Tuesday, July 9, 2019

Rehab vs. Training

I'm not training.  

But I am doing extensive rehabilitation.  

Knowing the difference is not easy.  

Old news about knee replacement.  Cut the old, worn out knee and replace it with metal and plastic.  One of the more involved and painful recovery processes.  The two key targets for rehab are getting the knee to flex as much as possible and to extend so that it is straight.  The surgery doesn't cut muscle, tendon or ligament.  But there is something about surgery to this area that makes the surrounding muscle, tendon and ligament want to shrink and stiffen up.  Scar tissue?

In August of '18 I had the right knee replaced.  The first three weeks were really hell.  Disorienting.  I'd never spent a night in a hospital, never had a surgical procedure.  The meds didn't do much for the pain and the subsequent physical therapy was painful in the extreme.  Yet, after 3.5 weeks I was back on the bike doing very slow distances on flat terrain.  

In June of '19 I had the left knee replaced.  I learned something from the first knee replacement and did my own physical therapy.  Still had exceptionally good results.  Instead of having a physical therapist push and pull on the knee joint I simply got on my trainer and put a few hours a day getting the knee to bend well.  In fact, the physical therapist admitted there was nothing he could do to improve on my work on the trainer.  

Four weeks post surgery yesterday.  I was on the open road for 3 miles two days ago and realized training was likely a distant goal for now.  Left knee joint moved really well.  But the surrounding muscle, tendon and ligament was still quite sore.  It was clear that if I had any climbing or complicated maneuvering it would likely be too much too soon.

So now I'm determined to focus on rehabilitation for a few weeks before I hit the open road again.  

On my trainer (Wahoo Kickr) I can crank out 30 - 50 watts for whatever time I'm on the trainer (typically one to two hours).  That certainly improves knee flexion and extension and it guards against development of blood clots.  

I'm going to stay on the trainer for as long as it takes me to feel comfortable cranking a steady 75 watts for an hour.  I'll assess the `soreness' of the knee and determine if it is `up for' some hills and complex maneuvering (crosswinds, etc).  If and when that happens there will be a clear change from rehabilitation to training.  

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