T Nation

Lifting Following Knee Surgery


#1

Hi guys,

I posted this on a knee problem forum , but figure some of you may be in a better position to offer advice regarding my lifting-related questions.

Any advice or words of wisdom would be greatly appreciated.

Thanks
Jim


4 weeks ago I had surgery to investigate why I was (still!) getting knee pain. As a result, a medial meniscus tear was removed (~30%) and also a screw from an ACL reconstruction was removed. To give a little background I've had the following surgeries prior to this, all in the same knee:

June 2005 - Shaving of ACL screw - was touching kneecap (ow)
June 2004 - Removal of scar tissue that was in region of Saphenous Nerve and causing lots of pain
June 2004 - Repair (not removal) of torn meniscus - saphenous nerve was aggrevated - caused tremendous amounts of pain!
Jan 2003 - ACL Reconstruction, hamstring graft
Dec 2002 - Arthroscopsy to figure out what was wrong with my knee.

My questions relate to rehab of my knee as it currently stands. I've been given a green light by the hospital physio to 'do anything as long as it doesn't hurt'. However, I want to be more cautious! A little about myself - I'm 24, pretty active, and enjoy weightlifting. I don't do any contact sports.

Currently, as things stand, walking can be quite painful - often when my leg straightens, I get pain just beneath/to the side of my knee (when I say side, I mean inside leg - not sure of technical term for it?). I've been told by my surgeon this is probably due to a muscle imbalance, or my VMO not firing. I'm trying to concentrate on gait and getting the muscles 'active' in my knee, my rehab sessions (daily) include:

  • Stationary Cycling (not going crazy, but anywhere from 10-30 minutes, feels comfortable)
  • Mini squats - one-legged squats to about 20-30 degrees, emphasis on control
  • Not sure how to describe this one - I wrap a thermoband around my knee, and tie the band to the wall. Facing the wall to which the band is tied, I let my knee be pulled in the direction of the band, then straighten it slowly - I'm told this works the VMO
  • Single leg raises off the floor
  • One-legged leg press - to about 45 degrees at present
  • Single leg hamstring curl - very light weight
  • Wall squats - squatting against a wall at about 45 degrees, for sets of 45-60 seconds
  • Plenty of stretching (hamstring, calf - quad stretching in the affected knee is not comfortable).

*** note some of these I can only do if i make it to the gym, which is 3-4 times a week - some I can do at home every day).

Does this sound like a sensible plan? Also, in the longer term, I want to return to weightlifting. I don't compete (other than with myself), but do take it relatively seriously, and so would like to be able to Squat and Deadlift again (and of course other variants of these exercises). Is this advisable given the state of my meniscus?

I would really appreciate any advice that people can offer.

Many thanks,
Jim Mc


#2

Jim,

What caused your knee to get so fucked up? A major accident? A minor one?

Obviously many people will disagree but it has been my experience that 50-100% of the excercises you mentioned are functionally worthless. You said that walking is painful, start there. Nothing is more important than walking without pain. Walk slow if you have to, take days off of walking for rest, but for godsakes lay off of your knee until you can walk.

If you start excercises that load the knee before you can walk without pain... well, it just sounds ridiculous, doesn't it?

It took over a year after the removal of a medial meniscal tear for me to be confident enough on my feet again to jog a mile.


#3

The exercises for the most part look OK to me. The problem most people have is that they dont do them enough. Given the loading in these exercises is not high, I would be doing them 2-3 times daily. Or at the very very least cycling every day + one run through these exercises.

Keep it pain free, and back off the volume and intensity (or both) if you are getting sore or it adversely interferes with walking etc etc. However keep the frequency of stimulus high regardless. With your history, this (rehab exercises) will be a lifelong thing for you if you want to get your knee pain and function under control.


#4

T4me,

Not trying to blast you or anything but the reason he can't stretch or walk without pain is probably because he is trying to do these excercises. Walking is the only thing that helped me after surgury. The advice I got from my physical therapist to do these kind of excercises was probably the worst advice I got. These kinds of excercises set me back months and caused a tremendous degree of pain. PT is BS as far I am concerned. :slight_smile:

Ultimately, the only statement I can agree with you about is "keeping it pain free." But seriously, if you can't walk without pain, what good is doing a hamstring curl or a one legged squat 3x a day? The hamstring curl is an unnatural motion that rarely, if ever, occurs in real life and the one-legged squat is an excellent excercise for someone that is at the top of their game.

Basically the argument is is that if you currently can not walk without pain then you are wasting energy/recovery/time doing anything else until you can walk again. When you can walk then that is the time to talk about "don't let these single leg squats interfere with your walking".


#5

To be fair though, I should retract the statement that "PT is BS" because some of it is great. But when your knees are jacked PT shouldn't start for a long time after surgury because your knees can be swollen for months and months after the actual procedure. Knees are just too priceless. I mean, jacking your shoulder won't land you in a wheel-chair.


#6

Hiya,

It's worth mentioning that I tore my meniscus originally during ACL rehab (we dont know how), and since then, every operation has been a result of that original meniscus repair / the ACL op.

Over the last few days, since attacking the rehab with renewed vigor, and paying particular attention to slow, controlled repetitions (esp with mini squats and the knee extension/rubber band thingies), walking has felt a lot more comfortable. I agree with the previous post about doing the exercises often - as is my understanding, their primary function isn't to induce hypertrophy, it's more to regain muscle control and 'wake up' muscles that have pretty much gone to sleep.

The walking pain is something I've experienced before - after both ACL tear and meniscal repair - so im hoping itll go away once my VMO starts firing properly. I have to walk a fair distance every day, as I walk to/from work (no parking), probably further than would be advisable at this stage after surgery..

What i'm more interested in is the long term prospects of my knee - in terms of the activity that i can undertake, safely, to train my lower body. The last thing I want is another meniscal tear

Thanks
Jim


#7

Beebuddy,

Sorry, just read your original reply properly.

Originally, I tore my ACL. I had it repaired (hamstring graft) and everything was fine. Felt fantastic. A few months later, my knee randomly started hurting. MRI scan revealed a meniscus tear, which I was to have operated on.

Had an operation to repair meniscus tear - woke up in a LOT Of pain. after 2 weeks it turned out scar tissue had formed around the saphenous nerve in my leg and was causing crazy amounts of pain, so I had more surgery to remove the scar tissue.

After this, things felt pretty good. Could run, squat etc.. no probs. A few months later, pain came back. Had investigative surgery and it turned out the screw from the ACL operationo hadn't dissolved as quickly as expected, had drifted slightly, and was touching my knee, hence pain. They shaved the screw (couldnt remove it as it might compromise the integrity of my ACL graft, apparently).

After this, things felt pretty good! (notice a pattern?). In fact, they felt great. Was perfect. All of a sudden, around the start of Jan, i was getting sharp pains in my knee. The surgeon assumed it was the ACL screw having drifted further, so operated. Found this was not the case, but he was able to safely remove the screw, so did so. He also found that I had a tear in my meniscal cartilidge, which he stipulated is what was causing the pain. This was removed. I was told it equated to around 30% of my meniscus.

Since then, things have felt 'ok', but im still getting intermitten pain. I'm OK with that though, since I do seem to be getting more of a handle on the pain. I am walking a lot (by necessity - I have to get to/from work), around 3 miles a day. Not a lot by active standards, but a lot by 'I just had surgery' standards.

I was always under the impression that meniscal removal was quick to recover from (it's meniscus tears that are meant to take time, since you don't want to damage the repair - with a removal, there's nothing to damage?). I'd love to hear from anyone that has been in a similar situation and has returned to a similar level of activity.

Cheers
Jim


#8

I fucked up my knee Nov 2002.

Dec 2002 I had surgery to trim the torn flap of my meniscus that was preventing me from having any kind of range of motion. (My meniscus is now 90% intact) He knew the ACL was gone but he wanted to get some mobility in my knee back before he did the ACL.
My knee mobility did not respond to any PT pre surgery and he wanted to see what was going on in there.

Feb 2003 I had ACL reconstruction with the patellar tendon graft.

I did all the exercises you have listed plus leg presses and lot of work on the eliptical.

My knee still gives me some pain and my kneecap clicks sometimes.

I can run and jump and squat. I can sprint but my knee swells when I run distance.

You sound like you are way behind the rehab curve.

My suggestion is keep doing your exercises. I don't think they are so hard that they should mess up your walking.

Are you icing your knee after EVERY workout? Whenever I would skip icing my knee I would have troubles.

Do your exercises, Rest, Ice, Compression and Elevation.

Good luck. I feel for ya.


#9

When you say way behind on the rehab curve, do you mean my approach is flawed, or I'm simply not doing as well as I should be at this stage? (I'm inclined to agree - although it has only been 4 weeks...)

I am doing leg presses, although I haven't tried using an eliptical trainer yet.

I ice very regularly. Knee doesnt look swollen at all tho..

Jim


#10

Here is my thoughts on this. After having 2 knee surgeries last year, I am now fully into doing my deadlifts, front & back squats and am doing power cleans. You have to look at your ultimate goal of getting back into those things & see what will facilitate success. Yes, you are probably walking too far if it is that painful. But I have to disagree that you exercises are BS. I wouldn't stop your exercises, especially the ones for your VMO. You need to do those at least 2x/day because if not you will continue to lose strength. If your losing strength, you are getting farther from your eventual goal & will not get strong enough to get rid of your pain while walking. When I had my surgeries, I was doing straight leg raises before I was allowed to walk to stop the strength loss immediately. You can pratically do those if you are dead! Turn your leg out a little & mentally think about engaging your VMO before you lift up your leg. They are shitty & boring as hell, but do them as often as you can.

Once you can walk without pain, try both step ups & step downs [starting on bench & stepping down & then back up, sort of backwards?], your mini squats and definately a 1-leg leg press.

You may have to do that extra work every day even as you get into your regular programs, just because it feels good doesn't mean it is up to par. So, even if you start deadlifting, you may want to continue to do single leg work at 50-60% just to continue to even out your strength. At over a year out & little to no pain, I still continue to do 1-leg work to continue to correct the imbalance of strength. You can lose a lot of strength, I lost over an inch in my right quad within 1 week after surgery. It takes a hell of a lot longer than that to get it back!

Sorry so long, Good luck with your rehab!


#11

Jim,

Here is what I am wondering... what inititally caused the ACL problems?

The reason I ask is because if you were in a skiing accident and you twisted your knee 360 degrees then that is different than what I did.

In my case I was rock climbing and I extended my leg out in a "splits" position and got my toe on a hold. I pivoted on that toe and put weight on the saggital plane of the knee. There was a pop and ZERO pain. The reason I knew it was messed up was because it was frozen and the mobility was reduced. It took a long ass time to recover from the surgury and my PT's advice was really crappy.

IMO the reason for my injury was weak knee stabilizers from years of poor posture, imbalanced knee-tracking etc... So in my case stretching, posture and core work are what will prevent future injury and get me back in the game.

This could be what you need too, I have no idea at all but it is worth investigating for yourself. The difference is what caused the very first injury and working to correct the causes and conditions that were present and led to that injury. If the first injury was caused by being clubbed Tonya Harding style then this advice is probably worthless.


#12

Fell over. Stumbled and friend of mine (weighs about 250 lbs) fell on top of me, and my leg bent the wrong way. Complete accident. Hurt like hell!


#13

Just slow progress. I can't say your approach is flawed.

The elliptical machine was great for me. I don't know if the machine was the cause but I think my improvement was more rapid when I started using it. I felt more like an athlete and less like a cripple when I was on it because I could actually simulate running instead of hobbling around. Much better than the bike.

Ask your therapist if you are ready.

You don't need immense visble swelling to have it mess you up. My knee was bigger than the other for a year. If it swelled beyond its "normal" swollen state I had lots of trouble, extra pain, loss of flexibility etc.

When you say you ice regularly are you doing it every time after exercise or just once a day? I used to do it immediatly after exercise plus a couple times a day.

Are you elevating it? That was probably the biggest pain in the ass with a desk job.