Knee Surgery Part 2: Drugs, Muscle Wastage & Crutch Workout Videos

The Drugs and the Pain

As I mentioned in part 1, I was given morphine when I came round after the surgery. I was still wired via the top of my hand, so they whacked me with "2" (mg I assume) when I reported pain.

"Does it still hurt?"
"Yes"

Boom - another 2.

4 x 2 later, I said "Don't worry about it." I was starting to sound like a junky and it was clear that at this dosage, their willingness to administer the drug was going to run out well before it had a tangible effect. In any case, it was tolerable. It seemed only right I should be in at least some discomfort.

Shortly afterwards, they gave me two codeine and paracetamol tablets (30mg and 500mg respectively, combined). Later, after they had wheeled me to my room, they gave me another tablet, this time diclofenac, a non-steroidal anti-inflammatory.

Add to this two cups of strong coffee and the fading anaesthetic and you've quite a cocktail. I spent an hour sending ill-advised Blackberry work emails from my hospital bed while I waited for Mrs M to arrive, then half an hour marvelling at the passing street lights.

The first two nights after the surgery were painful. As I mentioned in Part 1, the small scars left after keyhole surgery do not reflect the extent of the trauma underneath.

To fight this pain, I had been armed with a pack of the codeine/paracetamol 30/500's and a pack of diclofenac. Codeine every 4 hours, Diclofenac every 12.

The problem with codeine, as with all opiates, is that it causes constipation. Evidently I am especially sensitive because three days later I realised I was a stranger to the toilet seat; and the trouble with Diclofenac is that, as with all NSAIDs, it's not very good for your stomach.

I therefore went out of my way to medicate on the basis of need, rather than habit. As a result, I awoke squealing in pain once or twice, usually because I had slept with the leg in a bad position. I found the best approach was to avoid the meds during the day, then take them at night, thus ensuring a good night sleep in return for a little suffering while awake.

Muscle Atrophy and Physiotherapy

Never underestimate how quickly a muscle will waste away if you don't use it. Not going to the gym for 3 weeks will not appreciably reduce your leg muscle mass if you are reasonably active - simply walking up stairs is a strong enough signal to your body that you need those quads.

Yet when you put a leg into a brace [click to enlarge], your quad stops being used at all. Here, three weeks later, is the difference in size between mine. Note - this photo was taken in the mirror, so it looks as if the wasted leg is on the wrong side.


I'd been given exercises by the physiotherapist at the hospital. One was designed to progressively introduce bending to the knee, the other to tense the quads and prevent wastage. This latter was pretty lame, as the photo would suggest.

Had I realised the importance, I would have initiated my own program sooner; but it was not until 2 weeks later, when I saw my regular physio, that I realised how much muscle I had lost and that there was much more I could do to prevent it.

Now, I tense the muscle like a posing bodybuilder for 30-60 seconds a few times a day. In addition, I am doing Romanian (straight-legged) deadlift, which the physio also endorsed (I described the most recent session here.) It allows me to give the lower body a serious workout without affecting the knee.

Crutches

Although I can happily limp around my apartment with the knee brace on, it's not an efficient method of propulsion for longer journeys; and eventually it does start to aggravate the knee.

I took a fine pair of crutches home after the operation, and it has been interesting to experiment with ways to use them for exercise. Here are my top 3 crutch-based workouts.

Crutch Cardio
When using crutches to walk, you can rely completely on your upper body, or only a little. It depends how much you want to protect the affected leg from contact with the ground. Either way, it's actually rather an effective, low level workout because it combines upper and lower body effort. You can aslo move pretty fast once you get used to it.

Note: if, like me, you are crutching for up to an hour per day, it does take a few days to adjust. For the first week I struggled. Doing a few thousand shallow dips per day comes as something of a surprise to the triceps.

Crutch Leg raise
The video says it all - this was a good discovery and I expect to continue to use the crutches when I am working out at home and would like to do leg raises.


Crutch Balancing
As you can see, I need to work on this one... but it's pretty taxing and something to pass the time when you are waiting for trains or buses.


In three weeks the leg brace comes off. I can still only manage 70-80 degrees of flexion. Full fitness should come in two months. No doubt there will be a part 3 to this post.

Knee Surgery Part 1