Knee Surgery and Aftermath

I am a bit more than 200 days shy of my 40th birthday. On Thursday, I had a third arthroscopic procedure done on my right knee – the second in 210 days. Fortunately, Thursday’s procedure was not as extensive as the prior repair in August (which healed nicely) and the recovery seems to be on track.

The doctor and I had a long discussion on what caused these two injuries prior to my surgery. I showed him the movements of the snatch, swing, jerk, and the way I squat and much to my surprise he is adamant that nothing I am doing caused either of my meniscus tears. He does not believe there is a pattern or underlying cause to either of these injuries, and his examination of the inside of my knee surprisingly yielded “a very healthy looking knee.” I have no arthritis or other deterioration of concern.

His explanation for my problems? Possibly a circulation issue of unknown cause in the cartilage, possibly genetic in origin. He called my two injuries a rash of bad luck, and he does not see a readily apparent reason why there would be a recurrence. I have to trust a trained professional who has done thousands of these and is well recommended in the Houston medical community.

Still, I have a lot of questions, and a lot to think about. How do I rehab? How do I prevent this from happening again? Did I come back too fast the last time?

As far as rehab, I am advised that beyond ice and mobility drills, there is no rehab besides taking it easy. In theory, I am told, I could do anything I wanted today and there is no way to re-injure the knee. Of course, I would pay a price in swelling.  Discretion is the better part of valor, and this is my knee we are talking about.

Since it is my knee, I am entirely responsible for what I do to it. Naturally, I am going to look more into rehabilitation options and strengthening exercises. Joint mobility, jump stretch bands, maybe even some supplementation.

I am going to assume that I did come back too quickly the last time, and I am going to be quite vigilant as to what I do this time. The best steps I can take right now are ice (to get the residual swelling down) and mobility drills.  A period of mobility exercises and non-knee flexing body weight exercises seem to be order. Mobility drills with situps, pushups (with the right leg suspended), kettlebell chair presses, chins, planks, etc. will be my focus. There is no timetable at this point as to moving on to other kettlebell exercises like the swing, snatch, standing press, clean and press, push press, jerk, etc.

My priority is to heal, with a secondary emphasis on maintaining some semblance of condition.

I recently purchased a copy of Scott Sonnon’s Intu-Flow, and have been using his basic class as a mobility program for the last couple of weeks as a run up to surgery. I’d really like to get into his Flowfit program again, but I need healthy knees to practice Flowfit effectively. I will post up a review of Intu-Flow in the next few weeks once I have spent more time with the program. A few weeks or months of primary focus on joint mobility should be beneficial.

I don’t know how to prevent this from happening again, but I am going to reduce the odds. Shutting down all physical activity is not an option for me. Logical preventative measures seem to include joint mobility drills, exercises to strengthen the adjacent muscles, and making sure I am entirely comfortable resuming exercises that require knee flexion before resuming such exercises.

Stay tuned – more to come over time.

300 – Knee friendly style

Tom and I are both fans of Steve Maxwell, and we thoroughly enjoyed Steve’s recent video 300 Kettlebell Challenge. Of course, we wanted to try out the routine but both of us have defective knees. Not wanting to totally trash my knee five days before a minor repair job, I modified the routine to make it more knee friendly – no squats, no lunges, no getups, and no cossacks.

We both used a 16kg bell, and the reps went like this to total 300:

Around the world – 15/15

Halo – 10/10

Windmill – 5/5

One arm swing – 30/30

Snatch – 10/10

Clean and press – 10/10

Clean – 20/20

One arm swing – 30/30

Crush press situp – 10

Russian twists – 10/10

Pushup with kettlebell on the horn – 10

I finished in 14:34 and Tom was about the same. I may play with this workout to make it more challenging, or I may move up 4kg. It sneaked up on us – it was all good until the second series of swings, and then it quickly turned into a game of survival.

Common Sense sometimes escapes all of us

Like many of you, I am a project guy. For some things, why buy it when one can expend inordinate amounts of time in the garage or on the patio making the same thing? Invariably, all project involves several trips to Home Depot. The end result of what I have made will probably land me on Double Secret Probation from the American Kettlebell Club. Fortunately, I was able to borrow a friend’s pressure washer to remove the remaining metallic evidence from the patio.

Everything below is for entertainment purposes only – I would not recommend trying this at home. You can fill your heavy kettlebell needs more economically from the good folks at the American Kettlebell Club any day now.

Scott Helsley was the inspiration for this project, but my temporary insanity coupled with my desire to occasionally press heavy objects did me in. You can read about Scott’s successful endeavors to make hollow kettlebells heavier at the following links:

Making a 36kg from an adjustable 16kg Before you go an purchase a bell from the supplier cited in here, do a little checking.

Making a 12kg into a 29.5kg bell

Making a 12 into a 46kg bell

Here is how a professional metal worker accomplished the same in a much cleaner manner. Once again, do what I say and not what I do – don’t try this at home.

Here is where my temporary insanity came into play. I thought the recent AKC sale on 32kgs would be a good opportunity to try this experiment to make a heavier kettlebell. They are hollow, right? Err, yeah, but they are two inches thick. To drill through high quality steel two inches thick, you need a drill in which you can control the speed, a good hole saw (or two) and some patience. Using Scott’s melted lead technique and thanks to his generous offer of the use of his hot pot, I was able to make this 32kg bell’s sister:

Into a beautiful 36kg bell that is regulation AKC gray for this size.

I can swing this weight, jerk this weight when my knee is healthy, and I can press this weight at maximum effort with good form.

I had some extra lead, and ordered some more off the internet. Here is where I totally lost my senses. I decided to see how heavy I could get a 12kg bell. My math indicated somewhere between 46 and 48lg. So, I took this 12kg bell’s sister:

And filled it with lead – a lot of lead. I got to about400 grams short of 44 kilograms before deciding to stop. I think the regulation color for the AKC bell of this size is gold. However, I decided to take a different approach which is probably going to get me put on double secret probation for contemplating such a paint job.

In retrospect, maybe I should have painted this thing black with red flames. On the subject of painting kettlebells, you can read about my methods here.

Happy lifting.

Knees

My MRI report read as follows.  What I know it means is that there won’t be any squatting or jerking for a long time, and it also means I have an underlying structural imbalance that needs to be corrected with the help of a knowledeable therapist. If you know one in Houston, please leave me a comment.

Along the way I tore my meniscus, but there is nothing loose floating around inside the knee this time.

FINDINGS:

The study shows foci of advanced chondromalacia, grades II and III, over the central weightbearing region of the lateral femoral condryle…

The intrinsic ligaments of the knee are intact, including both the anterior and posterior cruciate ligaments, as will as the medial and lateral collateral ligaments.

There is no sign of franel tearing of the medial mensicus.

Lateral meniscus is also intact.

There is mild lateral patellar subluxation and there is marked thickening of the distal end of the patient’s persistent medial suprapatellar plica. The plica thickens to approximately 4mm, when compared to the 1 and 2mm thickness of the remainder of the more superior portion of that plica.

The included portions of the quadriceps and patellar tendons are intact.

Image #17 of sequence #8 shows an additional small linear area in the anterior horn of the lateral meniscus. This configuration suggests a small and nondiscplaced tear of the anterior horn of the lateral meniscus, distinct from the normal artifact of the insertion of the anterior intrameniscal ligament.

CONCLUSION:

Findings of advanced chondromalacia of the weightbearing portions of the lateral femoral condyle as well as a small and nondisplaced tear of the anterior horn of the lateral meniscus extending obliquely, from anterior and superior to posterior and inferior. This configuration appears to be distinct from the normal anterior artifact related to the transverse meniscal ligament.

Random musings

The Office of Common Sense has discovered something that makes a lot of sense – increasing 2 reps per minute in a snatch set over 8 minutes makes a huge difference in effort. I went from 12 to 14 reps per minute over 8 minutes. Once I master 14 reps per minute over 8 minutes, I will try for 10.

Tonight I did:

Warmup and mobility

1APress12kg – 8/8

1APress16kg – 4/4

1APress24kg – 2/2

1APress32kg – 2/2

1ASn16kg – 8m. (14,14,14,14)/(14,14,14,14). 56/56. Right then left.

1ASw24kg – 30/30.

1ASw32kg – 15/15. 100 swings total.

My wife is doing something harder than timed sets, 24 hours a day, 7 days a week:

 

Finally, I have torn my meniscus again. Repair is scheduled for Thursday, March 27th in order to maximize time watching the NCAA basketball regionals. Of course, my calculations may backfire if Texas wins in the first and second rounds since they would be playing at Reliant that weekend. Fortunately, snatches, swings and presses are rather knee friendly. I can always pick up jerks again in 2009. Besides, I am going to have much higher priorities than improving my jerk numbers in a few months.

Adapt, improvise and overcome

I go for a specialized MRI today on my right knee, the one that was surgically repaired last summer. My surgery last summer was successful, but there is an underlying problem that is causing pain. So what does all of this mean? I’ll know next week. Maybe a new injury, maybe a circulation problem in bone and cartiliage, maybe something else. If there is something loose floating around in there, like I think there is, then I get to do a redo. I also am going to consult a joint specialist to see if there is a root cause to my recurring right knee problems.

Jerks do not bother the knee, but with a heavy heart I am going to stop doing them until I get to the bottom of this. I have found swings, snatches, cleans, and presses to be quite knee friendly. Rack holds don’t bother the knee either. So, I am going to duct tape a program together consisting of snatches and swings with a pressing component of some sort. There are more than a few people in the community who do just that – heck, that is what Enter the Kettlebell is all about. I am particularly impressed by a gentleman I know who is in his early 60’s who has achieved incredible results from mainly snatching the 16kg. I figure if I practice rack holds and pressing that I will have a shorter curve with jerks when the time comes to resume jerks.

The lesson here is to adapt, improvise, and overcome. I plan to do just that.

I am now totally sold on timed sets

I haven’t been keeping an online log recently, but I have been training.  My consistency has not been what I would consider ideal, but I have been spending time under the bells. Besides lifting for time, I have not had a particular emphasis or competitive goal. In fact, I have been spending most of my time with the 16kgs – jerks and snatches. Due to inconsitency, my progress has been slow as far as increasing duration, but I lift kettlebells mainly for fitness.

The Office of Common Sense had heard that timed set lifters working with the 16kgs were pressing the 32kgs for reps. If I did not know the people involved, I would not have believed that 16kg lifting for time carried over to pure stength. Well, the Office of Common Sense decided to try an experiment straight from the tool box of the RKC – Rite of Passage Day.  Keep in mind that I have been on a maintenance program using mainly 16kg bells.

I did not test snatches, but I decided to test my press. I warmed up with the 16kg and 24kg. Then I picked up a 32kg and did a couple of reps each side. Finally, I decided to try a 36kg. Lo and behold, it went up on the right side, and it went up on the left side.  Wow. I have never jerked anything heavier than a 32kg, much less even tried to press anything heavier than a 32kg. I’ll leave the scientific explanations to others, but the fact that I have gotten far stronger from performing mainly rather pedestrian 5-8 minute jerk and snatch sets with the 16kg amazes me.

I am not here to tell you there is One True Way to lift kettlebells and I am not here to denigrate whatever you’re doing to improve your health with kettlebells, but the Office of Common Sense wholeheartedly gives timed set lifting its seal of approval.

I am going to transition from a maintenance program to a program where I will be in a position to compete in the biathlon. For now, that means progressively longer sets with the 16kg and gradual introduction of assistance exercises.