Tales from the rehab room Recovery: Patients in physical therapy for knee problems warn President Clinton to brace for pain while he works to repair damage he incurred in a stumble last week.

March 16, 1997|By Scott Wilson | Scott Wilson,SUN STAFF

Eula Hammond, pant leg raised to reveal a 5-inch, blade-straight slash down her right knee, has something she'd like to make clear to the hobbled leader of the free world:

Prepare for pain.

"I saw a picture of Bill Clinton with his thumb up," said Hammond, a 57-year-old Pikesville resident who makes circuit boards. She flexes her new titanium knee. "When he starts this therapy, that thumb is going down."

Hammond was exercising yesterday morning in Woodlawn at Kernan Physical Therapy, a nondescript place except for the framed Baltimore Colts jerseys in the reception area -- Johnny Unitas' 19, Lenny Moore's 24. Both men are clients.

The main rehabilitation area is a low-ceilinged room filled with machines like those in any health club. Except people here limp, gasp and groan, including Hammond, who is strapped into a straight-backed seat used for leg curls that she calls the "electric chair because it's going to kill me."

Clinton joined the more than 1 million Americans who have knee surgery each year after he stumbled on steps in Florida Friday. His ruptured quadriceps tendon, a relative rarity in the world of knee injury, has been surgically reattached to his femur, or thigh bone. And it will take months of hard, painful work to repair, in a place like Kernan, on machines like the "electric chair."

Patients, knee surgeons and physical therapists say the president's recovery from knee surgery, the most common orthopedic surgery, amounts to a character issue.

The massage treatments aren't too hard to take, but experts on the body's biggest joint say Clinton will have his work cut out for him once the bending, flexing and twisting begins two hours a day, three days a week. The president is expected to leave the National Naval Medical Center in Bethesda, where he had the surgery, today.

Bearing up

"If this guy bears up and does what he has to do, he is not the coward that a lot of people say he is," said William Neill, medical director of physical therapy at Kernan, part of the University of Maryland Medical System. Clinton's rehab regimen is expected to take six months.

Neill, who helped Unitas recover from two knee replacements and treated former President Carter for a torn thigh tendon, describes himself as a "rock-ribbed Republican, a Rush Limbaugh kind of guy." But, he said of Clinton, "If he makes it, I'll change my tune about the guy."

To Dr. Andrew M. Tucker, a Ravens football team doctor and director of primary care sports medicine at the UM medical system's Kernan Hospital, Clinton will have to be careful not to "take things too fast, to do too much too soon." The result could be the equivalent of knocking the scab off a healing wound.

"I would imagine he's a headstrong individual like a lot of the athletes we treat," said Tucker, who has also treated ballet dancers and Olympic-caliber ice skaters. "I don't think you are going to have to tell the president to push himself. He's probably going to test the patience of his therapist."

The knee is universally described as a complex joint that is easily injured. Most young people harm their knees playing sports.

The elderly can do serious damage to the joint when it is brittle with age, simply by squatting and twisting.

Pat Lydick hurt her knee while visiting a company for a job interview. Two workers returning late from lunch to the Property Owners Exchange in Catonsville knocked her over, leaving her knee full of cartilage fragments.

She had arthroscopic surgery late last month, and yesterday she lay on her stomach while physical therapist Mike Forziati pushed her ankle to her thigh. "If I scream you'll know it hurts," she told him.

"Before this accident I was walking and bicycling 15 miles a weekend," Lydick said. "I'm not doing it now, but I plan to."

Unlike the hip, which is a simple ball-and-socket, the knee flexes back and forward, but has little give from side to side. Thick, strong ligaments keep the femur and tibia aligned one above the other.

When they get misaligned. it may result in torn anterior cruciate ligaments. Aside from arthroscopic surgery, when a doctor makes a dime-sized incision to sweep out bone chips and loose cartilage with the help of a tiny television camera, "ACL" repair is the most common type of knee surgery. It requires doctors to stretch and sew the ligaments, oftening using muscle grafts to fill holes.

In January, Joe Fiorino climbed down a ladder at the Columbia door company where he works, a task the 30-year-old performs dozens of times a day. But when his right foot hit the ground, it slid on a slippery floor while his left leg stayed on a ladder rung.

"Instant pain, let me tell you," said Fiorino, working out yesterday at Kernan for the second time.

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