T Nation

Blew Out My Knee - Advice


#1

About two weeks ago I did some pretty serious damage to my knee - I tore my acl, partially tore my mcl, and tore my meniscus. After being pretty stiff for the first week or so, it has gotten a lot better, the ROM is a lot better, swelling and inflammation is better, etc - but only to the point where I can hobble around.

I saw my surgeon today, and he advised I wait about a month to look at surgery, just so I can continue to strengthen the knee, and have the swelling go down completely.

I've been to the gym, and haven't had too much trouble working out (obviously lower body is out of the question), but I am mainly concerned about keeping conditioning up, and maintaining my weight. Anybody out there have any ideas, or better yet any experience with conditioning / cardio with a busted knee? I can only do so many pushups / chins and med ball tosses.

Any advice would be greatly appreciated!


#2

get on a rower and dont use your legs. OR arm bike. swimming is great. i swam a lot when i blew out both my knees. only breaststroke! haha.


#3

The terrible triad(Acl,Men,MCL)…Just from a rehab point of view its good to go into surgery with strong quads and hams and as little swelling as possible…Oedema actually decreases muscle activity and will thus weaken your muscles…Pre surgery i’d suggest a compression bandage of sorts to decrease swelling…quads and hams drills within pain limits, you should work on achieving FAROM…i’d say swimming for cardio is probably the safest bet…

Not really answering your question…just some general advice…


#4

[quote]tjamesdavis wrote:
About two weeks ago I did some pretty serious damage to my knee - I tore my acl, partially tore my mcl, and tore my meniscus. After being pretty stiff for the first week or so, it has gotten a lot better, the ROM is a lot better, swelling and inflammation is better, etc - but only to the point where I can hobble around.

I saw my surgeon today, and he advised I wait about a month to look at surgery, just so I can continue to strengthen the knee, and have the swelling go down completely.

I’ve been to the gym, and haven’t had too much trouble working out (obviously lower body is out of the question), but I am mainly concerned about keeping conditioning up, and maintaining my weight. Anybody out there have any ideas, or better yet any experience with conditioning / cardio with a busted knee? I can only do so many pushups / chins and med ball tosses.

Any advice would be greatly appreciated![/quote]

Why would lower body training be out of the question? Probably the worst thing you could do for a month before surgery is not do any lower body training. The ACL and MCL provide lateral stability with change of direction motions. There is no reason why you couldn’t continue to perform squats, rear foot elevated split squats, lunge squats, touchdowns, single leg press, etc. I would stay away from step-ups as this brings into account the lateral stability deficiencies. Also, if you are going to complete knee extensions stay at a ROM of 90-40, anything greater will cause anterior translation of the tibia (essentially what the ortho MD did to test your ACL ie. open drawer test or Lachman’s). Also, complete full range of motion hamstring curls, RDLs, bridges and anything else that strengthens the hamstrings as the hamstrings are the muscular equivalent to the ACL. The only thing I would refrain from would be any repetitive pounding activities (TM, sprints, jogging, plyos, even elliptical machine) as you may have pain and swelling with these secondary to the torn meniscus. A very easy exercise that you could complete would be the supine straight leg raise for maintaining quad strength (this is also one of the first exercises you will be completing when you start PT).

The stronger you go into surgery the better/quicker/stronger your recovery will be after surgery. Ancedotal evidence…I had a client who had bilateral remote ACL tears. Had one ACL done and then the other a month later. The whole month we completed the above mentioned exercises on both legs. She walked in 2 days after surgery on the second leg without any crutches or even a limp. I thought she had decided not to have surgery that is how well she was moving.


#5

Good luck on the surgery, stick to the rehab after is the best advice. prior to its just a case of hold onto your upper body and let the leg rest. as soon as the fluid goes down you can get into the dr. swimming is probably the only exercise i would consider ok for cardio, bounce steps in neck deep water, otherwise breastrokes, free arm, etc. ive had 5 knee surgeries to date, and figured out to rest them prior to the operation about the 3rd time around. just my opinion.


#6

[quote]physioe wrote:
The terrible triad(Acl,Men,MCL)…Just from a rehab point of view its good to go into surgery with strong quads and hams and as little swelling as possible…Oedema actually decreases muscle activity and will thus weaken your muscles…Pre surgery i’d suggest a compression bandage of sorts to decrease swelling…quads and hams drills within pain limits, you should work on achieving FAROM…i’d say swimming for cardio is probably the safest bet…

Not really answering your question…just some general advice…[/quote]

Good advice about the swelling inhibiting muscle contraction. The more you can contract the muscle the better with pumping swelling out. I give the analogy of a wet sponge, if you squeeze the sponge water comes out, if you contract the muscle swelling comes out. The heart is a pump not a vacuum. If you allow swelling to build up it becomes a downward spiral of inhibition followed by more swelling which leads to more inhibition… The one thing you want to make sure of with a compression type bandage is to not walk with a stiff leg (ie pirate) this will only make the swelling worse as you have essentially shut down the muscles used for knee extension and flexion during walking.


#7

thanks for the advice so far, truly appreciate it.

I guess the reason I thought lower body training is out is because I still don’t have a full ROM. I can almost straighten my leg completely, but can only bring it back close to 90 degrees (not quite). I will have to ease into it and see what I can do. So far, I have been doing physical therapy stuff including wall squats, very low step ups, etc.

I will have to test the waters with the suggestions above, but if it’s going to help with the surgery and rehab, I am all for it.

thanks again fellas


#8

[quote]tjamesdavis wrote:
thanks for the advice so far, truly appreciate it.

I guess the reason I thought lower body training is out is because I still don’t have a full ROM. I can almost straighten my leg completely, but can only bring it back close to 90 degrees (not quite). I will have to ease into it and see what I can do. So far, I have been doing physical therapy stuff including wall squats, very low step ups, etc.

I will have to test the waters with the suggestions above, but if it’s going to help with the surgery and rehab, I am all for it.

thanks again fellas[/quote]

Sorry, of course you want to make sure you get full ROM but you also want to maintain the strength. If you have already started PT, hopefully they will have you completing bodyweight squats much sooner rather than later (no reason to be completing wall squats - absolutely no functional value). Also, they should have started you on single leg press, through an ever increasing active range of motion. You could also be completing hamstring/gatroc stretches with belt while lying on your back, could also complete standing gastroc stretches with or without a slant board/ball of foot elevated. Extension is the most important motion to regain both before and after surgery, flexion is easy to get down the road, but extension is the most difficult if left unaddressed. Also, hopefully they have started you with straight leg raises in order to facilitate full extension and quad activity.

Also, if you have already started to look into physical therapy. Make sure you find a therapist that has a pretty strong background in ortho/sports rehab especially post-surgical ACL reconstruction. You have no idea how many therapists have really no idea what they are doing when it comes to any surgical rehab especially the ACL. They are unaware of just how much you can push a reconstruction (safely of course) for the optimal benefit. You will find a lot of therapists who rarely, if ever, see any post-surgical patients especially ACLs and their overly cautious and out dated methods definitely show it. Also, find a rehab center that has at least a leg press, knee extension and hamstring curl. A squat rack would be even better. It is unfortunate but far too many places don’t even have the basics for proper rehabilitation and it is only you that will suffer. You may even want to meet with a few therapists to find one that you mesh with (athletic interests etc) as you will be spending a lot of time with them. Also, you want to make sure they have experience with the surgery, know you want an aggressive rehab as you have athletic interests. Rehabbing an over weight mother with knee pain is a lot different that a post-surgical athlete looking to return to a high level of performance.

Sorry for the long winded post. I just spend a significant amount of time fixing other therapists mistakes with ACL reconstructions since they don’t have the experience. I also field quite a few phone calls on a daily basis regarding the proper exercises for these ACL reconstruction patients. It is quite scary the limited amount of knowledge that most physical therapists possess when it comes to post-surgical rehabilitation.

Just want to make sure you have the best rehab possible since an ACL reconstruction is a highly
successful surgery when rehabbed properly.

One final thought, make sure you train the uninvolved leg just as strenuously as the involved leg. You have a much higher incidence of tearing the other ACL and you get some carryover to the surgical leg while training the non-surgical leg. Don’t let a therapist tell you it is unneeded or that the uninvolved leg will get too strong. It all evens out over time and you don’t want to make the surgical leg appear stronger in comparison to the non-surgical leg by making the non-surgical leg weaker over the course of the rehab.

Again, sorry for the long winded post. I will now step off my soap box.

Good luck with surgery and rehab.


#9

This isn’t advice: I knew a guy who was playing Halo and blew out his knee. I’m not kidding.


#10

[quote]BodyByGame20 wrote:
This isn’t advice: I knew a guy who was playing Halo and blew out his knee. I’m not kidding.[/quote]

what the flip!


#11

Yep, sitting there playing Halo and BOOM! “My kneeeeeee!” falls off couch

…He has “beast mode” tat’d on his chest. It should say “Breast Mode” though, dude is seriously lacking the beast, but he has bountiful breasts!


#12

[quote]BodyByGame20 wrote:
This isn’t advice: I knew a guy who was playing Halo and blew out his knee. I’m not kidding.[/quote]

I had a football player at my old job who broke his hand playing Madden. He fumbled, lost the game and punched a chair. When our doc heard the story, he couldn’t stop laughing. The woman who transcribed our doc’s dictations emailed me after that one laughing too.


#13

Rowing machine - upper body only works well as does a one legged rowing


#14

I had mine done 6 years ago yet there’s still some meniscus arthroscopy type work I need to be done.

Have they recommended what style of repair they’re going to do? There are different options. I had the middle third of my pattellar tendon used, but they also offered a cadaver ACL/MCL. I’m sure there’s other options out there now too.


#15

The doctor has offered hamstring, patellar, and cadaver options when it comes to repairing the ACL. He said that the cadaver fails about 30-40% of the time, and said that the patellar method is the tried and true way, and probably the best bet. I think I am going to go this route. I don’t like the idea of cutting along the back off my leg for the hammy tendon - just sounds more painful to me.

Thanks to everyone with all the advice so far. Surgery has been suggested about three weeks out as I still have a lot of ROM and inflammation to get rid of. The leg has improved a TON in the last week. I can walk with little problem, and also got out on the golf course and hit a few shots even today.

Training wise I have taken much of the week off, but plan to get back at it again tomorrow. I have gotten a few sessions of easy biking and med ball tosses in throughout the week. I have started pretty intensive therapy, and thanks to the exercises, I am feeling pretty confident on the leg.

Again thanks for all the advice and the well wishes, really appreciate it!


#16

Hi, well this is my first post ( I think ) 1rst sorry for my english I just out of practice, any way here’s some tips for you.
Train your legs !!!
ok again… TRAIN YOUR LEGS !!! you must keep your legs as strong as you can previus tu surgery.
About the excercise, do leg press for cuads, and for hams you can go from curls to DL, also do some calf work.
The scuat is not advice, well may be just a 1/2 scuat.
About the LCA it give you anterior stability, not lateral ! ok it do some lateral ( rotation ) but is not its main function.
The “ham” tecnique is not painfull, and its made with artroscopy, so only get a 1 - 2 cm cut.
The “patelar tendon” is supouse to be a little more stable.

Cheers!


#17

Hey guys,

Had surgery on Thursday, so I am now three days post-op on my torn ACL and meniscus. The DR. said that everything went very well, so I am pretty excited to get back on the road to recover. The pain has not been too bad so far - the pain meds are doing wonders. Howeever, right when I woke up from surgery, I wanted to scream, the pain was so intense!

Anyway, I start rehab on Tuesday - I can’t wait. They sent me home with a Cryocuff and another contraption that moves and bends my knee for me. So far, I have it set to 50 degrees. I have most of my extension back as well, but it is still tough to do because of the pain.

Perhaps the biggest pain in the ass since having this done has been the pain in the heel of my good leg. I don’t know if it’s from hobbling around on my crutches or what, but I keep getting some discomfort back there…and I am freaking out that I am going to tear my achilles!

Thought I would share some photos of post-op, thanks again for all the advice.


#18

Another shot


#19

Looks good. You shouldn’t harm your achillies. Put a pillow under your good calf to unload the heel from the bed. That should help some.


#20

did it playing soccer, foot got stuck on the turf and my upper body kept moving, which bent it in a strange angle. i honestly chalk this up as a freak accident, i was in pretty decent shape and my knees were fairly stable and strong.

for specific info for keeping your knees in good shape, check out Bulletproof Knees by Mike Robertson.

thanks for the advice danjo, i will try that.