Total Knee Replacement: 6 months in.

Sorry for the extended delay in updating the blog--super busy times as I'll get into below.   First-off, here is a summary of my volume totals for the first 6-months after my Total Knee Replacement:

Swim

As you can see, my swim totals are not that impressive so far.  Comparatively, during the first 5 months of 2022, I swam 219k yards compared to just 88k yards this year.  In other words, I've only swam about 40% of last year's volume so far this year.

This is really not that related to the TNK.  Obviously, December was, as I still had the open wound and so had to stay out of the pool.  However, since then I've had the green light and my limited kicking means the TKR really has not been a barrier to my swimming.  What has happened is a series of life commitments as well as admittedly, less motivation to swim with no clear multi-sport plans laid out.  From the life commitment perspective, I've already attended 4 weddings (out of 9 this year) and two of those were in Mexico (including my youngest daughter's wedding) that involved 5-day trips.  I've also driven to Kansas and back twice and once to Cleveland to help my other daughter with her residency driven relocation.  Also, we went to London for 5-days to support Alex/Rachel in the London Marathon.

I started to ramp up in May but then we moved our primary residence to the NJ shore and this necessitates open water swimming but for the first couple of weeks the water temp was below 60 degrees and my usual NJ swim crew was not yet back in town and this didn't help my motivation.  I started June off strong but then we got hit with the Canadian wildfire smoke so that was another 3-day set-back.

Lot's of excuses I know, but I'm now starting to get wet more regularly and expect to do at least 100k yards for June-August and frankly will try to do more than that.

As a consequence, I'm swimming about 15 sec/100 slower right now than last year (1:55 vs. 1:40)....

Bike

It was quite challenging/painful for me to ride my bike much for the first ten weeks or so.  My knee just didn't have the range of motion.  I found it was a little easier on a recumbent bike but I wasn't able to really get going until the later part of February.  My volume since then looks pretty solid but its really not, compared to my historical standards--for example, last January I rode over 1,700 miles in just that one month (more than April/May combined this year).  The net of this is I rode 3,123 miles in the first 5 months vs 6,569 last year, which about 48% of last year's volume--not really what I'm looking for.

Early on, as I mentioned my TKR really held me back and while its noticeably better now, I still find when I push up above about 200 miles/week, my knee(s) start to get achey.  Some of this is probably related to the TKR but I think some of it is a function of the detraining that may body went through post surgery and the difficulty one has, when you are 65-years old, when you ramp up again.

I'm at the shore now and able to ride more consistently outside so I expect my volume to climb up above 1,000 miles/month.  I've also began to ride a bit longer (although I still haven't gone further than 50 miles in one ride) and I'm starting to add more intensity intervals/higher spinning rpms on my Zwift trainer and hope to begin to see my bike fitness begin to shape up.  I'd say at this point I'm down about 30 watts relative to last year, which is pretty substantial.

Run/Walk

Almost all of the volume to date has been walking although I ran for the first time on the beach in Mexico for about 400 yards in early May and then I ran 1/2-mile in 5:30 in the 3rd week of May.  I finally, on a bit of a whim, decided to enter the Stone Harbor Turtle Trot 5k run over Memorial Weekend and see what happened.  Low and behold I was able to run the whole thing--although quite slow!

You can see I managed to average 10:54/mile and I even negative split the run.  It frankly felt normal and like I didn't have nearly as much of the limp that characterized my run pre-surgery over the last few years.

This is encouraging and I've started to run 2-3 miles 2-3 times week (which is about the most I plan to do--at least for now) and my knee seems to tolerate it reasonably well so far.

Physical Training

You can see that I peaked out in March with 20 hours of dedicated PT.  I'm still doing this fairly regularly but I suspect that will be down around 10 hours/month or less going forward.

Looking Ahead

I think I'm going to try to do 2-4 super-sprint/sprint triathlons this year including the Stone Harbor Sprint on 7/9 with Anders when he comes out and visit.  I'm also planning on doing several open water swim events and in fact have a 1.2-mile OWS on that same day in July!

I'm also planning to do, in October, a solo through-hike of the Shenandoah NP AT section, which would be about 105-miles over 6-7 days.

I'm hopeful that these events will help with training motivation and that I can begin two ramp up my post-surgery fitness some because while I've recovered well from the surgery, and the knee pain is by-in-large gone at this point, I'm not in very good endurance shape and I suspect my races will clearly show that...

Time to work harder!

Onward and upward!

1st Two Weeks of April

 Here is what the first two full weeks of April looked like

Week of 4/3

Swim: 6,000 yards

Bike: 201 miles

Run/Walk: 16.4 miles

PT: 3:15

Total Time: 23:05

Week of 4/10

Swim: 5,000 yards

Bike: 211 miles

Run/Walk: 14.6 miles

PT: 3:15

Total Time: 22:11

Solid weeks and I'm continuing to rebuild post-surgery.  I'm also having to juggle a very intensive travel schedule (was just in Cleveland for 5 days helping Jen find a new apartment) and will be shortly over in London.  It's going to be a challenge to hit 30,000 yards on the swim and 1,000+ miles on the bike for the month but I'll do what I can given the circumstances.

Here is what the last few weeks look like:

Total Knee Replacement--What the first 4 months look like from a volume perspective

 OK, my TKR surgery was 11/30, so Dec-Mar represented my first 4 months of recovery/rebuild.  Here is what that aggregate volume stats look like:

Here is a description of what's been going on:

Swim

After the surgery there is a period of time where you have an open wound and can't swim--basically I had to wait for a while after I had my staples out.  This then bumped into the holidays so I decided to start swimming in January.  For my start-up swim month I ease into it and swim just 2-4 times/week and relatively short.

February brought a whole host of travel and other commitments, so I decided to back away from much swimming and focus on the other aspects of my recovery.  In the last 3 weeks of March I've begun to ramp again and hope to jump up to near 30,000 yards in April--from there I can return to my normal swimming volumes (40,000+).  today, I swam for the 8th time in the last 9 days.

Bike

The bike is my main thing.  I've tried to push it along as quickly as I could but was definitely limiteds by pain/mobility over the first 2-3 months.  Finally in March, I began to return to quasi-normal bike-wise and you can see that I'm approaching 1000+ miles/month.  I would expect to be above 1,000 miles/month going forward and I will also begin to start building both intensity and the length of my longer rides.

Walk/Run

All walk so far.  I got a little carried away in December but my docs shut me down and I've been slowly rebuilding.  I still have trouble walking much beyond 5 miles so this is my area of biggest disappointment so far.  I just took a whole week off to settle my knee down a bit.  I definitely want to build this number and begin to push up more towards 10 miles at a time.  I'd like to be able to do full on legit hiking/climbing down in Shenandoah by May and maybe even run a bit (not much).

PT

My docs were mostly against this at the outset but you can see that I'm spending significant time on it now.  I expect to do so for another month or two and then hop[e to back off from the time I'm investing there.

Total Time

For the first time since the surgery, I feel like I was beginning to be a real athlete again in March.  Almost 100 hours!  Pretty low intensity, but beginning to get there!

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Here is what the last few weeks look like:

Pretty solid 4-week block in the books--backing off this next week....

 Yesterday completed a pretty solid 4-week building block, considering that I'm still in my 4th month post-Total Knee Replacement.  Here are the volume stats:

Swim: 4,500 yards

Bike: 224 miles

Walk: 13 miles

PT Time: 5:10

Total Time: 24:40

At first blush, with 24:40 of training time, this almost looks like a legit Long-Course Triathlon training week.  However, with over 5 hours of dedicated PT/rehab time for my knee, my SBR time was sub-20 hours, so a relatively light week by my historical standards.  You can see that reflected in my SBR volumes which are all below where I would normally expect to be this time of year (10,000+ yards/300+ miles/25+ miles).  These reduced totals are also a reflection of the very modest levels of intensity/effort I currently have in my SBR training.  Here is a graphic showing the last few weeks (other is PT):

You see the general rise in effort and the consistency of my training in the above.  I even went over 4 hours on back-to-back days last week.  You can also see the prevalence of my PT efforts--I did sone form of PT in 26 of these 35 days--about 3/4ths of the days I do PT.

I'm also now able to easily tolerate biking most days and will begin to increase the length of my longer rides beyond 2 hours.  You can also see I'm getting my feet wet again and getting ready to build up my swim volume in April.

My recovery continues a pace.  Still making progress but also still quite a ways to go.  I underwent dry-needling this week to try to trigger my calf and hammy on my left-side to loosen and lengthen a bit so I can get the last 5-10 degrees of extension that I'm lacking.  Also, I feel my walks (in the knee) once I get up around 5 miles or so.  I'm definitely still a ways away from being ready to head out on my more substantial (5+ hour) treks/hikes/climbs.  

For the upcoming month of April, in addition to getting to the point where I might be able to do legitimate long-distance hiking again, I plan to bring my swim up into the 30,000+ yard range and add a lot of intensity, especially to my bike and swim.  I'll keep doing the PT as long as necessary but hope that I can eventually get it down to a more maintenance like schedule--say 2 hours/week, vs. the 4-5+ I'm doing now.

I'm heading to Florida today to help my Mom out a bit and will use this trip as an excuse to ease back on my volume a bit this week to consolidate the last 4-week block and to get ready for the greater volume/intensity I envision for April.

Onwards and upwards!

Last week volume

 More of the same--so 3 pretty similar weeks over the last 3--my knee feels a bit better so I seem to be adjusting to the volume....will try to do more of the same this week:

Swim: 4,500 yards

Bike: 210 miles

Walk: 14 miles

PT: 4:15

Total time: 23:07

At my rehab this week we are going to try dry needling to see if I can get the last 5-10% of leg extension.  My flexion is pretty close to normal.  pain continues to diminish!

Last two weeks--volume wise almost returning to normal....

 Here are my last two weeks of total training volume:

2/27-3/5

Swim: 0 yards

Bike: 185 miles

Walk: 12 miles

PT time : 4:10

Training time: 19:49

3/6-3/12

Swim: 3,000 yards

Bike: 194 miles

Walk: 13 miles

PT time: 4:20

Training time: 21:30

Objectively, from a volume perspective, these last two weeks haven't been that far off.  Just starting to ramp back up the swim.  Solid bike mileage and lots of PT emphasis leading to 20ish hours/week, which is pretty solid 3.5 months after my knee replacement.

Still, it's all very low intensity and my knee definitely feels it.  I hoping to stay near this volume for a couple of more weeks and see if my knee fully adapts or if I have to back it down again.  If I can hold this volume then I'll look to begin adding intensity in April.

The PT has shifted from being focused on mobility/flexibility to that plus strength.  Both legs, but especially my left are still very weak--lots of rehab to go!

New Knee: 3 Months

 Well, I had the TKR on November 30th so I recently clicked over 3 months post surgery.  Everyone tells me my recovery is going great....but I really don't know what that means.

From my perspective four things are true:

1. I can do a whole more today than I could even just 1 month ago and I've made huge progress from those days immediately post surgery

2. I can't do nearly as much as I want to do and still have my painful moments, although for the most part I can almost always get a good night's sleep now, so thankful for that!

3. I don't know if I should feel good or bad about this cause no one has ever been able to articulate a specific set of quantifiable measures that establish the expected or normal recovery time table.

4. I still don't know when I'll get to the point that I consider "fully recovered" except that it doesn't seem to be very imminent.

I am pretty much able to bike and walk (more briskly) every day if I want and I'm working hard 4-5 days/week on my PT.  I have a one-hour PT session with Hash each week and then 3-4 on my own where I'm generally working on my knee for 45-60 minutes.  I do notice progress from these efforts on a week-to-week basis--especially if I look back over 10/15 days to where I was.  Individual days can be up and down however.

My schedule has been crazy with a trip down to Naples, FL to help my 86-yo mom, who is struggling a bit after her bike fall and fracture.  We also had Kara's wedding down in Mexico City, which was basically a week-long affair (and out of this world fun!).  I did however contract a pesky cold (no CoVid) that has been bugging me for the last 10 days.  Oh, and I forgot to mention that Anders, Alex and I did a last minute trip out to Phoenix to see the Super Bowl.

A couple of highlights along the way was the 10 miles I walked on Super Bowl Sunday and a couple of everyday 5-milers.  At the wedding I found that I could jump up and down again (not a lot of vertical of-course) on the dance floor, which is something that I haven't been able to do for 10+ years.  Also, the other day I was late to catch a train and actually ran about a quarter-mile, with a backpack, reasonably quickly and PAIN-FREE (!!!!) and was able to make the train--I can't remember the last time I was able to run pain free!

So the net of this is I've come a long way from the beginning of this New Knee journey but I still have a significant ways to go and I'm not sure how long it will take to get there.  Nothing to do but continue the journey!!

Training wise, February saw more productive physical work in vs. January but still a very long way from my "normal" February.  Notably, I decided to skip the pool work for most of February to concentrate on my rehab and scaling up the walking/biking.  I'm anxious to start a full swim program this month that I expect to continue for the balance of the year, but am off to a slow start so far in March with this pesky cold.  I'll probably give it the weekend and then start my swimming in earnest next week:

January Totals:

Swim: 17,000 yards.  Bike: 142 miles.  Walk: 27 miles.  PT: 6:30.  Total Time: 31:48

February Totals:

Swim: 6,000 yards.  Bike: 329 miles.  Walk: 52 miles.  PT: 10:20.  Total Time: 49:01

Onwards and Upwards!

New Knee--10 weeks in...

 Looks like I'm starting to turn the corner a bit now.  I've been going to PT and this has helped (or at least not hurt) my recovery a bit.  I'm getting a lot more m ability in the knee and for a fair amount of time each day I can actually walk around fairly normally--no limp!  The pain is far more manageable and I'm off of all pain killers including Tylenol and am now able to sleep close to 8 hours a night--I still wake up 3-4 times a night but shift around a bit and the pain subsides....much easier to deal with now!

The big news is I am now able to tolerate riding on my Wahoo Kickr/Zwift set-up and after driving home from Kansas last Monday and Tuesday morning, I was able to ride for 6 consecutive days starting Tuesday afternoon.  My last 4 weeks my bike mileage was: 19 miles; 60 miles; 36 miles and 128 miles this past week!  I'm not putting out very impressive power (100-140 watts generally) but Its definitely heading in the right direction.  I'm a little surprised at how challenging it is for my left quad, but I guess the inactivity has really detrained my left leg (and right for that matter).

I'm still just walking about 10 miles/week but I actually did a 2.2-miler yesterday, which was the longest of my post surgery and I plan to do more on it this week.

I'm just swimming 1-3X week right now mostly because of my schedule but I plan to ramp that up after Kara's wedding in a couple of weeks......

Onward and Upward!

Me and my new knee, Day 40

 Lot’s going on post holidays on many fronts, including with my post surgery rehab.

I began to log up to 3 miles a day in 4-5 walks towards the end of December and into January.  I began to spin on first my Wahoo Kickr/Zwift trainer and then on my recumbent.  I started a regular swim block (did 4th swim of year today) which my plan would be to build on.

I suppose, not surprisingly, my knee started complaining louder.  Sleep was a real challenge (never more than 5 hours a night).  Hard to walk first thing.  My Docs had an intervention and I just went through a 6-day stretch of minimal stress on the knee.  To be sure, I’m still doing a lot of PT (more on that in a second) and as I mentioned above, hitting the pool every other day.

I also started working with James Hashimoto “Hash”.  He has given me some pt exercises that are not so much focused on stretching as they are on recruiting and properly sequencing muscle activation so I can regain normal knee mechanics.  It’s been so long since I could straighten my knee when walking that some of my muscles deactivated due to limited use.  Because of this my tibia doesn’t glide relative to my femur in a way that allows me to strike the ground with my heel and a 180% extension of my leg.  So I have to retrain them to fire and in the right sequence.  Turns out you can do this by walking backwards.  Reach back with your toe and then roll your weight back to your heel and presto, your tibia glides and you have a straight leg.  So I walk backwards and then slowly forward to try replicate the activation sequence but in reverse.

Anyways, after sprinting out of the gates, my rehab progress has slowed quite a bit. I’m still progressing but slower than I’d like.  I think patience is required and I’m optimistic that it will be rewarded.  Just going to take a while.

My main near-term fitness goal is to walk my daughter down the aisle, without a limp, in the middle of February. 

Onwards and Upwards!