

Test/Re-Test:

Initial test on my ankle was a difficult 3" dorsiflexion, with restriction in the anterior compartment.  Re-test was a fairly easy 3.5", with far less feeling of restriction.

The day's test on my knee was initially 8.5" short of being able to touch my heel to my butt while laying supine.  We finished at 6", which was pretty significant.

Bruising:

There was redness in my calf, but it was really no worse for wear:

My quad tendon/vastus medialis/whatever started turning a bit purple about an hour after we finished:

The lateral side of my knee was much the same, and bruised a bit within an hour.

Next Day Feels:

My ankle was stiff, but not painful.  My knee was a bit of a different story.  I started to have a lot of discomfort alone the posterior line of my knee when trying to move into extension.  It was super weird.  I wound up spending a lot of time doing knee extension work.  I got a lot of relief from doing banded terminal knee extensions.

Assessment

So, assessment for adhesion release.  This was a series of mobility screens coupled with some poking around in my legs, hips and lower back.  I failed just about every mobility screen (the one I passed was "touch your toes").  This wasn't particularly surprising to me, as I had just recently failed pretty much all the same ones when doing my Bulletproof testing.  Here's some examples of my current terrible mobility:

Hips.  This is where my back starts to round:

Knee flexion.  My left (ACL) is straight up awful, but my right isn't optimal either (ie. also fails):

And finally, there's my knee extension and just how my left leg sits while I'm laying down, compared to my right:

No word of a lie, when the doctor grabbed my knee to do a flexion assessment, what I got was "Darron, are you serious?"  Yes, yes I am.

So my three-pronged diagnosis of my immobile lower body was adhesion, nerve entrapment and degeneration.  None of these things surprised me as the whole point of me coming was adhesion, I've felt the pins and needles/burning of the nerve issues, and many an ortho has told me about degeneration, making my goal to degenerate less over the next many years.

Having been assessed, it was now time to book my first treatment, which I scheduled for the next day.  No sense wasting time getting this show on the road.
 

Strength Imbalances, Mobility and Adhesion Release

Having broken my ankle and had my ACL reconstructed and having that go along with already not being the most mobile person in the world before both those issues came about, it would probably be an understatement to say that there are some serious holes in my mobility game.  Coming out of my year of surgery, I have started to take proper form, mobility, recovery, etc. a lot more seriously, instead of just going HAM all the time and dealing with the (often painful) consequences afterwards.

Despite my efforts to clean up the imbalances in strength between my right and left legs, I had been starting to see some favoring of my right leg creeping into my squat videos.  Some days worse than others, certainly worse with multiple reps.  The other major problem that I've actually been trying to deal with via the ostrich-head-in-the-sand approach was my complete inability to squat properly without the help of oly lifters.  Deep down I've known that this was a dumb decision, but after a year and a half of rehab, I really just wanted to feel "normal" and do powerlifting training for realsies instead of feeling like a permanent bench-only candidate.

My back issues have catalyzed me jumping full on into this corrective programming, but originally I committed toes in.  I heard about Performance Care first through a friend, but then again on a podcast that I respect a lot.  Two points of recommendation was enough to get me on their website checking things out and I decided that hey, it couldn't hurt to try.

As I was going through their week one baseline testing, one of their "tips of the day" emails sent fear and trepidation shooting through my body.  "You should be doing these without belts, knee sleeves and lifters".  Belt, ok whatever - I'm fine with beltless work.  But knee sleeves and, most importantly, lifters?  Oh geez.

So I did the rest of my testing in my inov8s.  And then started my week two workouts in them as well.  Knee sleeves I've been doing my best not to wear, but on days where my knee feels a little sad, I've been rocking the single rehband.  For this week's (W3) front squats I actually went with SBDs as I decided with my back feeling wonky, I wasn't willing to go naked knees too.  Progress, not perfection.

What I quickly noticed (well, re-noticed - I already knew this from knee-hab) was that air squatting or back squatting in inov8s was an exercise in instability.  Essentially, I became this creaky, unstable creature doing something vaguely resembling a squat.  Given that my hips were on fire, I felt they were part of the problem, but wanting to know more I posted a video on the Bulletproof Facebook group asking for the designers' perspective.  What they immediately noticed was my ankle mobility - or lack thereof.  Not all that surprising considering my history.  But what they suggested was different than the mobility/physical therapy road that I've been on for the last 18 months or so.  What he suggested was that I go see a guy about adhesion release.

So I check out the website and decide to give them a call.  I was initially a bit skeptical as the first thing the receptionist tells me is the price for the initial visit (higher - not surprising, assessments typically are) and that there is no treatment on first visit.  I've been to a lot of assessments, but this is the first time I was getting told that there would be no treatment.  Here is the part I actually super respect - she got the doctor to call me, and he explained the what and why behind that.  The fact that he took the time to call and explain it to me was what pushed me on board, and I booked an assessment for the next day.

Banking Too Much on Things Going Well and Pushing Them Over the Edge Into Not Well

So my training since my last competition has been going pretty well.  I competed near the start of April, and did not go in feeling particularly confident in my abilities - most specifically in my squat.  It became pretty evident to me during my peaking weeks before the meet that things were not going to go like I had hoped - I failed at what I had been looking to take as a second attempt during my last heavy week of training, so that sucked.  To make a long story short, I finished with 105/80/160 for a 345 total.  This was good enough to qualify me for Regionals, but 20kg short of my national total.  I knew going in I would need a near-perfect day to get it and I didn't.  Not going to lie and say I wasn't disappointed, but dealing with disappointment is also part of the game.  There's also quite a lot of 2016 left for me to nail down that total so hey, live to fight another day.

I took the week after my meet off as a deload.  The week after that I was off on a semi-vacation and a set of work meetings, so it was also a pseudo deload.  The only work I did in those two weeks was three squat sessions to kick off a three-week higher volume program.  One day involved 3x10, one 5x5 and the other 8x3.  I had run this back in November when I was finally getting back to squatting and saw a ton of improvement, which was the motivation in me wanting to run it again.  I re-integrated the other two lifts in week three post-competition when I got back to Edmonton, starting on a four week block of the Stinn System.  I modified the squats in the first two weeks of that block to allow me to finish out the volume cycle.

I came out of the volume feeling great; my first workout back into the Stinn cycle I easily hit a double at 97 and then proceeded to singles at 100, 103 and 107 (more than my meet), all beltless.  Great start.  A week after that, I went for a single at 110 belted (my failed third at the meet) and then a new PR of 112.5 and hit that too.

It's at this point I made a series of poor decisions.

Poor Decision The First - I went to football practice.  This wasn't necessarily a super poor decision in and of itself.  I wanted to see how my knee would react and this allowed me to do so.  The poor decision was less doing football practice and more what came afterwards.  The answer to how my knee would react was "by swelling, a lot".  Two days later I sat on a bus for 11ish hours going to/from a football game to watch from the sidelines, which also didn't do much that was great in terms of getting swelling out of the joint.

Poor Decision The Second - As I was perusing videos I had previously uploaded to Facebook, I discovered one of me squatting 215 for 9 and the little hamster in my brain starts spinning on its wheel.  This is now five days after I've gone to football practice and the swelling has not resolved itself.  I squat 215 for 10.  Beltless.

Poor Decision The Third - Thursdays are supposed to be my rest day, but I'm doing some baseline mobility and strength testing for a program that I want to run.  It calls for a 10RM sumo deadlift.  Thinking that I won't be able to do that much for a 10RM, I decide to go for it on my rest day.  I undershoot my 10RM twice, meaning I do three sets of deadlifts (225, 255 and 270).  I'm not going to lie - this actually felt really damn good.  I was thinking "wow, when I re-test my 1RMs things are going to be sa-weet!"

Poor Decision The Fourth - Friday when I go in for my workout, things are starting to break down.  My depth (which is normally never an issue for me) is creeping up for squats and my deadlifts feel heavy as fuck (go figure, considering how many loads I have blown this week).  I figure I'll be "smart" and in addition to my Saturday rest day, I'll take one Sunday as well and that should fix everything.

Poor Decision the Fifth - So I've blown my load a few times over-exerting myself.  I've also started integrating this imbalance/mobility work into my programming - because obviously by doing so that's going to fix my problems.  At this point, I also start running a peak cycle because I want to re-test my numbers on my ACL surgery anniversary.  To make a longs story short, this was a bad idea.  I lasted a week.

Thankfully it doesn't seem like my back is too bad from all of this.  I've progressed from unable to roll over in bed, put on socks, or get my shoes on, to being able to do all those things again.  I tried some light squats tonight with no ill effects.  Same goes for a light dead.  I have learned enough from the above to not be like "woo, hop back on the peaking program and let's continue as planned".  I've quickly realized that the strength imbalance/mobility stuff is taking way more out of me than I thought it would and that if I want to see some true improvement from it, I need to focus on long game, and drop the heavy weights for the short term.  So I'm going to come up with something different but difficult and fulfilling to do on my surgery anniversary and give myself the opportunity to re-test later, when I'm more ready.

Hardware Removal

Just over 9 months after the screws went into my ankle, they came out.

I was supposed to be at the hospital for 9:40 with surgery slated for 11:10.  We stopped off before I went in and voted in the Federal Election as I didn't want to risk being doped up after surgery and not being able to vote.

The worst part of the day was honestly the morning wait.  I had been told that with my surgery time penciled in for 11:10, the porter would pick me up around 10:40.  Yeah, try 12:40.  The extra two hours of anticipatory nerves were not a thing I was looking for!  A nurse friend of mine reassured me over text that they weren't going to cancel my surgery (my biggest fear!  I wanted this over with!) and so I read some magazines and impatiently waited it out.

So I finally got wheeled up to the operating room and learned that my anesthetist plays hockey with the surgeon who did my ACL reconstruction.  Small world, right?  They wheel me into the (freezing!) operating theatre proper and within a few short minutes I was out.  I came to at about 14:05 in recovery, which gives a pretty good idea of how short a surgery it was.  Similar to my ACL surgery, I came to quite alert.  Unlike my ACL, I didn't feel the need to cry for no reason, making this by far the easiest time I had coming out of anesthetic of my three surgeries this year.  This is also evidenced by me being bumped back down to day surgery almost right away.

My nurse friend Nancy came to hang out with me and then take me home when they finally cut me loose.  It was great to have her there as she got me two extra pieces of toast!  Unlike my ACL, they also let me have two drinks.  Either the Mis is less stingy with this stuff, or the Grey Nuns was just really, really convinced I was going to puke.  Either way, toast was delicious.

As I was about to get discharged we had a length back and forth between me and the nurses about my limitations post-surgery.  I had asked Dr. Toreson before surgery how this would affect my bench press training (I'm competing in a month) and he had told me no restrictions, let pain be my guide.  The only thing he said to be sure to avoid was body contact (which is off limits right now anyways due to my ACL).  Well, the nurses were like "oh god you're going to break your bone!!" and the literature they gave me said not to lift more than 10 pounds.  They tried paging my surgeon for clarification but he had left for the day, so they made me promise that I would call him (which I did yesterday - bench training is a-ok).

I was surprised with how well I could walk.  I had read some people's accounts of their hardware removal where they were on crutches or back in the boot; I walked out under my own power just like Dr. Toreson had said I would.  Made it back home, got myself installed on the couch, and stayed there for most of the rest of the night.

I took yesterday off work but didn't really feel too worse for wear, so I mostly just watched TV.  My partner was home from work early and I wanted out of the house, so I tagged along to the gym.  I didn't work out really, but did a few sets of strict pull ups, kipping pull ups and dips.  Hooray for upper body!  Today I'm back at work and off pain meds.  Other than feeling a little more tired than normal and the obvious reality of a bunch of staples in my leg, I'm feeling pretty good.  Optimistic that the hardware removal will help with some of the residual swelling in my ankle and allow me a bit more range of motion.  Squat time is coming!

Days 9-19

On Day 15 I had my second physio appointment, and my first with the physio that my surgeon wanted me to see.  Overall I was happy with him - he ran the appointment efficiently, explaining each new exercise and then giving me enough time to complete it.  Very seldom was kept waiting in between exercises, explained stuff well, seemed to be progressing me along.

New exercises for Week 3:

• Bridge (3x5 progressing to 3x10 with a 5 second hold at the top)
• One-legged bridge (alternating legs)
• Swiss ball roll-ins (3x20)
• Swiss ball bridge (3x5 with a 5 second hold)
• Box air squat (3x5 progressing to 3x10; decrease height with success)
• VMO squat/wall squat (1x5 progressing to 3x15 with a 10 second hold)
• Air squat series (1x10 progressing to 3x10)
• toes straight forward
• toes straight out
• toes straight out with a toe raise out of the squat to the top
• lunge (one set with each leg forward)
• AM terminal extension with belt (1x5)

Roll ins seem to be helping with flexion, so that's good.  The bridges are getting easier and have the added bonus of helping with glute engagement, which I suck at at the best of times.  The one legged bridge, especially trying to bring my left leg into extension, is definitely a challenge.  

With the exception of the VMO squat, which is not exceptionally difficult, all things squatting are demoralizing and frustrating.  I seem to be improving, and I don't even necessarily think that I'm behind, but going through two straight injuries that eliminate your ability to squat functionally is awful mentally.  I just want to be able to squat to parallel and not look like I'm trying to fold myself in half.  It's embarrassing and frustrating.

I saw my surgeon on Friday (Day 16).  I finally got the low-down on what went down during my surgery.  As she expected, my knee was a mess when they went in there and there was a lot to clean up.  Overall she was happy with how this went.  My ACL was repaired using a hamstring graft.  My bucket handle tear was indeed flipped and blocking the joint, rendering me locked.  None of my torn parts were repairable and they took 2/3 of my medial meniscus.  My medial compartment is my best one in terms of osteoarthritis, where I am a 2 on a scale that goes from 0-4.  My lateral compartment was a 2-3, with a section observed at 40 flexion that was a 4.  My anterior compartment was also a 3.  The hope is that now that my knee is stabilized we can slow down the further degradation of the joint.  She doesn't anticipate weightlifting putting undue stress and damage into it.  Football is obviously another story.  Overall she says that it shouldn't bother me arthritically for several years yet, and once it does my activities will be dictated by how I take pain.  Not the greatest news, but no surprises basd on what my MRI had showed.

I'm still swollen, but less so than in the first two weeks. I have fallen off a little bit on my icing regime and should probably take some more care to be doing that.  I think I may leave my cryo cuff at home from now on and emphasize icing from there.  I don't think that I need to be icing while I'm at work anymore.  

I got my fluid trainer set up last night so that I can happily bike away at home in addition to when I'm at the gym.  I forgot to ask about the ski-erg at my last appointment so I'm going to make sure that's on the list for this week.  I've seen pictures on instagram of another Sather patient able to use the rower, so I was going to ask about that as well.  As of tonight I'm going to restart doing some upper body work as well so that I can try and get my routines back to some semblance of normal.  

Not too sure what my goals are in terms of hitting them by my next physio appointment.  I guess just general comfort and vague improvement in my squats so I feel less awful and incompetent.  I am going to have to ask Ian what reasonable targets are in between my appointment on Thursday and whenever the next one will be as I am not a good judge and have proven to be a very harsh critic right now.  

Post-Surgery - Days 6-8

Day 6

I slept better last night than previous nights which was probably a combination of being able to sleep on my side and it not being nearly as obnoxiously hot.  I'm still not sleeping soundly through the night - I'm waking up every couple of hours.  Normally I'm a really good sleeper, so I'm hoping this will pass soon.  I'm feeling a bit foggy and tired during the day, which I'm sure is related to my quality of sleep.  I could do without it though!

I'm off prescription meds entirely and taking ibuprofen instead.  I have a bit of pain upon waking up when I first walk and the blood rushes into my leg but overall not too bad.

Day 7

I was convinced to head over to Commonwealth and hang out at our booth during the Women's World Cup.  I did very little - I stood around for while chatting and then the rest was spent sitting with my leg up on a bucket.  At halftime I ran a till with two friends pouring beer for me.  Sketchiest part of the day was probably my brain fart when I decided to walk around the opposite side of the stadium to the one I normally walk - the one with a huge slope down and then up.  I had the debate of "what is better - turning around and walking all the way around to the other way, or sucking it up and walking this?"  I went with the latter and started moving very, very slowly downhill.  About midway down a guy I know who drives carts in the stadium picked me up, called me an idiot for walking it, and took me to the booth.

When we got home I made up for lost time and iced every hour (well, every hour +20 counting the time I as using the ice).  Other than feeling fatigued, I didn't feel any worse for wear for my adventures.

Day 8 - FIRST PHYSIO APPOINTMENT

The highlight of today was my first physio appointment.  My friend Sharon was nice enough to drive me there as I wanted to at least ask about the safety of me returning to driving before I did it.  My physio was pretty happy with my progress - I've hit the marks they wanted in terms of pretty much full extension and 100-110 degrees of flexion, so that was good.  The biggest thing I need to work on is re-training my gait to include the component where you heel strike and are in extension - after having been locked for so long, I have modified into a bent knee walk that I do not want to keep long term.  It's always interesting to have to think really hard about doing a motion that you take for granted.  I pulled out both crutches to help brace me, and spent some time really emphasizing the extended position heel strike, keeping the quad engaged, and getting a proper stride.

Speaking of quads, we did a lot of quad activation work.  We started with a lot of quad setting from progressively lower each set.  My first one I had a fully rolled towel under my knee, then a half roll, then no roll.  Then we did some work dorsiflexing the ankle against a towel to try and push into terminal knee extension.  Then straight leg raises, which I definitely struggled with sans towel.  The quad activation part, and trying to actively make sure that my knee stayed as extended as possible was definitely a challenge.  This is a weird feeling as someone who has historically been very quad dominant, but the comeback has to start somewhere.

Still trying to work terminal extension, I also did some work standing with a theraband around my knee, and then pushing into extension.  After that, I got cleared to ride the bike, which was super exciting.  I can definitely see how the movement helps to loosen up the joint.  The first couple revolutions were very difficult, but the pattern naturalized for me very quickly.  The last thing we did were wall slides, and again it was the quad activation to go from the bottom (in flexion) back to the top that was the hardest part.

My next appointment is in a week, and I switch physios to the one that my surgeon wanted me to see (same clinic).  They told me to continue really emphasizing my extension this week, and that he would expect me to be walking with a proper gait next week and that we would continue pushing to regain terminal knee extension.  They also expect my flexion to continue improving; I feel like I'm being held back by my stitches more than anything.  After I hit a certain point it just feels really tight against them.  We'll see what happens.

NEW EXERCISES FOR THE WEEK:

• Wall slides (20-30 reps)
• Quad setting (20 reps x 5 second hold)
• Quads over roll (20 reps x 5 second hold
• Straight leg raise (15-20 reps x 5 second hold)
• Terminal extension (3 sets of 8-10 reps)
• Baby squats (3 sets of 8-10 reps)

My goal is to complete my exercises a minimum of 2x/day (lunchtime + evening).  I'll also be riding the bike daily, starting at the recommended 5 minutes per time and progressing from there.