Help! I've Dislocated My Kneecap... Now What?
I've been dislocating my kneecap my entire 30-something year old life. Not dislocating it in the sense that I'd have to go to the hospital each time it happened. It would pop out of place - to the outside of my leg - then it would pop back in.
And all my life I kept thinking that one day my kneecap was going to pop out and not pop back in. I actually fantasized about having a cast on my leg, having friends come over and make me dinner, being coddled over... you get the message.
However when it actually did happen, I couldn't have asked for a worst time.
I had just relocated to a foreign country. Actually it was me and my 4-year old daughter, which should give you some idea of why I say it happened during the worst possible time.
I'd just enrolled my daughter into summer camp. And I was basically settling into the city.
One afternoon as I was preparing to pick up my daughter from summer camp, I barely grazed my knee on the side of the bed. "Barely" was apparently just enough to knock my kneecap out of place.
I fell onto my knee, while the kneecap was still out of place. Then out of reflex, I grabbed the knee, and popped the kneecap back into place. Needless to say it was extremely painful.
I sat there for a good five minutes massaging my leg. It did hurt more than the usual popping out. But I really didn't have time to focus on it. I had to get my daughter.
I walked six blocks to the camp, picked her up, and walked back home. When I got back home I sat down. That's when I heard a strange cracking sound.
When I stood up, I could no longer put any pressure on the injured leg. I didn't realize it at the time, but that cracking sound was my kneecap popping back out of place.
Still not realizing that anything was seriously wrong (and not being in a tremendous amount of pain) I didn't go to the hospital until the following morning. All night I just wheeled myself around the house in my office chair. I actually thought it would get better after a good nights rest!
The Emergency Room - FINALLY!
When I arrived at the emergency room (after being carried downstairs by the elevator repairman) I was taken for x-rays. Naturally the x-rays revealed that I had a dislocated patella - also known as a dislocated kneecap, or a patellar subluxation.
Initially the doctor was going to put me to sleep to reduce the kneecap. "Reduction" is the medical term they use when they're going to reset your bones into the proper place.
However I got a gung-ho orthopedic surgeon who popped my kneecap back into place when I wasn't looking. OUCH! Actually it sounds worse than it felt - but it wasn't a massage at the spa either.
Next I was fitted for a full leg brace that would completely mobilize my leg. This brace spanned from the top quarter of my thigh, to my ankle. It was quite tight, almost to the point of being uncomfortable. But it was doctor's orders to be that way.
I was also given a pair of crutches, along with a quick lesson on how to use them. Then I was sent on my way.
Week 1 of Hobbling
It should be no surprise that your first week will probably be your most difficult week of them all. You're adjusting to life with a full leg brace. You're trying to maneuver with crutches. And if you're a mom, you're probably still trying to do the normal duties you performed before you hurt your leg.
During my first four days I was on a steady regimen of pain medication. I also took ibuprofen and used ice packs for 10 minutes at a time to assist with the swelling. I was also forced to keep my leg elevated with pillows most of the time.
When I was in the bed during the day, I took off the immobilizer (leg brace) while I elevated the leg. I would never attempt to walk without the brace because my knee still felt very wobbly at this stage. But I did feel comfortable enough to take it off while I was lying down.
When I was going to sleep at night, I did keep the leg brace on (while it was elevated by the pillows), as I was afraid that I would move the wrong way and possibly dislocate it again.
Because it was just me and my 4-year old daughter in the house, I initially didn't feel comfortable enough to get in the shower with the full leg brace. So for the first week I took sponge baths at the sink.
Speaking of bath time, it was also a challenge for me to bathe my daughter. With the full leg brace on, it was impossible for me to get her into the bathtub, bend over and wash her.
Even with a chair in the bathroom, there simply wasn't enough room for me to comfortably maneuver. That leg brace is as stiff as a board.
So what did I do? I bathed her in the kitchen sink! She's a petite thing, so I could do that.
This way I was able to stand up, I could easily reach her, and I didn't have to worry about her slipping in the tub. (You'll be surprised to know that even after my leg got better my daughter still preferred to bathe in the kitchen sink!)
What Else Made My Life Easier During That First Week?
- I utilized paper plates and disposable cups so I wouldn't have to wash a lot of dishes.
- I purchased juice boxes for both me and my daughter. Always thinking of easy clean up.
- I kept the plates and silverware in the refrigerator so that my daughter could easily reach them.
- I kept a roll of paper towels in every room.
- If I were at home by myself, I'd pack my food into a plastic container, put it in a lunchbox and carry the entire meal into the room at once.
- When my daughter was at home I'd put our meals on two different trays (that I'd previously purchased from the $1 store). This allowed her to easily carry the trays into the room.
- I found a grocery store and a pharmacy that delivered. This may not be much of a deal if you've got friends and family easily within reach. But since I was in a new city, it was truly a blessing for me to have such services at my disposal.
- And of course, it was also quite helpful to have access to restaurants that delivered. Even if you don't have the actual paper menus on hand, you'll probably be surprised to see how many menus you can find online. I was fortunate enough to find a Takeout Taxi that delivered from some 20+ different restaurants.
Week 2 of Draining and Paining
Exactly one week after my injury I went to see an orthopedic surgeon.
During the appointment he asked that I remove my leg brace, then he helped me onto the table. I realized at this time that I could not completely straighten my leg out.
Apparently even with the full leg brace on, my leg still wasn't completely straightened out. And when I elevated my leg at home, it was always bent across the pillows. Naturally it was quite painful to try to straighten it out now.
The doctor felt my knee and wiggled it a bit. Uuugh... I didn't like that at all! It really felt like he was going to pop it back out of the socket again.
He told me that it felt jiggly because I still had some fluid on the knee. He told me that he would have to drain some of the excess fluid, and that would alleviate the unstable feeling I was having. And that's exactly what he did.
He inserted a rather longish needle into my swollen knee area, and drained much of the fluid. As he was draining it, he massaged the knee somewhat gently.
I won't lie... It was a painful experience. On a scale of 1-10, it was around a 7. But I imagine 2 of those points came from the fact that I was still extremely nervous he was going to pop the kneecap back out with his massaging.
When it was over, it was like a 10-pound weight had been lifted off my knee. Not only did my leg feel lighter, I was now able to bend it almost straight. He told me that I'd probably be able to put more pressure on the leg now.
That afternoon I went to the park. While I was there I realized that I was able to put some pressure onto the injured leg.
Don't get me wrong, I was still walking with the crutches. But instead of holding my leg straight out, I put it down in the standing position. As I walked with the crutches, I also walked with my leg instead of just carrying the leg.
So my orthopedic surgeon was right. Even though I'd been icing the knee on a consistent basis, elevating it and taking ibuprofen for the swelling, my progress was basically halted because I had all that fluid around the knee. The only way to move forward was to have it drained.
My First Appointment with the Physical Therapist
During my appointment with the orthopedic surgeon I was also given a prescription for physical therapy. (Much to my surprise you need a prescription to get physical therapy for the type of injury I had.) I began therapy two days after my visit to the orthopedic surgeon.
During my first appointment I was evaluated by the therapist. She asked some typical questions... how did the injury occur, what medications was I taking, what was my level of pain at this point, etc.
Then she had me take off the leg brace, and she assessed how well I was able to lift my injured leg, bend it, and stand without it (without the leg brace).
Without the brace I couldn't stand on it at all. It felt like I was trying to stand on a wet noodle. Nor could I lift it - or bend it for that matter.
She explained that I had muscular atrophy. That's when you have a loss of muscular strength after a period of not utilizing the limb.
In addition to not being able to lift, bend or stand on the leg, I could physically see that my left leg was significantly smaller than my right. In just a week and a couple of days, my injured leg looked to be almost half the size of my working leg!
The cure for atrophy, she explained, was to rebuild the strength level for the injured leg. That would require increasing degrees of strength training, along with some other things.
To get the ball rolling, she hooked me up to a muscle stimulator. A muscle stimulator sends electrical pulses to a specific muscle or a group of muscles. These pulses contract and relax the muscles. In my situation the muscle stimulator was used to help re-educate my muscles that had gone into atrophy.
I HATED the muscle stimulator upon first using it. It genuinely hurt. It felt like someone was manually pulling my muscles - from the inside of my leg.
Plus, as the stimulator contracted my muscles, she told me to manually contract my muscles at the same time. It just didn't feel pleasant at all.
Fortunately you can adjust the intensity of the pulse. And even though my therapist kept trying to push it higher, I demanded that she turn it lower - which she did.
At the end of the appointment, she wrapped my knee area with a stretchy Ace bandage. She explained that the tightness of the bandage would help keep the swelling under control, and that it would make my knee feel more secure.
She initially suggested that I come in once a week for therapy. But I was in a rush to get better. So I asked if twice a week would be okay, to which she agreed. Each appointment was to last an hour.
The Shower Re-Visited
Once I had the Ace bandage on my knee, I thought I'd feel more stable about getting into the shower. I tried to get in with just the bandage on, and stand on one leg, but that sounded a lot easier than it really was.
The only thing I could do was put the brace back on, stick my injured leg out on to the side of the tub, and wash quickly.
My goodness, the hot water felt sooooo good!
Unfortunately the water ran down through my brace and wet the entire bathroom floor. Not to mention that my brace and the bandages were now cold and soaking wet.
At this point you're probably wondering why I didn't just put the entire leg - brace and all - into the shower, since everything was getting wet anyway.
That might've worked if I had someone to lift me in and out of the bathtub. But because I was unassisted, I didn't want to take the chance of trying to climb into the tub with that stiff brace on. This brace is so stiff you literally can't bend your leg when it's on.
Also, it was mainly the back of the brace that got all wet. The front wasn't as wet. So if I would've put my whole leg in, the brace would have taken even longer to dry.
Physical Therapy the Second Time Around
The physical therapy appointment was far more tolerable the second time around. Mainly because I knew what to expect, and I was able to mentally toughen up for the experience.
First she elevated my leg and massaged it for 10 minutes or so. How good that felt!
Then she applied the muscle stimulator around my knee muscles. But this time she put a rolled towel under the back of my knee, so that my leg was slightly bent. I was told to try to lift the leg with each contraction delivered from the muscle stimulator. This would help to strengthen my quadriceps (thigh muscles).
It was still relatively painful. But as the saying goes, "No pain, no gain." This time I just gripped the side of the table, went through the pain, and did my best to lift the leg.
I really wasn't able to lift it much - which both amazed and saddened me.
What Else Made My Life Easier During That Second Week?
- I ended up purchasing two more sets of Ace bandages. This way when I got out of the shower I could re-wrap my knee with a dry set. Ideally I should have bought another leg brace just for the shower. But as I explained, I didn't think it was safe for me to try to climb into the shower by myself.
- I initially began walking around the house without my crutches a day after I went to physical therapy, because she told me I needed to start strengthening that leg.
However be forewarned, walking around the house isn't the same as walking on the street.
First and foremost, the streets have cracks and hills and rocks and other features that you don't notice when both legs are working. Those features seem like they're magnified 1,000 times when you're hobbling. I almost fell twice on my first day out, and I was quite shaken.
So you have to be very aware of your surroundings. And most important, cross the street only when the light just turns green to give yourself enough time to make it.
It's amazing how many people will disregard the fact that your disabled, and make dangerous moves around you.
The 3rd, 4th and 5th Weeks
I'm going to lump the next three weeks together because the physical therapy appointments were basically all the same. She'd massage the knee for 10 minutes. I'd get the muscle stimulator for 20+ minutes. And we'd do a few other strength/mobility building exercises.
One thing I learned was how to walk down the stairs without pain. Instead of bending my knee as I went down to the next step, I kept the injured leg extended and allowed myself to drop onto the step.
This - of course - was done without the brace. And it actually worked. In fact, I still use this technique today.
My therapist also told me to start using my crutches again while I was walking. Why? Because I was teaching myself how to walk with a limp.
Walking with the crutches enabled me to maintain a more steady gait. The crutches were such a hassle to carry around, but I did it.
During this time frame I also went back to the orthopedic surgeon for a follow-up examination.
My physical therapist had written a progress report for him, suggesting that maybe I needed some more fluid drained from the knee. The orthopedic surgeon said it wasn't necessary.
Instead he gave me a prescription for another leg brace - a shorter, much more comfortable leg brace - the M-Brace 40-41 Patella Stabilizer. I put my crutches to the side and began wearing the new brace immediately.
My regular walking self was back again! What a relief.
During my last few therapy appointments I still used the muscle stimulator. But this time I did it while standing on the leg and bending it. I also did exercises on the exercise ball.
For example, I put the ball behind my back and leaned against the wall. Then I went down into a squatting position, and came back up.
Week 6 and Beyond
It took another two weeks before I felt comfortable enough to go outside without any leg braces on.
By that time my leg had definitely regained a lot of the strength I lost during atrophy. But even today - 2 years later - if I stand on my left leg and bend it, it's not as strong as my right leg.
That's totally my fault. I never did regain a steady weightlifting routine, though I do walk a lot. My therapist told me that walking is good, but strength training the legs is better.
Fortunately I haven't had any more dislocations since then. And for the most part I'm virtually pain free.
Once every blue moon my knee will swell for no apparent reason. But I'm not in any sort of distress - even when it rains outside.
So that's my story.
If you're currently trying to manage life with a dislocated kneecap, please know that it does get better. Just continue doing your exercises, visualize a healthy leg, and be strong.