A friend caught me in a funk this week whilst I had a knee that felt like a lump of wood. She asked “But are you progressing?”. Truth be told some days it may be difficult to see through the haze! The focus is to chip away each day at what is going to help you progress & try not to take your eye off the end goal, whatever that might be or how far away it may seem.
I am pleased to report great progress in the last 4 weeks with increases in knee bend, walking pattern and ability to tolerate load. I’m the turbo trainer but trying not get too carried away with that otherwise the knee let’s me know I’ve pushed too hard. Pain and swelling being the tell tale signs I’ve done too much.
Whilst moving forward with rehab this isn’t a time to get complacent or push too hard and create any further swelling as the ACL graft is actually at its most vulnerable at approx 8-12weeks post op when it revascularises. Mechanical properties of the graft are actually at their weakest. You want some loading to stimulate graft cells but without compromising graft integrity. After 12weeks the ligamentisation phase of graft healing begins & it is able to accept more tensile loading. It becomes more similar to an intact ACL ligament but this process takes atleast 1year in human biopsy studies.
Generally speaking from 6 weeks onwards I have been focusing on strengthening hamstrings, quads (thigh), glutes (buttocks), calf complex. To achieve this without aggravating swelling or pain may mean a smaller range of movement or adapting the load to suit you better. Primarily the most controlled way to add load at this time (as mentioned in my last post) is in a closed kinetic chain position when the feet are in contact with the ground. So exercises such as bridging, squats, calf raises, single leg squats (adapted as needed) are really useful. Finding the sweet spot of adding the right amount of load, reps, sets to help improve strength is key! Make sure to be guided by your therapy team on this. Also don’t neglect your balance work.
If we ignore the major elephant in the room of the global pandemic, the quiet life can be a useful time to be rehabbing as long as you feel you have the correct support at the end of a phone or video-call to keep you on the straight & narrow & offer support. However, it does mean being a little more creative with loading and potentially the progression of your balance exercises if you suddenly don’t have access to a gym and equipment. It is unfortunate not to be able to jump in the pool as by now full front crawl (still no breastroke) would be an option.
If you feel you’re struggling to progress at this point is definitely worth analysing where things are going off track. Are you respecting pain and swelling? Are you sticking to your exercise prescription or deviating and working too hard or going offpiste? Did you follow up a new strength session with a tonne of housework/gardening and now wonder why you’re sore? Are you getting your joint moving prior to strength exercises? The ability to get terminal knee extension as mentioned is going to be critical to the ability to strengthen the quads (thigh muscle) effectively. A long, slow simple weighted stretch needs little equipment & can be a game changer.
It’s definitely worth keeping a log just as you might do with training of your activity levels, cardio-vascular exercise effort/duration, exercises completed with loads, sets, reps and any flare ups. This will help you & your therapist work to iron out and tweak your rehab programme as appropriate. It will also help you see progressions when it can sometimes feel like the gains are minimal!
If you are going through this process it is definitely a long old slog & still many months lay ahead on the journey to full fitness or perhaps your chosen sport. Whilst it may feel like a long haul I hope that if you are 2 months+ post op you can look back over the last few weeks and see positive progress.
Lindsay Vonn knows a thing or two about knee injuries ….
Onwards through the current storm with positivity.
HD Physiotherapy & Sports Massage 