Sunday, March 11, 2012

Physical Therapy


My brother told me a story of a trip to the public pool.  The staff was moving lane lines around to prepare the pool for the next program.  They’d asked everybody to get out, but one guy was lost in his own world and didn’t hear them—he just kept swimming.  Finally they pulled in the lane lines next to him anyway, and one of them clipped his hand.  He raised a huge stink and was yelling at everybody for hurting his hand and they just ignored him.  Finally my brother said to the guy, “Why don’t you go blog about it.”

I think that’s a good cautionary tale for any blogger.  In my opinion, the point of a blog shouldn’t be to complain in public to whoever will listen.  Feeling sorry for yourself in such a forum is even worse.  I promise to keep these ideas in mind as I write about my recent history with physical therapy.  I’ve done a lot of PT after breaking my femur fifteen weeks ago.  If you’ve done PT yourself you may relate; if not, you’ll get a glimpse into this gloomy realm.  I’ll also offer up some thoughts on where life philosophy meets physical therapy.


My first exercise, technically, was just getting out of bed to go to the bathroom.  At the hospital they encouraged me to be up and about as much as possible, but “possible” was a slippery concept.  Just being vertical would make me dizzy, and by the time I’d dragged myself and my walker the twenty or so steps to the bathroom, I felt like I was about to pass out.  A couple weeks after my surgery, I learned that it wasn’t worth it to stand to pee:  that much exertion significantly increased my pain for the next several hours.  A “field trip” down the stairs to entertain guests became possible by the second week or so, but the trip down and back would be my big effort for the day.

My more formal physical therapy began more than a month after my injury.  Why so long?  Well, the first two weeks I couldn’t really leave the house—I was in too much pain and became exhausted too easily.  (I’d lost about 30% of my blood during the operation and was only gradually recovering from severe anemia.)  After that, my leg was still in so much pain it seemed cruel to even move or touch it.  If legs could talk, it would have said, “Just leave me the hell alone!” 

I was also scared.  A friend had described a post-surgery machine that forced his leg to bend; not only was this excruciating, but he could hear scar tissue being torn up inside his leg.  Letting somebody inflict pain on my already hurting leg was a terrifying prospect.  (Pain is much easier to handle when you’re inflicting it on yourself; check out this post for more on that topic.)

By the time I made it to the PT center I could get around on crutches pretty well, but couldn’t bend my leg enough to sit in a chair.  (I’d worked hard to get my knee to bend at all.  I would sit at the edge of the bed, supporting the bad leg with the good, gradually lowering them until the pain became too great.)  My first therapist-prescribed exercise was perhaps the simplest of all of them, but also the worst.  I was to sit on the bed, legs stretched out straight in front of me, and flex my thigh muscles.  Both legs were atrophied from spending so much time in bed—I’d lost fifteen pounds after my accident—but at least my left leg could still flex and become taut.  The right leg wouldn’t do anything.  It was like a prosthesis or something.  The physical therapist swore she could see a little flicker in the muscle, but I couldn’t.  She might as well have been asking me to wiggle my ears.

Not until my wife took me to the pool did I convince myself I didn’t have major nerve damage sufficient to paralyze my leg.  In the pool, I could actually lift the leg.  This proved that the brain and the leg were still talking.  Before that, I really worried that they weren’t.


Is it possible to write about the tedium of PT without being tedious?  I’ll try.  More exercises were added to my regimen.  One was to massage what was left of my muscle, pushing it toward the kneecap from either side (above and below).  I was also instructed to sit in bed, loop the belt from bathrobe around my ankle, and use the belt to draw my foot toward me, so as to make my knee bend more.  This was impossible at first because I couldn’t even bend my leg enough to put my foot flat on the bed.  So I looped the belt under the knee and pulled up.  Excruciating.  I took to lying on my back in bed with my straight up, foot propped against the wall, to let gravity help pull the foot downward.  I’d bend the leg as much as I could, then hold this for thirty seconds.  Ten sets of this, twice a day, along with the other stuff.  Painful, demoralizing, and boring.

Normally I’d satisfy the boredom problem by listening to music.  But for the first month or so, I didn’t dare listen to the music I like, for fear of forming unpleasant associations.  (Think of the main character in Kubrick’s “A Clockwork Orange,” who is tortured while hearing Beethoven, and afterward can no longer hear Beethoven without freaking out.)  So instead I tried to listen to a Top 40 station.  This just added insult to injury—I could become sick of a song before I’d even finished hearing it for the first time.  So I tuned in to a classic rock station, only to discover that it played Steve Miller’s “The Joker” so regularly I seemed to hear it every time I did my exercises.  At first I was amused, what with “pompatus of love” and so forth.  But then it got really old.  I started to think maybe Steve Miller had died.  What else could explain all this airplay?  Eventually I got really sick of that song; I doubt I’ll ever find it tolerable again.

Life philosophy meets PT

I saw this caption on cute doggy calendar at physical therapy office:  “If you love life, it will love you back.” I see two problems with this little aphorism.  First, it’s demonstrably untrue.  After all, I was in the process of loving life when I suffered this crippling accident.  Second,  this notion is almost exactly backwards.  It’s easy to love life when it does seem to love you.  I’m more inspired by people who stubbornly love life even when it doesn’t.  I think often of something a close friend once said to me:  “I ought to be really depressed right now but I won’t take the bait.” 

What is the more stirring cinematic moment for you:  Leonardo DeCaprio’s character in “Titanic” standing at the prow of the ship yelling, “I’m the King of the World!” or the Black Knight in “Monty Python and the Holy Grail” who’s lost both arms and legs in a battle but yells at his departing opponent, “Come back here and take what’s coming to you!   I’ll bite your legs off!”?  To be plucky and sanguine when life seems hateful is far more inspirational to me than kidding myself that life is fair.

So it is with physical therapy.  In the absence of any sign that I’m getting anywhere, I have to hold out hope, and go through the motions as if I had some guarantee of success.  “Success,” of course, is a humble prospect here to begin with:  all it means is eventually—after what ... four  months, six months, a year?—getting back to the place I started, if I’m lucky.  (More immediate goals are even more humble:  only recently did I achieve the dream of being able to step into a pair of jeans normally, without holding on to something for balance.)

How do you manage to love life when you’re basically under house arrest and can’t do the things you normally enjoy?  Years ago, I made a list of the top 20 things I do for fun, so I dug up that list and discovered I can still do ten of those fun things.  Not so bad.  Plus, I’ve added to the list:  now, when I do my PT, I sometimes have one of my daughters read to me, or we do a Mad Lib.  (Here’s a highlight from today’s Mad Lib:  “So now you know how illegal politicians learned to murder like cats and dogs—from their ignorant pets!”)

The bike

Using my bike on the indoor trainer has been a useful form of physical therapy.  A little over a month after my surgery I was able to climb on my bike (using a shower stool) and put my feet on the pedals.  I couldn’t pedal a whole revolution, of course, as my knee wouldn’t bend enough.  But through much effort I could get incrementally closer.  At first I could only get the right crank to go from 3 o’clock to about 8 o’clock.  I’d back-pedal to about 3 and hold it for 30 seconds, rest, and then forward-pedal to about 8, hold it for 30 seconds, and repeat, for about 10 minutes total.  Each day I would try to get the pedal a little higher up.  It hurt like a mother but at least I was in familiar territory.

At the PT gym, I managed a full revolution one day.  This was on a stationary bike with the saddle jacked way up.  Encouraged, I raised my bike saddle at home, and within a day or two was getting so close to a whole revolution that one day I ordered my left (i.e, good) leg to turn all the way around, dragging the right leg through it.  Agony, but exhilaration.  The next day, I bit the bullet and turned ten whole revolutions in a row.  By the end I was in tears, whether from pain or relief I can’t say.  Once that feat was accomplished, the return to regular pedaling (and normal saddle height) was a matter of refinement.  The basic ability had returned.

Life philosophy meets PT – revisited

 “That which does not kill you will make you stronger.”  This bit of pop-philosophy, the darling of college freshmen, strikes me as completely false.  The more accurate statement, in my opinion, is “That which does not make you stronger will kill you.”  Think of all the ways people gradually kill themselves:  booze, cigarettes, overeating, sloth ... these activities don’t feel like they’ll kill you, while you’re doing them, but they gradually are.  They’re sure not making you stronger.

Of course, I’m being disingenuous here, and doing a disservice to Nietzsche.  His point is probably more along the lines that enduring suffering, and living through a painful ordeal, strengthens your character.  But I still take issue with this.  True, the willingness to suffer is a gateway to mental and emotional fortitude, but the suffering itself can be good or bad.  If, for example, you’re stupid about training or PT, and simply ignore all pain (whether it’s the kind that indicates intense effort or the kind that indicates you’re causing damage), you’ll end up hurting yourself—getting tendonitis or worse—and then you’re sidelined and most certainly not getting stronger, either physically or psychologically.
With physical therapy, a systematic approach—under the careful guidance of a physical therapist who knows what he or she is doing—is key to getting better.  Suffering alone will not heal you.  Often you must do what doesn’t come naturally, and retrain your body to behave itself.  Needless to say, doing what doesn’t come naturally can get you into so much trouble if you blindly flail away.  Structured, targeted suffering, of a more careful nature than the “that which does not kill you” variety, is needed.

(Re)learning to walk

Over the months my mobility has improved.  I’ve gone from the walker (depressing and geriatric) to crutches (less depressing, more suggestive of a sporty injury) to one crutch (Tiny Tim) to a cane (geriatric all over again).  Cane shopping was a drag.  I looked at the canes at Walgreens and was shocked at how ugly they were.  Most were fake wood and one was the color of streaky feces.  All of the canes were too short.  So I made the rounds of the cane shops:  Canes R Us, the World Cane Emporium, and that boutique-y place up in Kensington, Ye Olde Cane Shoppe. 

No, there aren’t really any cane shops, but my physical therapist referred me to a crazy medical supply place that looked like the home of a crazy hoarder.  Stacks of stuff from floor to ceiling, with narrow walkways carved out.  A salesman there, who looked and sounded like Philip Seymour Hoffman, advised another, “The long canes are in the back.  We hide them so the short people won’t buy them.”  I’d wanted an aluminum and foam rubber cane that looked like a loaner from a hospital, because a nice wooden cane would make my physical infirmity seem permanent.  But all they could offer was a wooden cane, cut to size.

The musculature in my leg got so fouled up by the surgery that my brain stem seems to have given up on the whole limb.  I guess this makes sense.  For most of human history we didn’t have the medical technology to fix a broken femur, so the brain developed tactics for getting by without a working leg.  I worked up a host of unconscious compensations. 

At first, I would practically lock my right knee when I walked, and swing the right leg around to the side, in an arc, instead of swinging it straight forward, because that way the knee wouldn’t have to bend to keep my toe from hitting the ground.  Moreover, my instinct was to put weight on the bad leg very tentatively and for as short a period of time as possible, so the left leg would shoot forward instead of my gait being balanced.  I would swing my right arm to help swing the leg forward, rather than using the leg’s muscles.  Watching myself in the mirror at the PT gym, I realized I walked like a drunken mummy zombie.

The absurd thing is, these habits have persisted after the leg developed much of the strength and flexibility needed for a normal gait.  My brain just doesn’t trust the leg.  So I’m in the peculiar position of overriding what comes naturally and applying conscious thought to walking.  Normally, thinking while walking makes you more, not less, awkward (try it!) but this is the best I can do for now.  There’s still a lot more strength-building and flexibility-gaining left to go.

A final note

My mom has praised me for my determination and doggedness in doing all my exercises.  She kind of has to praise me—it’s her job.  It’s what moms are for.  But in case she actually means it, and in case you yourself had thought anything of the kind, I assure you that anybody in this situation would be just as diligent.  When your body is broken, you want it back, and you’ll do anything to get there.  Training for sport is totally different:  you can always think of worse things than not being perfectly fit for your next big race or group ride.  But there’s not much worse, for a relatively young, fit person, than limping his way through the rest of his life.

dana albert blog


  1. Wow... I really hope I never have to go through that. I mean, I am not good at all at suffering on the bike. The pain of PT seems quite a bit worse because, as you say, there's no getting around it. Come out and ride with us again soon!

  2. I realize I didn't really describe my physical therapy regimen in this post. At home, I do a prescribed set of exercises twice a day. The set grows all the time, but right now consists of a combination of on-my-back exercises and standing exercises. On my back: 10 reps of a knee-bending exercises; 20 reps of thigh-flexing; 20 reps of hip-bending (pulling thigh toward chest); 20 reps of straight leg lifts; 6 reps of these horrible bridge things; and 40 reps of an exercise I cannot easily describe. Standing: 20 reps of straight out-to-side leg lifts, 20 reps of lifting the knee, and 20 reps of up-on-tiptoes-and-back-down. It's about an hour a day. I also do bike riding (indoor and, soon, outdoor). At the gym, I do a variety of weights and elastic-band tricks, plus whatever my physical therapist comes up with when I work with him.