Arvind Ashok: Fitness & Nutrition Simplified

So, here’s where we are

Here’s part 1 in case you missed it. A quick recap — I rotated my knee, heard a snap. Con­sulted var­i­ous doc­tors and was advised to rest. I real­ized my knee con­di­tion was dete­ri­o­rat­ing, rather than improv­ing. Even­tu­ally, I started some mobil­ity work by myself, and started to feel bet­ter. Surgery was the rec­om­mended option, but I was not gonna even think about it while my knee was in ter­ri­ble shape. So, I found a physio on the same wave­length as me, and started to work on my range of motion.

Walk­ing with a limp

My knee was swollen, and I had the nar­row­est range of motion. If I tried to straighten my leg out, I was lag­ging behind my about 20 degrees. And when I tried to bend my knee and try and kick my butt, I was off — by a lot! I was obvi­ously walk­ing with a limp.

I had spo­ken with a bunch of folks with ACL injuries but none of them suf­fered from a lack of range of motion around the knee joint. The most com­mon issue when you tear your ACL is buck­ling — your knee is pretty unsta­ble. And if it buck­les, you risk dam­ag­ing your menis­cus (a shock-absorber of sorts). My knee was pretty sta­ble though.

Just as I was look­ing for a good physio to go to with this, I ran into a friend of mine after ages who had torn his ACL too. And he was work­ing with a physio who he absolutely swore by. He got me an appoint­ment the very next day, and I went to see him. It had already been 5 weeks and some. The physio’s first response was “You should’ve seen me ear­lier”.  I had a long con­ver­sa­tion with him, and with no lead­ing at all from me, he said his pri­mary goal was to restore my knee func­tion­al­ity, and then see what needs to be done. Music to my ears. And so I began some intense physiotherapy.

For folks who haven’t had to go through phys­io­ther­apy, it is def­i­nitely not easy. Mine was a slow and ardu­ous process but slowly my knee started to improve. I could almost sit down on my heel, and forcibly touch my heel to my butt. Flex­ion (bend­ing) was fine, but exten­sion (straight­en­ing) was not, as you can see from the image below.

Couldn’t straighten the knee out beyond a point

Beyond a point, I stopped see­ing improve­ment. The sur­gi­cal team main­tained that it was not pos­si­ble to extend my knee fully because of a pos­si­ble impinge­ment by a torn piece of tis­sue (from my lig­a­ment or the menis­cus). My physio on the other hand was rea­son­ably sure that it was cap­sule tight­ness, and we tried some dry needling. This basi­cally involves stick­ing a small nee­dle into the knee area, try­ing to rup­ture the cap­sule and attempt­ing to get it to re-heal but in the right fashion.

Stick­ing nee­dles into the knee

But it never did hap­pen, unfor­tu­nately. I had a restricted knee cap­sule, due to adhe­sion inside which couldn’t be released at all. In addi­tion, I had a menis­cus tear (hor­i­zon­tal tear in the pos­te­rior horn) and a ACL tear. I had improved my knee range of motion as much as I could, and it was time for surgery.

Find­ing a surgeon

Mean­while, I had set­tled on a sur­geon, in case I had to go down that route. Again, the sur­gi­cal team’s analy­sis of my lack of joint mobil­ity was that my ACL could be caught between the shin bone and thigh bone, thus not able to ‘close’ prop­erly. While my physio dis­agreed with that diag­no­sis, we agreed that surgery was the best route for­ward as we had hit a dead-end.

On Dec 15, I went in for surgery. The sur­geon was expect­ing to clean up the menis­cus, repair it if pos­si­ble. And graft my knee ten­don to replace the torn ACL. And also to clear up the fibrous tis­sue buildup. I had spo­ken with a friend of mine who had his ACL recon­structed just a few months back and he gave me valu­able advice. And that I should absolutely watch the surgery on the mon­i­tor inside the oper­a­tion room. For­tu­nately, I was not given any such option while in surgery. I was wheeled in, a bit ner­vous to be hon­est. The oper­a­tion the­atre had a lot more con­ver­sa­tion going in it than I thought there’d be. But then, reg­u­lar day at the office for them, right. The bit I was dread­ing was anes­the­sia, given spinally. It felt kinda weird but after I lost sen­sa­tion of my lower body, it felt kinda fun. I floated in and out, heard snatches of con­ver­sa­tion, and was too zonked out to know much. In fact, it took me quite a while to real­ize that the sur­geons had made the inci­sion and were prob­ing around my knee. I lay there for quite a bit think­ing, “Hmm, when is this thing gonna start?”.

Uhh, why did they have to shave so much of my leg again?

Once I was out of surgery, a mem­ber of the sur­gi­cal team demon­strated to my wife and mum (who were keep­ing me com­pany in the hos­pi­tal) that I could extend my leg — and pro­ceeded to snap my leg into exten­sion. Thank­fully, I was still under the effect of the anes­thetic. And now, on to the inter­est­ing bit. The sur­geon had probed around for quite a bit but could not find any indi­ca­tion of menis­cus dam­age. And the ACL that was sup­posed to be torn fully, was actu­ally torn under 20%. He spent most of his time clear­ing the adhe­sive build-up and sealed me up. Didn’t touch the menis­cus or ACL, as it was still rather strong. Pretty cool huh!

How did that happen?

First up, as I men­tioned ear­lier, the MRI is just one part of the diag­nos­tic process. But is it so far off that a >90% tear was actu­ally a <20% tear? Appar­ently. What about the other tests done to deter­mine if the ACL was torn, which every­one I saw did? Did they all get it wrong?

What hap­pened was I tore my ACL very min­i­mally when I rotated my knee, but the jump that pre­ceded it was also rather poor and that led to the bone con­tu­sion. Doc 1 (who got it right, said there was no lig­a­ment dam­age) exam­ined me within a cou­ple of hours. Am guess­ing that enabled him to make the right call as well. But by the time I went to the other doc­tors, my knee had locked up a lit­tle and I had also had the MRI taken. Am guess­ing that these vari­ables might’ve thrown them off. But hey, why am I find­ing excuses for them? Any­hoo, I am glad my sur­geon cleared up the prob­lem and left me untouched oth­er­wise, and that my physio was clued in all along.

Where am I at now?

Back to phys­io­ther­apy. But would my research about pre­hab hold true? Well, it has been two weeks and some. For the first 10 days, I was on crutches and min­i­mal phys­io­ther­apy. The last 10 days, I’ve been rather aggres­sive (with my physio, obvi­ously), and am at where I was before surgery. Per­fect! Coz that was exactly what I was hop­ing for, and that’s why I put in all the work dili­gently before surgery as well.

(Do You Wanna) Get Fit With Me

I am in ter­ri­ble shape. I can­not walk prop­erly, let alone run. I need crutches when I go out. Climb­ing up or down a floor takes me for­ever! I can­not even get into a plank posi­tion. And even when I am able to walk prop­erly, I wont have the lungs to run a mile. It will be ages before I can think of squat­ting. Hold up! Am not set­ting all this up for the love and pity to rush in. Here’s the deal. I know there’s a bunch of you out there who have been wait­ing for some­thing to kick-start your fit­ness adven­ture. Maybe you’ve let your­self go so much that you hate it, maybe you didn’t have the time, maybe you got injured and then let it go, or you’ve just been a lazy ass — it doesn’t mat­ter. Guess what? You now have company.

This time of year, a whole lot of us make fit­ness res­o­lu­tions and fail to keep them. Here’s your chance to ride along with some­one who isn’t (that would be me) gonna fail to keep them. Stay tuned for more on this. I am going to give the com­mu­nity (that’s you!) a cou­ple of days to share any ideas. You can use the com­ments col­umn below to talk to me. And do share this post if you think it might be use­ful to folks who’ve been injured/lazy/unfit/busy/“waiting for tomorrow”.