Scar Tissue

Or, Keep Moving

A Continuous Passive Movement (CPM) machine is what the doctors called it, but I knew it mostly as a sound, not a name. I was so familiar with the soft hum of the equipment that held my left knee in place as it slowly, slowly, slowly moved my leg from straight to ever so slightly bent, I could almost drift off to sleep in the middle of a session, as if I was listening to the ocean. The eight-inch incision drawn from my quad to my shin was still fresh and painful, and so was the movement of my knee. But every physical therapist and doctor I had ever worked with—through eight knee surgeries, and, by this point, years’ worth of physical therapy— had told me the same thing: you can’t let the scar tissue win. 

When the body has an injury that requires surgery, it often feels worse before it gets better. Opening the skin, drilling into the bone, putting what’s broken back together in intricate ways is traumatic. But because our bodies are smart, they respond to trauma. And with each knee surgery, my body sent out an SOS to legions of healing cells, calling them like first responders to the injury, flooding the area with blood and heat and throbbing, telling them to get to work. My job was to respond with them.

After a significant orthopedic surgery,

range of motion was vital to everything I needed to be strong for the future. Learning to walk again, regaining strength in the leg muscles, managing the balance in my hips in order to protect not just my knee, but eventually my back and pelvis and entire lower body from future chronic pain—all of that starts with movement. My body was working so hard to heal, sending all the protection it could find to that injury. But it would quite literally put a hard shell—scar tissue—around that area and keep it safe forever if it could. 

I needed to heal, but I couldn’t heal with a knee locked in place. I had to move. And I had to move before I felt ready.

So there I lay, on my couch, my back propped up by pillows, not 24 hours removed from a six-hour surgery and a two-night hospital stay to fix a badly damaged knee, with my leg strapped in the CPM machine. It started with a setting of something like 20 degrees, not more than a slight bend in the knee. Back and forth, back and forth, that gentle hum my nearest companion for a minimum of four to six hours a day.

I retold myself the doctor’s refrain again and again, you must stay ahead of the scar tissue. My body had been through so much, and it was screaming to just be still and left alone. But feelings are indicators, not dictators. I had to tell my mind what to think and do; not the other way around. In this case, discomfort wasn’t the enemy; not moving was. The goal would be to increase flexion by five to ten degrees every day, until the incision healed more. 

Getting through those first few days was tough, but in retrospect, that’s when the hard work was just beginning. 

I choose the same spot on the wall in front of me to focus on every time I’m lying on my stomach on this therapy table: an anatomy poster with labeled muscles and tendons all over the body. I’ve nearly memorized it by now. My crutches are leaned up against the wall next to the poster, and the long incision down my left leg has healed pretty well up to this point. My physical therapist, Luis, is on my left with one hand on the back of my knee and another on my bare foot. I put the small white towel in my mouth to bite down on, because Luis told me weeks ago it would give me somewhere else to channel the pain. 

“You ready, Katie? Deep breath in, and, go…”

With the force of his body weight, Luis takes my left knee from straight to bent: 0 degrees to the ultimate goal of 135 degrees, full flexion—the most important marker I’m chasing to get better. I can always make it to 90 degrees easily, but once the knee joint gets there, it stops, and it is pain pain pain pain pain—the sharpest pain—for the next 15 seconds, as Luis forces my knee to bend even a few more degrees. That’s when I bite down on the towel and try to breathe, but it comes out more like a squeal. 

“5, 4, 3, 2, 1. Relax,” Luis says.

I exhale audibly, somewhere between not crying and crying. I followed post-surgical protocol down to the last detail, with continuous passive movement above and beyond the suggested daily hours and still, the surgery was intense, the incision is large, and my body did what the body—miraculously, really—does: it tries to heal, and sends protection to what’s hurt. Breaking up scar tissue is simply part of the rehab process, and Luis assures me that given the scope of the repair, I’m doing really well. 

“We got to 110 degrees that time, Katie. Really good. Let’s do a few more.”

We repeat the process over and over. Luis’ slow count down, my forceful bite down on the towel, the goniometer measurement—another name I have memorized, along with muscle anatomy, that tells me the angle my knee can bend. Pain, but also progress.  

Does one ever come without the other?

//

I never set out to be a bike rider. In fact I always thought the shoes looked really funny and helmets do nothing for one’s hair but alas, here I am. What started in my basement with the bike I purchased to work off some postpartum weight became the practice that helped me, sustained me in many ways, through a different kind of pain management.

It’s been a year and half of tough, very tough, work in our family, and in my marriage. And while I’ve come to think of healing and recovery as more like the stock market than a pediatrician’s growth chart, I’ve also learned that almost everything the doctors and therapists told me about my knee has also been true for my heart. 

Keep going. Don’t let it heal frozen in place. Feelings are indicators but they aren’t dictators. Discomfort isn’t the enemy; not moving is. Pain before progress. And maybe—for me, certainly—the most important one: you need full range of motion again if you're going to be able to do everything you could do before the injury.

And that part is rip apart the scar tissue hard. 

Because sometimes your feelings want to stop halfway there, locked in place, both because it hurts to keep going and because it is protecting you from hurting more. Or being hurt again. Pain and discomfort, fear and triggers, none of them are without a purpose, and there is no roadmap or formula anyone can give to show me how to navigate my way perfectly. But almost all of my decisions have felt a bit like moving before I felt ready, working not against, but within my discomfort.

Today, I’m halfway up the steepest hill I’ve attempted on my bike training. Alex and I are just a few days from our first triathlon together—he swims, I bike, he runs—and each rotation of the wheel is slow and heavy and burns. But I cannot help but think, marvel really, look at what you are doing, Katie! This moment is a miracle. 

What Alex and I are working toward is a miracle. 

He is, quite literally, working in his strengths and doing his own hard work, his own training. And I’m doing mine. My knee—ten surgeries, six screws, three cadaver tendons and one cadaver bone, countless hours in a CPM machine, and so many physical therapists excruciatingly pushing their weight against the joint of my knee—moves today with full range of motion, with strong, round pedal strokes up this hill. 

He’s swimming and running. I’m climbing. Together, we keep moving. 

When the gravity of my knee injuries first became clear to my surgeons, the discussion went from “How can we make her a high-level athlete again?” to “How can we allow her to walk again?” 

I’m no longer a high-level athlete, but I kinda feel like one. Because this is the hardest climb of my life and regardless of how slow I’m really going and how much better other people will do it or how uncoordinated it might look to those watching, I’m on this hill, and I keep moving. 

I have a five inch scar on my femur. One that is eight inches over my kneecap. Three half-inch horizontal ones around my patella, each of them cut into four times. It’s not the same knee it was before, and I am limited in so many physical areas where I once thrived. But this rebuilt knee is good, and strong.  

The scars on the outside are remnants, but the scar tissue that threatens to call all the shots forever—we beat it. This knee, it’s such a hard worker, and it has overcome the odds in every way. Nothing about it is perfect. There are lots of new boundaries, and it needs ice all the time. 

But I mean, look what this knee, this heart, is doing. 

The girl on the table at physical therapy could hardly imagine who she would be outside of the pain of that moment. But by God’s grace–and I mean that, by God’s grace alone–she kept moving. Today, she’s climbing. And not just on the bike.