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Learning to run (again)

July 2, 2019

Very weird to say, but my recovery started 18 months before my stroke. Sadly, at 32 years old, I stopped playing cricket and running because my knees were frustratingly sore.

 

 

I had a knee arthroscopy [minor keyhole surgery] - but the doctor found out I had early-stage osteo-arthritis my both knees, but the left knee was worse. This degenerative condition is a wear-and-tear type of arthritis that occurs most often in people 50 years of age or older. In my case, I am bow-legged and my knees were not aligned, so my knees were abnormally forcing across my knee, hence the cause of my arthritis.

 

I felt miserable with the diagnosis and very sorry for myself. It was almost a ‘dagger to my heart’ because running was far and away the favourite thing in my life, and also I was still enjoying playing cricket and I was nowhere near to retire. I am uncertain if my marathon running exacerbated my arthritis or not, but I was feeling brokenhearted.

 

The doctors told me that I will need a knee-replacement eventually, but my circumstances - eg I was relatively young - the recommendation was different operation called ‘high tibial osteotomy’. In a knee osteotomy, the tibia (shinbone) is cut and then reshaped (with screws, pins and plates) to relieve pressure on the knee joint. In layman's terms... broken leg - but on purpose. 

 

 

It is a big operation and the theory was that conserving my knee and not required to knee replacement surgery yet. It is a good chance I need a knee replacement in the future - but this surgery is people normally over 60 years old, not 40 (I am 39 now) - hence surgeon opted for the osteotomy instead because we were conscious of new medical breakthroughs (with knee arthritis) in the future.

 

I decided to proceed with the osteotomy operation because the long-term goal was no pain in my knee and resuming my active life - includes my starting a family. My son, Oscar, was born in June 2013 - six months after the operation - hence it was better to operate before he came out.

 

The operation was late December 2012 (Christmas time) so I used my work annual leave for the operation and I was off work for three weeks. During this time, I watched lots of cricket on the couch - I missed Boxing Day - and I was very swollen and sore. I used crutches for seven weeks however I was improving a lot, I was diligent with my rehab and my motivation was high. In fact, I bought a second-hand stationary bike at home for my knee recovery. Ironically, I use this exercise bike now still for my stroke recovery.. 

 

 

Fortunately, the operation was a success - in fact - my knee surgeon (Julian Feller) said my [knee] alignment was perfect after the surgery. I was very excited for my new chapter - fatherhood with better mobility and zero (or less) pain.

 

Fast forward one year (after the osteotomy), my pins, screws and plates was removed in January 2014. This was a minor operation (and a little bit of rehab), however I missed my follow-up surgeon appointment because my stroke happened - 10 days after the operation (31 January 2014). 

I am not sure if I have subscribed to the concept of fate, but I had few lucky coincidences in my stroke recovery. My stroke happened after my minor surgery - not the major osteotomy surgery 13 months before - because if so I am unsure possibly never to walk ever again.

 

After the stroke, I was left with a right-sided disability (hemiplegia), therefore my [unaffected] left knee was (and is) so important for my recovery, because my right knee and my movement was impacted severely by my stroke. Basically the right leg is very weak, I can’t control my ankle yet and I am always favour this knee now. I am so grateful to Julian Feller because he fixed the alignment (with the osteotomy) and I am rarely in pain now - little bit sore sometimes but not arthritis pain. My quality of life currently is so much better because Julian’s interventions. He is a life-saver... figuratively speaking.

 

And for my right knee? I still have arthritis, obviously, but fortuitously - I can’t feel the pain because I have much less sensation in the right knee after the stroke - very common with stroke survivors - and I am very comfortable not using sensory re-education for my right leg anyway!!

 

It is fate? Unsure. The negative was that I had a stroke at a very young age, but the positive I was very lucky to survive this trauma and I am still improving mostly due to my age… I mainly tend to favour the positivity attitude angle. Anyway my wife always reminds me about how must be a reason for me to be still alive. 

 

 

I will not be rehashing the ‘My journey from wheelchair to walking’ blog post, but one long-term goal for my recovery was to run again. Roughly two or three years ago, I was still improving and walking a lot and, at the same time, I bumped into a mutual friend - Michelle Kahn. She is a neuro physio working at Epworth Hospital and she recommended a physio program (high-intensity running group). She said her boss - Gavin Williams - 'is a guru and has taught me everything I know!'. I will not boring the detail, but basically, she organised a referral to Gavin and this decision was possibly the best choice ever.

 

Gavin is a neurological physiotherapist at Epworth and a University of Melbourne researcher, and he targets power training following traumatic brain injury - just like me. “Instead of making someone simply stronger we’re trying to make them more powerful. The difference between strength and power is the speed at which you move,” Gavin says.

 

At Caulfield Hospital, I was an inpatient over 4 years ago, I volunteered to participate in an intensive physio six-weeks trial (Ballistic Strength Training in Stroke) and I got a big boost of this therapy - and coincidentally one of the principal investigators for trial was Gavin. Small world!! The trial is completed now and recently I heard the feedback was very good for successful for ‘improving mobility compared with usual care exercises to improve mobility and leg strength in stroke patients.’ So I am very grateful for seeing Michelle, by chance, and eventually to refer to Gavin. 

 

This video was taken at Caulfield Hospital in 2014.

 

I am very lucky that my Rehabilitation Physician - Dr Mithu Palit - works at Caulfield hospital and Epworth Hospital. I regularly attend Caulfield spasticity clinic with Dr Palit for checking my improvements in my hand and leg functions. Mithu knows Gavin, and Mithu knows my [long] history of my stroke. Anyway, I told him I am keen to start the running group. He was very supportive in this idea, in fact, supporting with Gavin, he gave Botulinum toxin (Botox) injections with my right calf muscles. The Botox definitely helped my acceleration of leg therapy.

 

 

I commenced my running group sessions at roughly two years ago with Gavin - and various other physios - I am still continuing now, however at this time I was not running - only walking so the title (running group) was a bit misleading… basically I was learning to run again. 

 

It is an amazing program - guided professional neuro physios - and in the beginning, I was exposed to lots of and repetitious exercises and I was pumping my legs with exercise - included stretching, squats, hip flexor machine, leg press, total gym machine, cross-trainer, mini tramp, weights, ‘the claw’ exercise, stairs and lots of more. 

 

This video was taken at Epworth Hospital in 2017

 

 

The running group helped me with my fitness, strength, stamina also my fatigue and roughly nine months later - I technically ran for the first time (post-stroke). I was wearing an AFO, soft ankle brace and a belt because I needed assistance (eg. a Physio) to run safely. It was a very surreal and amazing feeling to see the tangible progress for my recovery and it was a huge milestone, however ‘learning to run’ and ‘running’ is very different things. 

 

While I love exercise and going to Epworth is never a chore - in fact I love going there and I am definitely improving - but I am still waiting for the magical feeling to run freely. I am still using my soft ankle brace when I am at running group however I am running without help and I am very confident I’ll be reaching this feeling some stage in the future. 

 

Paul

Also I need to thank everybody for the supporting in my running goal - and a big thanks for Professor Julian Feller (my pre-stroke knee surgeon), Dr Mithu Palit, Gavin Williams, Lauren Fink, Michelle Kahn, Lauren Chapman and all the other Epworth physios: Chris Byrne, Edwina Sutherland, Sara Aldous, Judy Ngo, Shannen Bertram, Hannah Ryan, Sarah Mackay, Amy Leong, Mijke de Bruijne, Steph Bruce, Rebecca Davey, Meg Walker, Elizabeth Moore, Katrina Meharry, Megan Banky and Sergio Quach

 

 

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