A few weeks back, I had X-rays taken of my knees and legs. Don’t worry; there have been no new symptoms or a worsening of symptoms. I’m still in a pretty good place. In fact, I’m doing the best I’ve been doing in the two years since surgery. I’m just trying to work out why I still have so much pain doing certain activities, especially since some of the activities cannot be avoided or are actually kind of important parts of life. I can’t avoid stairs all the time, nor can I (unfortunately) avoid vacuuming my living room.
Good news is that my knees look ok from a radiographic standpoint; there’s no compartmental arthritis that has caused joint space narrowing or anything like that. Not so good news is that I’ve been subconsciously favoring my “bad” leg for so long, there are radiographic changes in my right tibia. The doc pointed to the X-ray showing my legs side-by-side and showed me the difference, which was pretty easy to see.
The left leg is normal (an opaque, whitish color on the image). The right leg shows radiolucency (dark bone when it should be whitish).
The doc indicated this is because I’ve favored/protected it for so long because of the pain that the stresses aren’t enough to keep the normal metabolic process going. You need to stress a bone to make it strong. Mine looks weak on film.
I was surprised to see that there were radiographic changes; I wasn’t aware that was something that could happen in my case, though I guess it makes sense. I think it also validates that the knee hurts. Duh. My brain likes to protect the things that hurt, so my body adapts new ways of doing things. I’ve talked about the incorrect movement patterns and the way I walk with my foot curled in at length. None of it is something I consciously do. At least not anymore, if it ever was conscious.
Side note. After I heard this, I started doing research… as usual. According to the Department of Radiology at the University of Washington, a person must lose 30-50% of bone mass before it shows up on a plain X-ray. That sounds great. Just great.
After looking at the X-rays, I’m pretty much sitting there just staring at the doc. I wasn’t exactly sure what he was telling me. I mean, I understood his words, but I didn’t understand what it meant. He said “you’re only as strong as your weakest leg,” so we still need to work on that a bit. Build back the strength. But first, he wanted me to work on ROM… again.
I was measured at only four degrees off of extension and had full flexion, so it didn’t sound like much of a big deal to me. Regardless, I was told to do nothing but work on getting full extension back. I was given three stretching exercises to do five times a day for two weeks. I was also told to do no more walking than absolutely necessary; I could continue with the bike and swimming but had to limit walking. You know that means no more Challenge Route.
I was a stellar patient (I can’t often say that since I frequently take things into my own hands), and I walked back in to the clinic after two weeks of stretching and had regained full ROM. That it had been accomplished without an exacerbation of symptoms was great.
I was really taken by surprise with the next steps. I had to build strength, but first I had to be tested so they had a baseline. I didn’t realize right away that this meant testing with the big, scary machines that I’d always been told would hurt too much to use for my case. Holy chipotle.
I was tested on both legs doing both leg extensions (ouch!) and leg presses (not as much ouch). Turns out, I am exactly equally deficient in all four ways they tested. Seventeen percent across the board. I was told that’s pretty uncommon. Most people are deficient in one or two areas, but few are equally deficient across the board. I’m no longer surprised when I hear things like this. I can’t tell you how many times my doc or my PT has said I don’t follow the book or I’m not like most people in how I move/compensate/function. This latest rarity apparently makes me the “poster child for a deconditioned knee.”
All of that to say… I guess I’m back in PT. Sort of. I’ve been given two exercises to do at home that are intended to help build strength until I go in again in about four weeks. At that point, my strength will be tested again. Joy of joys.
I have so many questions right now. How can the strength test be accurate when it hurts so much to do leg extensions in the first place? How are two simple exercises with relatively low weights going to make up for a 17% deficit in four weeks? I wish I’d thought more quickly and had these answered while in the clinic. I think I was so floored by the fact that I had to do strength testing that I couldn’t think of much else.