Knee Rehabilitation – Part 1
About the Author:
Kelly O’Donnell has been competitive skiing for the past 12 years. Currently employed in the healthcare sector, Kelly holds a degree in sport and exercise with a major in management and coaching and a diploma in rehabilitation.
Knee Rehabilitation (ACL reconstruction)- prior to surgery.
In February this year I learnt first hand how a serious knee injury can affect the rest of your skiing season and everyday living for the following 4-6 months as you follow a rehabilitation program set to put you back on track and on the mend.
At the second tournament of the season, Waikato regionals I was skiing a routine forward slalom pass when I fell awkwardly coming off the wake on one foot. What followed was a lot of discomfort (considering a backwards run was on the cards) and a nagging feeling that the outcome was not going to be good.
After visits to a couple of doctors, physio, radiographer and surgeon I learnt the extent of the injury. It involved a slight dislocation of the kneecap, a grade three tear to the medial ligament, a large amount of bone bruising and finally, the big blow: a torn ACL and meniscus tear. In short that was my season of skiing over and what I had to look forward to was 9 months of rehabilitation and a year long wait before entering any type of competitive sport. To say the least I was gutted, feeling the missed opportunity of competing in the following 2012 competitions and of course 2012 worlds.
However, time for feeling sorry for myself was cut short when it came to looking at how to approach the rehabilitation of the knee. Due to my age and amount of sports involvement I was advised to look at the surgical option of treating the knee; it would allow full recovery and full use of the knee again to participate in all sports.
Having surgery meant that the rehab process started even before I went into surgery for the ACL reconstruction. Throughout my injury I did all of my rehab work with a great physio. I learnt a lot about the rehabilitation program and the importance of an adequate rehab program as well as actually following the program and doing the work. The amount of time you put into the rehab program is exactly what you get out of it in the long run for the best long-term results for competing in sport and everyday lifestyle.
The importance of pre-habilitation before surgery for an ACL injury cannot be underestimated; it is just as important as rehab after surgery. One thing that my physio shared with me early on in my injury was that the equivalent of a teaspoon of swelling in an injured area leads to up to 80% of the muscle around that area effectively switching off to protect it. I witnessed the truth of this myself as in only a small amount of time after the injury my leg muscles were starting to reduce in size.
Pre-habilitation is important for mainly one reason: the stronger the knee and all the surrounding muscles supporting the knee are, going into surgery, the better and faster rehabilitation will be post surgery. This provides a base level of strength for the knee to start at and continue to build from once surgery is complete. It also prevents the development of scar tissue that can occur in healing time leading into surgery, consequently hindering your range of motion.
Pre-habilitation exercises of ACL injury
– Cycling (on stationary bike):
Starting with only going back and forth halfway as many times as you can in a day for about 5 mins a time (huge factor in breaking down swelling and allowing normal movement to come back to the knee). Once knee has more movement do full circle cycles (no resistance to begin with) and slowly as knee starts to have less swelling add tiny bit of resistance. Cycling will become your best friend and most regularly used rehab exercise in an ACL injury. It helps break down swelling, allow range of motion to come back to knee joint, builds required muscles around the knee back to strength and is low impact therefore lots of it can be done!
– Sitting on a table or flat surface where your legs can dangle, turn the foot of the injured knee to a 30-degree angle. From this point start extending the knee as straight as you can get it, when coming back down do not go back to full 90 degree knee bend (means you work the muscle more). Once closer to surgery and knee is stronger add a rubber resistance band to the exercise. Either get someone to hold the band or put something heavy on end of the band (make sure it is tied together), sit band around ankle area and continue same movement of extending the knee with foot at 30 degree angle. Try and do this exercise 3-4 times a day, 3 sets and 20-30 reps (or to fatigue). This exercise helps build the Vastus medialis obliquus muscle by the knee (shown in image below) this helps with balance and control of the knee in the absence of the ACL.
– As part of my surgery to replace my ACL, part of my hamstring needed to be taken to create the new ligament. This meant the need to strengthen the hamstring before surgery was important as well as the rehabilitation and care of it post surgery. As illustrated in the pictures below is a common exercise used to strengthen the hamstrings, it can also be done without the use of a Swiss ball. Keeping stable and maintaining control of core aim to do as many hip raises as you can, this can lead to single leg raises (when hamstrings are strong and have good control). It provides good strength conditioning for the hamstrings prior and post surgery (this exercise is also a main rehab exercise post surgery).
– Single leg knee bends is an important exercise in the pre-habilitation phase. As the picture illustrates maintaining good balance, keeping core tucked in and tight, do small knee bends. Aim to do as many as you can without losing form (it is important to maintain form so that no further damage is done during this exercise). This exercise helps with all the small muscles in the knee area that help provide balance and compensate for the loss of the ACL. Make sure to do it on both injured and uninjured leg as helps maintain good balance between both legs.
– Lastly when the knee was back to reasonable control and stability I did a lot of walking and towards the end just before surgery some light jogging in a straight line only. This type of pre-habilitation was only done when knee was capable of control; therefore either walking or jogging was done in a straight line to prevent knee collapsing in and causing further damage. It is also important to recognize that with a knee injury there also may be a lot of bone bruising around the knee joint. Therefore, not too much jogging should take place as the impact can further aggravate bruising of the joint.
Continued in Part 2