A whopping 3 months on! We’re still in lockdown but the old right knee is improving.
As anyone rehabbing knows it can be monotonous, frustrating & let’s face it dull! What has helped me is structuring my days. So one day I’ll focus on strengthening with weights and for the last week or so aim to walk 10,000steps. The next day will be focused on a bike turbo session 50-75 mins where warm up for 10mins then gradually maintain increasing wattage for 40mins, then cool down with an easy cycle. I add on balance work and controlled movements challenging different directions. I might add in a Pilates class once or twice a week.
My focus is doing something everyday that is going to help improve my overall outcome with my knee & get me closer to getting back to running. Lots of small goals, building up to the one main goal.
This last week I started impact testing. Basically seeing how the knee responds to more loading. So I did my first jog on the spot. It felt slightly like I was co-ordinating legs that didn’t quite belong to me & as soon as there was any discomfort I stopped. So 30seconds is the current tolerance & I’ll do that every other day now & see how I react. Then I’ll gradually build that up. Hell…..you got to start somewhere!!
Returning to running can be a messy path with lots of twists & turns & surprisingly little evidence to guide the route. A stepwise return to running programme that you can stop or adapt is key. When we run 1 mile we essentially hop for approximately 750 reps on each leg. So having the ability to tolerate and manage that explosive movement is really important. Hence, plyometric work will be a keystone of the next phase of rehab once built on strength and proprioceptive control. This is sometimes also called jump training- you use your muscles to their maximum over a short period.
My dog walks are getting faster, longer & more adventurous. I need to be completely pain-free walking for at-least half an hour prior to considering a return to running. Any slight downhill is slightly nerve racking, add in a slightly infirm surface & I have no confidence. A lot of this is in my headed & gradual exposure will help build my confidence in my knee over the coming months. I suggested a family walk to a hill yesterday, loved the hike up but gripped onto my husband’s shoulders for every step when we navigated vaguely slippy terrain on the way down. Uneven slopes and rocky trails I would have loved bounding down pre- accident.
Which leads us to my next challenge and barrier to progression. The terminal knee extension! I’ve mentioned it since day 1 and it’s critical to have extension equal to the other side. For me I have a reasonable amount of hyperextension of my left leg, but not quite the same on my operated leg. This is often a barrier post op to returning to activities like running. Without gaining it the knee cap or patella-femoral joint can get irritable and overloaded. My main challenge is that I hadn’t achieved that range pre-op. I’m working hard to regain it! The long slow weighted stretches are 100% hideous, if you’ve ever had to do them I’m sure you’ll agree. Over a day my aim is 30 mins of stretch at the end of my current range. Little by little the hope is that this will improve.
*Be sure to do exercises appropriately for your stage of rehab and relevant to your surgeons protocol as instructed by your physiotherapist*
Outline criteria for progression 12 weeks – 20 weeks post op
-No patellofemoral pain
-120 degrees of knee flexion
-Sufficient strength and proprioception to initiate unweighted running
Goals for rehab
-Full range of movement
-Achieve full terminal knee extension prior to full weight-bear running
-Improve strength, endurance, proprioception, of the leg in order to prepare for sport
-Protect Patella-femoral joint
-Normalise running mechanics
-Strength approximately 85% of unoperated leg