Specific rehab following knee surgery...

[Snicko]

Re: Specific rehab following knee surgery...

So, back from the doctors again.

Last week has seen a general improvement in movement and reduction in swelling, but every time the knee is almost back to normal size it gives out on me (often on the horrendous black ice over here, but a few days ago just by stopping in the living room after I forgot something in the kitchen). It then stiffens up and swells, meaning the swelling/infection from last week is still there on the ultrasound.

Next doctors appointment in three weeks, until then I have to keep up exercises and physio as I have been doing with ice and elevation once again. The doctor will look at the knee again (hopefully without swelling) and there is a chance we will start on weights again. Three weeks after that (two and a bit months after surgery) comes the big decision about this season...not feeling very optimistic at the moment but will have to wait and see.

Cheers
Mark

 

[Liz Ward]

Re: Specific rehab following knee surgery...

Hi Mark,

I am so sorry to hear this. Has anybody suggested you wearing a brace, during the bad weather at least?

 

[Snicko]

Re: Specific rehab following knee surgery...

Hi Liz,

I have physio in the same building so I will ask tomorrow...might be a good idea.

Thanks
Mark

 

[Snicko]

Re: Specific rehab following knee surgery...

So, a brace is a big no-no apparently, the only exception is if I know I am going to possibly suffer, for example if I go to the shops in the snow then I should put it on just before I leave and take it off the second I come back.

Its all academic anyway, because the brace I have rests exactly on where the stitches were, so until the wound has gone I have to grin and bear it...

 

[Liz Ward]

Re: Specific rehab following knee surgery...

It worries me that your recovery is considerably hampered by instability on ice.

It is obvious that, otherwise, you are doing the rights thing(s). If the ice continues, I am not sure how much reinjury your knee is going to take. Every reinjury decreases the potential of full recovery; your ligaments really do need support whilst the ice is around. If you carry on, your soft tissue, in general, will suffer chronic issues.

The other occasion, when you stopped suddenly, was as a result of this increased instability. This kind of issue will increase if you do not allow the knee to repair.

If you cannot wear your brace when you go out, ask the doc/physio to show you how to strap it.

 

[Snicko]

Re: Specific rehab following knee surgery...

Was at the physio again this morning...was seen to by someone else who really seemed to enjoy pummelling the knee every which way. Was surprised to find that the flexibility increased afterwards, but now a few hours later it feels like I've been hit by a train.

My leg muscles are getting stronger and stronger though, the TENS machine and exercises at least seem to be working, but the muscles cannot support the knee movements yet.

One interesting thing I found was that there are some pro skiers and bike riders who have no ACL at all, but their thighs are so monstrously strong that they have no problems performing. With this in mind, the question arises that if the conservative treatment goes well and I get massive leg muscles that support the knee well, what happens if I take a break from sport...will the ACL give way again in later life? The surgeon has more or less suggested that the weakness to the ligament itself (ruptured at some time in the past and left to heal without treatment) is permanent...

Have a nice weekend...
Mark

 

[Liz Ward]

Re: Specific rehab following knee surgery...

The physio's treatment sounds great but can cause some inflammation. I assume they gave you full MICE advice if this happens.

With regard to sport, it really depends on the sport and the movements involved. If you are a pace bowler, I really don't think you will be able to carry on without either support or reconstruction.

I am surprised you ruptured the ligament without getting attention... it must have been enormously painful .

 

[Snicko]

Re: Specific rehab following knee surgery...

Icing and elevation have been on the plan since the very start...

Was stupid of me to not seek help to be honest. I just realised today that if I had it treated instantly there is a chance I would have played this season even with surgery. Assuming it happened in the nets, then the pain was there but it was more very swollen and a very light and airy feeling inside the knee, which then manifested itself as instability when the swelling went down (after about 1 week).

It could also have been when I fell skiing, flipped over backwards and landed in a snowdrift 10 metres away though...that was four years back, but I do remember actually bending my ski-pole by 90 degrees with my left knee :-O

I look at my lifestyle and sport in particular. Any weakness there means no cricket (wicketkeeping), no skiing, no badminton, little jogging...not really a lot to look forward to :-(

Cheers
Mark

 

[Liz Ward]

Re: Specific rehab following knee surgery...

Never say 'never' Mark, it is amazing what can be done these days... we have the technology to rebuild you! Unfortunately, you just need a little patience. You really need to give your knee the best chance going... rest it and stop skating on the ice . When everything has settled, your surgeon will be able to see what needs to be done... if anything.

In the meantime, keep us informed.

 

[Snicko]

Re: Specific rehab following knee surgery...

Only one physio session this week with some slightly more advanced exercises, but otherwise everything is the same. Leg muscles are strong now (if fact I would probably say almost fully back to normal) but the knee keeps pulling, almost slipping and swelling up with stiffness. In fact I would say we are now more or less back where we started when I first went to the doctors.

On a different note though, I have just had a ten millimetre screw inserted into my jawbone for a tooth implant and it feels like I have been smashed on the face with a baseball bat, so that is distracting me from the knee somewhat...not boring at the moment anyway.

 

[Boris]

Re: Specific rehab following knee surgery...

On a different note though, I have just had a ten millimetre screw inserted into my jawbone for a tooth implant and it feels like I have been smashed on the face with a baseball bat, so that is distracting me from the knee somewhat...not boring at the moment anyway.

You are having one hell of a time, aren't you?

 

[Liz Ward]

Re: Specific rehab following knee surgery...

...not boring at the moment anyway.

Crikey, you Berliners know how to have a good time... I spent a year in the north of the country in the 70s - never was this much fun!

Other than exercises, is anybody giving you remedial treatment to your leg and thigh muscles, such as sport massage?

 

[Snicko]

Re: Specific rehab following knee surgery...

Nope, no massage or anything...just exercises, TENS machine and short bursts on the bike (10 minutes)

 

[Liz Ward]

Re: Specific rehab following knee surgery...

Out of curiosity, how long are you using TENS...
How many minutes?
How many days in the week?

 

[Snicko]

Re: Specific rehab following knee surgery...

The 20 minute preset program for muscle rehabilitation, once every day at high energy.
That is a ten second burst, followed by 20 seconds rest.

 

[Liz Ward]

Re: Specific rehab following knee surgery...

A study carried out by the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon in Hong Kong [where else!] concluded that 40 minutes is the optimal treatment duration of TENS, in terms of both the magnitude (VAS scores) of pain reduction and the duration of post-stimulation analgesia for knee osetoarthritis, which would be the same for your issues. Optimal stimulation duration of tens in the manage... [J Rehabil Med. 2003] - PubMed result

The problem I have with your treatment is that it is treating the symptoms. You really do need to get to the cause. Try to get an appointment with a Level 5 Sport and Remedial Massage Therapist.

 

[Snicko]

Re: Specific rehab following knee surgery...

Thanks for the info on the TENS machine, have now increased it to one session in the morning and one in the evening.

Am not sure what sports massage will do...the intention at the moment is to see whether my leg muscles can be built up sufficiently to support a knee ligament which has been chronically weakened. The muscle building is actually going really well, but the knee still gives out on me.

By the way, just to see what it is like I actually tried getting down into the wicketkeeper crouch and then back up again...suffice to say I won't be doing that again in the near future...

 

[Liz Ward]

Re: Specific rehab following knee surgery...

...Am not sure what sports massage will do...

When people hear the word 'massage', they visualise a stroke and a tickle. Sport and Remedial Massage Therapists are not classic masseurs and you will not find us in massage parlours but clinics; we are soft tissue specialists and injury pathologists.

During an S&R Massage, the therapist will palpate each muscle to diagnose any issue, whether tension, myofascial trigger points, scar tissue etc. When issues are found, an L5 therapist will use a variety of techniques, such as Muscle Energy Techniques [post isometric relaxation/reciprocal inhibition], Soft Tissue Release, Positional Release etc to solve them.

Many physiological conditions are caused by somatic dysfunction. This dysfunction needs to be resolved or the condition will continue.

Bottom line, you should be well on the way to recovery with your knee, the fact that you are not brings up concern. Strengthening your muscles are all well and good if the muscles are in a good enough state to strengthen.

As a side, you say, "The muscle building is actually going really well...". I am afraid it is not or you would have found it easier to crouch. Physios have no strength and conditioning training/qualifications and I doubt your exercises are as functional as they could be.

 

[Snicko]

Re: Specific rehab following knee surgery...

Interesting...so what you are saying is that the knee problems may also be caused (or at least not helped by) some form of muscle imbalance or defect, a bit like when bad posture causes back problems?

On another note, I saw a picture today of Felix Neureuther (German slalom skier) doing an exercise for strength and coordination where he balances on one of those big inflatable ball things and then juggles three 3 kilo weight balls...never seen that before.

 

[Liz Ward]

Re: Specific rehab following knee surgery...

Interesting...so what you are saying is that the knee problems may also be caused (or at least not helped by) some form of muscle imbalance or defect, a bit like when bad posture causes back problems?

Absolutely! I am not saying it is, but it needs investigating. Don't get me wrong, I am not knocking physios or doctors, they are fantastic but their job is to deal with symptoms... if you have an issue in your knees, they will treat your knees.

It is possible that the issue you had with your knees could have caused somatic dysfunction elsewhere, which is now prohibiting recovery.

It could be that somatic dysfunction caused the injury and this still will prohibit recovery until sorted.

Most people who come to me with knee issues recover very quickly after treatment elsewhere.

On another note, I saw a picture today of Felix Neureuther (German slalom skier) doing an exercise for strength and coordination where he balances on one of those big inflatable ball things and then juggles three 3 kilo weight balls...never seen that before.

Fantastic! We used this recently in an Essex worshop, batting instead of juggling... that was hard enough .