The formal PT phase is over...

...and now it is up to me alone.

CIGNA has decided that I will have to finish on my own, and I cannot say that I entirely disagree with their decision.  My progress has been very good, and although the pain level is not yet at zero, it will be the strengthening which will take me the rest of the way.  The ASTYM therapy has, perhaps, reached the point of diminishing returns, as is inevitable, anyway.

My therapist has given me exercises to complete -- some daily and some every other day.  Eccentric loading is still painful, and I expect it to improve through exercise.  My first evaluation score, made upon my first arrival, was 14, meaning I was in a lot of pain and very limited.  My second evaluation score, made two weeks ago, was a 63 out of a possible 80.  My therapist was working on a plan to get me to 80 points -- full restoration of range of motion, activities, and zero pain when we got the news that CIGNA said I would have to finish solo.  I have her plan in hand, and now I must execute.  I do have recourse with CIGNA should I not get to that "80" in a month or two.

I am working toward having both my arm and my hamstring at 100% by year's end.  I hope the hamstring can be ready for running by November 1, 2016.  I can work on building the aerobic base via exercise bike and cross-country skier until I am strong enough to use a real bike.  One-legged squats will let me know when I am ready for running.

The quest for wholeness and wellness continues...

The light at the end of the tunnel...

...may not be an oncoming train after all.

I hit an important milestone with respect to the ruptured distal biceps tendon: I completed three curl "super sets" (30 repetitions each) using a ten pound dumbbell. My "super set" is 10 reps each of curls with the palms up, palms down and palms facing inward. Such a workout impacts the biceps and all the forearm muscles. This was my third such workout in the rehab process, but the first one completed within 48 hours of the previous workout -- and with no injury pain. This week, and another week or two at this weight, I can then move up to 15 pounds for a couple of weeks. After that, I will not just be doing rehab work on my arm, but can start a full workout regiment.  This will be my last post on this matter, as this milestone restores me to 90% of normal activities.

Grateful for a good doctor, grateful for your prayers, most grateful for my Great Physician Who is overseeing everything.

My hamstring issue is nearing resolution.  There are times when I have no pain at all, but then again, I am not loading it with running at this point.  Tomorrow is evaluation day at physical therapy, so I will post more after that session.

Feeling encouraged...

Yesterday was, as far as life is now, a "high activity day", with over 12,000 steps recorded on my Vivofit.  I use this number merely as a relative activity level guide, and it is pretty good in that sense.  And lately, as the hamstring and bicep have limited me, it is as good a guide as any since putting on my Garmin 620 is pointless.

I did my PT workout and extended it with a five-minute workout on my "old school" NordicTrack Challenger.  I also included my biceps workout of 10 reps each of palm-up, palm-down, palm-in curls, and three sets of those (90 reps).  The whole workout took about an hour to complete.

I then took the puppies out for a "walk", their first time to walk together on leads.  As expected, it was a hilarious disaster.  They did not like being separated because all they wanted to do is pounce on each other.  They cried as I walked them with my arms extended as though I was doing an iron cross on the rings -- not because of the strain of the leads, but because they could not play 'Bash Brothers".  We only went a couple of hundred yards (meters).  They are 11 weeks old, and such can be expected.

After I put the Bash Brothers in the utility room.  I took a mile walk by myself -- a test for the hamstring.  The time alone was good, and although the hamstring nagged a little from the beginning, it did not get significantly worse.  I really dreaded the afternoon, after the hamstring would have time to tighten again, and getting up and down out of any seating would be painful.  It did, but to a much smaller degree than expected, and I could walk it loose in a dozen or so steps.  This is what improvement looks like.  The next test would be morning, after the hamstring had seven to eight hours of no load.  Pain level was small this morning, a "two-or-three" on the pain scale.  Lifting my heel with a leg curl felt closer to a two.  After being up an hour, the pain level has increased to the three-to-four range when curling.

A few short weeks ago I would have been painfully hobbling about all day after a "high activity day", and sharp pains would arise throughout the day, especially when rising from being seated.  Today, such actions are not without some discomfort, but it is much less than before, and I am encouraged.

The longer road back...

Since my last post with the MRI details, I ran off to South Texas to do some consulting work for six weeks.  I had to walk while doing inspections in the field (uneven and often unimproved paths) and covered anywhere from two to four miles per day in HEAT.  South Texas HEAT.  Measured on-site at 106F (41C) and 30-35% humidity.  Heat Index of 114F (45C) to 119F (48C).  As hot as it was, making my line inspections with a 2.5L hydration pack made the task much safer, as well as wearing very light clothing (even with long sleeves) and a "cowboy hat" -- which may be the most useful tool for protecting the sensitive areas of the face, ears and neck from the sun.  The walking was helpful in some ways, but there were a few days I had to stand-down so my hamstring could recover.

All the above being said, when I got back home, I organized my physical therapy (PT) for my hamstring issue.  I found a PT clinic which specializes in ASTYM therapy, which is the only therapy I found with clinical trial results.  It boasts a 92% recovery rate, with recovery being broadly defined from significant reduction in pain (pain no longer impeding normal activities) to restoration of full activities.  I wanted something which had a real shot at working for me.  The information about ASTYM says it will take 8-10 sessions to achieve its goals.  Each session involves the use of various "tools" to work the tendons along the line of activity (everything which gets triggered when the knee is flexed, for example).  When a tendon is injured, fibrosis occurs to stabilize the tendon, and other muscles and tendons rush to compensate -- all are considered over-worked and injured to some degree, and this is why they focus on the "line of activity".  The tools are used to massage and otherwise work the fibrosis from the tendons, encouraging the fibers to realign, and thus restore flexibility and strength.  It is somewhat painful at times, but after my fourth treatment, I am seeing good results.  My therapist is noticing much improvement from session to session, so I am encouraged that I will eventually put this behind me.  Of course, I have my part to do between sessions, with various stretching exercises and eccentric exercises which also encourage fiber realignment.

I have also begun therapy for my torn distal bicep tendon.  The surgery went well, and the surgeon is pleased and expects full recovery -- though I am required to take things very slowly.  The week and next, for example, I am to do curls using a three-pound dumbbell.  Yes, a THREE-POUND (1.37kg) dumbbell.  Before the injury, I could do a set with a 45-pound (20kg) dumbbell.  After next week I can move all the way up to a FIVE-POUND (2.27kg) dumbbell for two weeks.  Beyond that, he says that I can add five pounds every two weeks.  If all goes well, I should be back to normal strength by the first weekend in December.

Putting the two of these together in terms of restoring normal fitness activities suggests the road will be a longer one than ever before.  Starting over after my broken ankle was not so bad since bones heal more quickly than tendons.  Rebuilding my aerobic base will be a challenge in its own right, but I will also have to rebuild form and body alignment and balance as well.  However long the road is, it will be OK, because it is all good, all geared toward improvement, all healthy.  I just want to run again.

MRI and the knee...

I have captured a couple of pictures of my knee's MRI.  Though nothing is torn or ruptured, there is damage.  I am basically dealing with tendinitis (perhaps becoming more tendinosis) of the biceps femoris tendon (BFT) (see image below).

From http://www.sportsinjuryclinic.net/

Rehabilitation will involve analgesics (pain management), static and dynamic stretching, and eccentric exercises.  I had to research the term "eccentric exercises", and specifically how it applies to the hamstring muscle complex (HMC).

Here are the MRI images, with the area of the BFT highlighted in the green box.  You can only tell it is intact (good news), and therefore my pain is from tendinitis and not a torn BFT.  The first image is more toward the front of the knee than the image which follows it:

Knee is improving...

I finally found a way to get my knee to feel better. What it needed was the extended rest.  The way of achieving that extended rest is shown in the picture below:

During the last day of Memorial Day weekend, I was trying to get our wood together from a fallen tree for a bonfire.  I had to flip a rather large log so that I could attach to my utility all-terrain vehicle and pull it to the bonfire.  I had managed to get the log to about 80% of its upright position when it slipped back on me (ground was soft and bark slipped under my hand).  My natural reaction was to try to catch it, and in doing so I ruptured my distal biceps tendon.  The picture above shows my arm week after surgery.  I will spend the next five weeks working on range of motion without lifting anything.  After that, I'll begin the long road back of restoring strength to the arm and tendon. All of this means that I will be able to do very, very little between now and then. Even so, the quiet time that I have been forced to take has worked wonders for my knee. The pain is now isolated to the biceps tendon connecting the hamstring to the knee. I'm using natural analgesics and rest to help that tendon recover.

Despite continual setbacks, there remains much beauty in the world to fuel the desire to push on...

It ain't happening...

...I am still not running.  The tendons behind the knee continue to debilitate me.  I have really taken it easy the last three days, and it feels better, which means there awaits a big chore to complete.  In this case, that chore is moving the remaining heavy cuttings and trunk from a 90 year-old pine tree to our burn site.  I dread it, because I know the strain will agitate my knee again and I will be in pain for a few days, hurting everytime I change positions either sitting or laying.

I am weary of this cycle, and have come to accept the notion that something is torn back there, and it needs medical attention.  I have an appointment with my GP, and he will give me the referral  I need to get a specialist to look at it (such is the way of insurance companies).  I had hoped to rehab this thing by this time, and everytime I get to the point like I am now, when the pain is there, but very manageable, doing anything strenuous -- even mowing the grass -- sends me into a relapse spiral.  I need a more informed course of therapy; I need to know with what I am actually dealing.  If I have to take a month off of any activity, so be it; I have already endured these pain cycles for six months.  If surgery is required then let's get it on and move toward rehabilitation.

I ache...to run again; I do miss it so.