Rehabilitation story – Knee arthroscopy
My Story - James Dodd
I sustained a tear on the inner rim of my medial meniscus. It hurt and made a pop when I landed and gradually I became less able to walk and climb stairs. Dog walking made me sore and grumpy….. Exercising just left me in pain. I had had some regular treatment on this, since the injury and it was not helping.
I chose to go and get my knee scanned. I took home the disc and looked at the images at home. Immediately, it was apparent that there was a tear in an area that takes load and the snapping was my meniscus being pushed out of the way.
Grrrrrr. Next step was to see Adrian Fairbank. A knee orthopaedic surgeon. I did not take this step with easily. I had had 10 treatments and this and the exercises were not working. The tipping point for me was when my function was actually getting worse!
Adrian was thorough. He questioned, examined and looked at the MRI and confirmed my thoughts. I had medical insurance and so we decided to try to fix this as soon as….. ‘Soon as’ was two days later!!
The operation went without any concerns or problems and I was home just after lunch. I had been given some very basic post operative exercises to keep my knee mobile and help with the inflammation. I did as I was asked.
I had some pain and anti-inflammatory medication and due to the higher risk of Deep Vein Thrombosis (DVT) post surgery, I was told I needed to wear a stocking for 2 weeks. This went all the way from my left foot up to the top of my thigh!
Why are there risks of DVT. Here is a link
After two days of ‘pottering’ and some time off my feet. I started to do a little bit more. Just little bits of walking is good – I was limping and it was sore, so I was careful to avoid doing too much. What I did start to do was more on my other leg. I started to do some basic single leg squats and some pistol squats and for my upper body, I used my TRX to start pushing and pulling work. It is important to keep the upper body control there. I feel that many people have such a large disassociation between their lower and upper bodies. The balance, in my opinion, needs to be better.
Day 4
It was still pretty sore and my range of motion still limited. Stockings were still to be worn for the next 10 days.
Squatting and adding load to my left knee was still too much, so I was starting to do some hand/arm reaches with my feet in various positions. I was trying to be as functional as possible with my exercises. These were really to keep my body working as an integrated unit. If my legs were wide appart with my left leg forward, I could reach with my right hand to the left at shoulder height or take my left hand overhead to the right.
I managed to walk for just over a mile. I actually felt I could do more. But felt I should be sensible as I was still only 4 days post surgery. What would I be telling my patients?? ‘Rest a bit and give it time for the swelling and the inflammation to subside’. ‘Add in exercises gently’.
Tomorrow we are to set off to Cornwall for almost two weeks. This is one of the reasons why I chose to have my knee done at this time. I could then use my time away to rehab my knee to give it the very best chance it could get. We were driving early, hoping to miss the morning traffic. So we packed the car today. This involved a fair amount of stairs and carrying bags and some kettlebells?! As part of my rehab work, I had decided to take with me the RIPtrainer, the TRX and various kettlebells. I often use these along the rest of my training as the TRX is about ‘body weight’ exercises which I love and they can both be used extremely effectively for multidirectional training.
For some pretty dumb reason, I made it my business to put most of this into the car from the garden including and many trips up and down the stairs.
Day 5
Getting up early, my knee was more stiff and more painful than yesterday. I suspect sleeping on my side my knees a little bent did not help and then almost 6 hours in a car (with knee bent). Grumble……I then did some more lifting to empty the car. …. More grumble…. I was suffering for my excess yesterday and this morning! I had done way, way too much. Bit of a wake-up call really. Quite simply, it was my body telling me that I had done too much. It was also more puffy than it had been. But I suppose this is to expected. We decided to put my leg up and straighten it for a bit – this did feel good and it helped calm it. I then also did some more of the exercises I was given at the hospital to encourage drainage and reduce swelling.
This is MY story of MY knee. Everyone will be different. It is important to get advice from your osteopath or physiotherapist with regards to your rehab post surgery. YOUR rehabilitation is crucial ……. you do need to do this to give your body the very best chances for full recovery.
Day 9
It is now nine days post knee arthroscopy. How is that knee doing and what is it feeling like?
It certainly still gets sore if I do too much. We walked a bit further yesterday (on road and more hills!) and as I got near to ‘you have done too much’… it felt ‘unstable’… that was the only way I could describe it?! So I backed off and rested it a bit. Later than day we did a bit more flat walking and it was ok. Loading my knee and stairs are still slow, but that is to be expected. The stitches are dissolving and wounds heeling.
Exercises
I have stopped the original exercises that I was given and doing all my exercises upright now.
Beyond walking, I am not ready to involve exercises with stepping just yet, so they are to be closed chain with my left foot fixed on the ground.
Knee is not too keen in sagittal plane (SP) (knee bend) loading, but I can load my left hip into rotation and SP. I can also load my hip into the frontal plane …. but interestingly, my knee feels ok with this too. Using the Gray Institute’s 27 different foot positions, I am positioning my feet to add small ‘loading’ to my hip and knee with my foot on the ground. The knee is less keen to work with my left leg behind me…. and easier with my leg in front. It is also easier if my left foot is turned in a little, which asks more from my butt/gluts.
Short hand notes say ‘left leg forward’ is called LXX and with your left leg forward, but a wider stance is called LWX.
So in LXX and LWX, I am fixing my knee at about 20º and using ‘top-down’ trunk movement, I am loading my hips and trunk with various hand reaches. I am also doing some of these with a straight knee and allowing it to bend to a max of 20º. I am making sure that these are NOT painful and I am able to achieve them, so that my brain does not perceive these movements as a threat. These exercises are proprioceptively great too!
I am doing a few sets 3-4 times a day. I am also using the TRX as before keep my upper body conditioned. It is funny to see how easily I forget to do them and so I have set reminders on my phone and have also used the “wallpaper’ screen on my phone, so that each time I look at my phone it says ‘do your exercises!!)
Knee arthroscopy is not a small undertaking and it really highlights how important your rehabilitation is to get youback to function.
Function is about doing what you need to do as part of your day to day activities. In my opinion, our lives do involve bending and squatting to various degrees. It does involve reaching and twisting and it does involve coordination and us being able to control our balance and movement onto one leg. This also involves various combinations of all of these movements. We want to walk, pick things up off the floor, we sit, we twist and reach to get things off shelves. To most, this is just life.
The aim of Functional Rehabilitation is to get people getting back to what they are capable of and so all of my exercises are as close to ‘real’ function as possible. None of my exercises are with me on the floor bending my knee or on my side lifting my leg up and down! I want to load my body and replicate normal movements with much more efficiency, in a way that my body recognises and remembers.
My life certainly involves all of the above and so much more. For completeness, my rehabilitation will involve many of these movements and my knee exercises are just integrated into these.
13 days post surgery
Sleeping is better and I can find more ways to lie on my side without discomfort. I am still a little stiff in the morning.
The last couple of days have produced a good shift. I am walking better with improved control. I am able to do slower ‘high knee’ walking. My exercises have started to include reaches with a small knee bend. Caution is still high on my radar as I can still feel a ‘bite’ if I bend my knee too far with load. I am yet to use a forward step in my exercises, but I really feel that this will be soon. I am now also able to do exercises with my right leg forward too. This was previously painful.
I am doing more frontal and transverse plane loading. These include small lateral and rotational reaching with the aim of working the muscles of my butt, but also the ones in my thigh. These all involve ankle movement, so I am encouraging good foot biomechanics. Going forwards, I will be using some correctly placed foot wedges to use with some of my exercises to integrate better ‘ground reaction’ and ‘push off’.
As Osteopaths at Back to Back, we recognise that it is crucial for post surgical rehabilitation to be UNIQUE to THE INDIVIDUAL. It really is not good enough to be given a sheet of exercises that are not tailored to the individual and being asked to ‘get on with them’. The progression of exercises is also unique to the patient and given under the advice of a good health practitioner.
The above is all the opinion of Back to Back. If you are concerned in anyway about your rehab, come in and see one of our highly trained team.