Doctor Becomes Patient: Part Three

After a severe combined right ACL and MCL injury during pick-up basketball, I elected to treat my MCL non-surgcially with prolotherapy injections and to have the ACL treated surgically. 

When I woke up from the surgery, it felt as though time had not even passed.  I looked down and saw that my right leg was wrapped with an ace wrap from my ankle up to the thigh.  There was a large brace with stabilizing hinges already fitted on my leg.  I also had a special femoral nerve catheter in place to provide continuous local anesthesia to the knee and was instructed to leave this in place for three days. 

Carefully, with crutches I maneuvered to the car and went home.  Within an hour of returning home the pain in the right leg began increasing, and I noticed that the inner thigh area was numb, and yet the front of the thigh and knee was not.  I surmised the reason was that the femoral nerve catheter was placed in a slightly different location and therefore was providing anesthesia to an area supplied by another nerve.  After waiting another day and discussing the issue with the anesthesiologist who placed the catheter, we agreed I should just pull it out since it wasn’t really working on its intended purpose. 

The first day post-op was the most difficult in terms of knee pain.  The knee was swollen, discolored (as happens from a bruise and is typical post-surgery), but there was no redness or any sign of infection. I was able to bend it about 40 degrees but was unable to fully extend the knee.   

On day two, I developed a sciatic pain down the right buttock and the back of the thigh and knee, which steadily progressed to the point where it was severe enough to mask the knee pain entirely. 

This turned out to be the worst case of “sciatica” that I had ever experienced in my life.  The pain prevented sleep, it prevented even normal conversation.  The pain medication which helped the knee pain did not provide any relief whatsoever for the new pain. I knew it would be unlikely that my orthopedic surgeon could help me, since my back pain was not directly caused by my knee.  However, my theory was that walking around the house with a heavy brace and stiff knee caused either my sacroiliac joint to become irritated or exacerbated a pinched nerve in the back. 

People who have experienced sciatica will understand what I am saying. When they lift up their leg, there is a lightning bolt of pain that shoots down the leg which takes the breath away.  Those who know will also admit that there is little sense in taking opioids for sciatic pain since it really does not work for this type of nerve pain.  As a specialist in interventional spine and rehabilitation, I was astonished at how quickly this ‘sciatica’ came on and humbled by how little I could cure it on my own.  I tried positioning my leg in different positions, changing my seatback, taking anti-inflammatories, vitamins, supplements, and anything else I could think of. 

Finally, I called our chiropractor and was seen for an adjustment as well as traction on a special machine that gently pulls the lower spine apart.  For several days I continued this program and gradually over the course of 20 days, the right sided sciatic pain resolved!   From a medical doctor’s standpoint, I know there are many in my specialty that might be skeptical of chiropractic treatments, however from personal experience, I can say that my pain was certainly improved because of a chiropractor.  Accordingly, in our practice, we deliver coordinated care with athletic trainers, chiropractors, medical doctors, and physical therapists all under one roof. 

By post op day 21, I wrote this in my journal: “ Swelling is about same as last week, perhaps more pronounced when I looked at it today at 4 p.m., towards end of the work day, on my feet all day.  And hot, humid weather.  Straight leg raise for quad strengthening hurts back /buttock only a little now, not shooting down leg as much, and now able to prevent knee from lagging although quite weak.  I wish I remembered what I felt like at this time post initial injury, b/c feeling frustrated that i'm not better than I am.  Also of concern is the lack of mobility of skin tissue overlying the hamstring incision located at per anserine insertion.  Seems to be fixed to underlying tibia.  Flexion of knee is passively to 100 degrees, actively 60 degrees. “

Up to this point, I had not started formal physical therapy.  Please join me in my next post, as I discuss my experience as a physical therapy patient.