Physical therapists from all over the U.S. come away from the annual APTA Combined Sections Meeting (CSM) with many things -- innovative therapeutic techniques and clinical practice ideas, free goniometers, receipts from dinners with former co-workers, etc.
I, however, came away with my first big break -- literally -- a patellar fracture and my first broken bone after slipping on the "safety bumps" in the walkway outside my hotel entrance. One minute I'm leaving the acute care lecture on technology and the next I'm at an emergency room in San Diego getting an immobilizer and crutches. Oh the absurdity -- a physical therapy supervisor getting injured by tripping on safety bumps at a physical therapy conference.
After an open reduction, internal fixation (ORIF) and retinacular repair six days later (a big thanks to Dr. Carlos Prietto, president of Hoag Orthopedic Institute and surgeon extraordinaire), I spent a week in a cast before receiving my hinged knee brace. However, the hinge was really just for decoration (literally, it was decorated with stickers by my 5-year-old son) since I was locked in extension.
At my three week post-op visit, I was picturing the freedom I was about to be granted -- returning to work, unlocking the brace, driving! -- when my hopes were dashed. Due to essentially non-existent quad strength and the need for further bone healing, the cursed brace was staying locked and I was not allowed to work for 5-6 more weeks, and I had to start outpatient PT!
I might have almost 20 years of experience, but it's all in acute care, not outpatient, orthopedic PT. But, if I wasn't going back to work, at least I had two seasons of Homeland and Game of Thrones to catch up on!
FACEBOOK post 2/25/13: "Starting physical therapy today as a patient not a therapist. hope I end up on karma's good side."
Let's Get Started
The goal was to get to 40 degrees of knee flexion in 4-6 weeks, which sounds so simple, but I was expecting physical torture .
Luckily, the people at Specialized Physical Therapy in Tustin, Calif., and my therapist Steve Ferdig, were fantastic -- not only from a therapy perspective, but from a social one as well.
Patellar fractures are quite rare (less than 1% of all fractures), and the course of recovery is a bit of an unknown and therefore varied. Between us, Steve and I had treated less than 10 patellar fracture patients in a combined 40 years of practice.
All I knew was that it was going to be slow and painful. But I was diligent -- I did my quad sets, assisted short arc quads, and I tolerated passive ROM by my husband and my 11-year-old daughter (who both looked nauseous when trying to help.)
FACEBOOK post 3/21/13: "Ultimate Silver Lining -- home for the Tournament, let the Madness begin."
Most therapists by nature are social people, and good at small talk, but it is different on the other side of the plinth. Therapy for me wasn't just physical -- it was really my only social outlet, and the only thing that kept me sane and gave a semblance of normalcy in this sideways universe, in which I now existed as a patient.
So, in a nutshell, the knee brace was unlocked after 9 weeks in extension, and 2 weeks later I returned to work on a part-time basis (no direct patient care). I became theoretically "functional" at 12 weeks post injury when I (really Steve) managed to hit 90 degrees flexion just in time for my birthday. I continued with therapy 2-3 times per week until mid-July when I graduated after 5 months with 142 degrees of active assisted flexion. Quad strength continues to be an issue, but I can finally do a deep squat and stairs without a railing, sometimes.
Hopefully, patient care is in my near future. By the way, scar tissue "popping" can literally feel like popcorn popping inside your joint although the pain varied. It's a bizarre feeling.
Sympathy for Patients
This isn't really about the amazing job I did as a patient. Yes, I teach people how to use crutches and how to get into a car after a joint replacement; and this knowledge was definitely very helpful to me. I even confirmed that a lot of advice I've been giving for years based on theory is actually true.
But I now have a much greater understanding and empathy for what my patients go through. Life after surgery and the recovery process was truly exhausting. Therapy was exhausting, life was exhausting. I often came home and slept for a couple hours after a therapy session.
I've given the same spiel for years about impact of anesthesia on endurance, energy conservation, etc., yet I thought I could go back to work administratively two weeks after my injury and surgery. Talk about unrealistic expectations. Luckily, my surgeon is a lot smarter than me.
In the beginning, everyone commented on how painful my fall and fracture must have been; and I always responded that it really wasn't. It didn't hurt, I didn't cry. Initially, I thought I had dislocated my patella. My remark was, "I couldn't have fractured it, it doesn't hurt." Of course, once EMS arrived, I got IV pain meds; and IV pain meds really work if you are not a chronic pain patient.
The only time I cried was the first time I tried to take a shower. My husband had gotten everything I asked for -- hand-held shower nozzle, shower bench, long handled sponge -- I was totally set up. But the effort required getting my leg over a 3" lip into the shower, then sitting down, was demoralizing, painful and draining -- I was done before I started. And I was prepared. I imagine it must be complete blindside for many of our patients.
Life is a journey, and my orthopedic one continues, and likely will for a while. I appreciate little things that I didn't before, like the ability to get in and out of the car easily or simply standing to shower. The kindness of others was invaluable -- whether rides to school for my kids, meals for the family, or a phone call/ Facebook message to check in. I was able to spend more time with my children, although I really couldn't do anything fun. I did volunteer at track practice, but crutches/ braces and 5 to 10-year-old kids is not always the safest combination.
I want to thank a few people who were with me at the beginning of the journey but can never be properly thanked: my grad school roommate Holly who came with me to the ER; my other roommate Kendra, who was stuck in the hotel with me that night; the Wisconsin PT students who stopped and stayed to help; and my former colleagues from Mass General, Andrea and Sue, who missed part of their social obligation to get me into the ambulance
I know that I'll be even more empathetic to my patients, because now I understand their journey a bit better.
Jen Brandon is a rehabilitation supervisor at Hoag Orthopedic Institute in Irvine, Calif.