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Knee Rehab

HawaiianPride.

HawaiianPride.

Senior Member
Oct 21, 2010
152
51
#1
Knee Rehabilitation

A successful, appropriate exercise program for the knee does not require expensive, joint-specific equipment, additional personnel, more office space or extra time. While isokinetic machines are valuable for research, current knee rehab concepts do not consider such equipment necessary. The low-tech approach can be quite effective for the treatment of most knee conditions. With an understanding of normal knee function, knowledge of the involved muscles, and simple, at-home exercise equipment, doctors of chiropractic can readily help their patients with knee complaints. What follows are the important rehab components, along with specific recommendations for several common knee problems.

Effective Programs for Specific Conditions

Stretching and passive motion. Muscle imbalance inhibits normal joint function and limits functional range of motion. In some knee conditions, improving the flexibility of shortened and tight muscles is necessary. Slow, sustained stretching, performed regularly and frequently, is effective, and can usually be started immediately, even in the early stages following an injury. Gentle, passive movement of the joint also should be initiated soon after an injury to prevent the formation of adhesions, which make future rehab more difficult. If an injury is unusually acute (with joint effusion),an initial period of relative rest with cryotherapy is appropriate.

During this period, however, exercise of the opposite leg should be encouraged. Vigorous exercise of the uninvolved contralateral leg muscles produces a neurological stimulus in the injured muscles (called the "crossover effect"),and helps prevent atrophy.

Three knee conditions, in particular, benefit from specific stretching. Iliotibial band syndrome is an overuse condition that causes pain along the lateral aspect of the knee. Ober's test is positive for a shortened iliotibial band and indicates the need for lengthening of this long segment of connective tissue. Jumper's knee (or patellar tendinitis) and Osgood-Schlatter's disease are caused by repetitive excessive tension on the patellar tendon below the kneecap. When the tendon is attached to the still-open growth center at the tibial tuberosity, adolescents develop the characteristic swelling and bony disruption. Both conditions benefit from gentle, progressive stretching of the quadriceps muscle group and temporary avoidance of jumping and sprinting activities.

Isotonic resistance (open and closed chain). Weak or injured muscles can be strengthened rapidly with the use of isotonic resistance exercises. The resistance can come from a machine; weights; surgical-grade rubber tubing; or using the weight of the body. More important than the equipment used is whether the knee joint is exercised in an open- or closed-chain position. The knee is part of a closed kinetic chain when the foot is fixed (usually on the ground). The knee and leg are utilized in this fashion during most daily and sports activities, and require the co-contraction of accessory and stabilizing muscles. An open-chain exercise is done with the foot and lower leg moving freely. Both approaches to resistance exercise are useful, but one may be more appropriate for a certain knee problem than the other.

Open-chain exercising can be initiated early with a symptomatic knee, as it doesn't require the musculoskeletal structures to bear the weight of the body. Initial exercising should be done with a limited amount of movement - from 30°( to full extension (called "terminal extension" exercises). These exercises are particularly useful for patients who have patellofemoral tracking problems, with symptoms traditionally described as chondromalacia patellae. Meniscal tears also are more safely exercised when the damaged cartilage is not bearing weight directly. As the patient progresses, additional resistance can be supplied safely with at-home equipment incorporating surgical-grade rubber tubing.(these bands can be purchased at gill athletics vis the internet)

Closed-chain strengthening, with the foot on the floor, is considered a functional form of exercise. However, when ligaments have been damaged and there is joint translation and slipping, much caution must be taken initially. Injuries to the anterior cruciate or medial collateral ligaments respond well to resistance exercises that control knee joint alignment, by fixing the foot to the floor. Examples include partial squats ,lunges and step-ups, or stairclimbing. Resistance can be increased progressively and gradually with the use of hand weights or a weight bar. The leg-press machine is another closed-chain exercise device available at many gyms; however, this machine does not retrain the co-contraction of accessory support muscles as fully as do weight-bearing exercises.

Eccentric exercise. When the injured tissue is a tendon, the eccentric portion of resistance exercising has been found to be particularly useful. This entails focusing on the lengthening or "negative" part of a strength exercise (the "letting down" of the weight or tubing). For the knee, this is performed most easily by descending a stair or stepping off a box. The contraction of the quadriceps muscles as they lengthen is particularly useful in strengthening the tendons involved in knee-extensor disorders, such as patellar tendinitis and patellar tracking problems. This movement also contracts other muscles, which must assist in the complex movements required of the knee. Specifically, the patient steps down onto the uninvolved leg, while controlling the movement with the quadriceps of the problem knee. The patient then returns by pushing back up with the uninvolved leg. Three sets of 10 step-downs are helpful when performed at least once a day.

Proprioception and coordination. For many athletes (recreational or competitive),it is important to regain the fine neurological control necessary for accurate knee and lower-extremity movements. Approximately five to 10 minutes each day should be spent standing on one leg on a mini-trampoline, or using a specialized rocker board, with the eyes closed. The advantage of these balance exercises is seen when a patient returns to sports activities and can perform at high levels without consciously having to protect the knee. Rocker-board exercises are particularly necessary after ligament, meniscus, and muscle injuries, but also can help patients with chronic knee problems regain full function. Research has shown that custom-made orthotic support also can help improve balance and proprioception.

Plyometric exercise. To re-establish the rapid responses necessary for ideal performance in many sports, advanced exercises designed to develop explosive power are necessary. Plyometric exercises include jumping with rapid returns, "bounding" style of running, or dropping off a box and quickly jumping up as high as possible. These types of exercises are useful during the final phase of rehab for all athletes who hope to return to full function after any type of knee problem. Sedentary patients, and those who do not need to develop this level of specialized contractions, generally do not need to progress to this specialized type of knee rehab.

Functional alignment. Many chronic and overuse knee problems develop secondary to imbalances in weight-bearing alignment of the lower extremities. These imbalances need to be addressed to resolve the patient's current symptoms and prevent future knee problems. In fact, measuring the Q-angle often demonstrates that patients with patellofemoral problems have underlying lower-extremity misalignments. Leg-length discrepancies and pronation problems frequently are associated with iliotibial band syndrome, patellar tracking problems, and chronic, degenerative knee complaints. Even anterior cruciate ligament ruptures have been found to be more common in athletes who have excessive pronation. The use of custom-made orthotics or heel lifts is often a necessary part of a comprehensive knee rehab program.

Shock absorption. For patients who already show evidence of degenerative changes to the joint surfaces, providing additional dispersion of ground reaction forces is necessary. Even healthy young athletes who expose their knees to frequent pounding (runners, basketball players, etc.) should be supplied with shock-absorbing insoles to decrease the stress transmitted from their feet to their knee joints. Many recreational athletes can avoid developing knee problems if they are fitted with custom-made orthotics that support the feet and ankles, and limit the forces on the knee joints. Shock-absorbing orthotics provide almost immediate symptom relief for patients with chronic, degenerative knee symptoms.8

Early Detection and Care

Instituting an appropriate and progressive rehab program is key to managing patients with knee complaints.9 Several rehab techniques are available, none of which require expensive equipment or excessive time commitments. Selecting the best exercise approach for each patient's knee problem is important. A closely monitored home exercise program allows the doctor of chiropractic or physical therapist to provide cost-efficient, effective rehabilitative care.

Perhaps most critical in the long term is addressing any biomechanical alignment problems associated with knee complaints. This entails screening the patient for excessive pronation and leg-length discrepancies. Failure to recognize these complicating factors can result in a patient with recurring knee complaints, or possibly symptoms that vary in location. In other words, once an area is treated and strengthened, another will begin to show the effects of the underlying biomechanical stress. Once the lower extremities are aligned properly, the muscles strengthened and lengthened, and the two joints of the knee work smoothly, patients can enjoy the benefits of functional knee joints well into their elder years.

Thank you to fellow Chiro Dr. K Christenesen for her valubale info and help..
 
Sadie

Sadie

TID Lady Member
Oct 2, 2010
167
30
#2
on the subject of rehab i'm curious to know if anyone here has had a detached mcl and severely torn acl and NOT had surgery? is it possible? did you get full rom and stability back? if so how?

the idea of surgery if freaking me out.. would like to avoid it if at all possible.. thanks guys
 
biguglynewf

biguglynewf

TID Board Of Directors
Oct 11, 2010
693
141
#3
Sadie...I am in the process of recovery from an acl reconstruct and meniscus repair. I also tore the mcl however the it apparently healed and required no surgery. The name of my injury was the terrible triad. (since I damaged all three - the acl was a grade III tear which means complete tear) You will be able to function without the repair however sports will be pretty much out of the question since without your acl you knee will have not stability front to back. So ROM will come back. Stablity will not. Do not let any one convince you otherwise. Strengthening and developing "quick" hamstrings will not compensate fro the lack of the ligament. Basically you will not be able to pivot and the knee will click out, sometimes you will even fall over. Unfortunately it looks as though I may have to get another surgery as there seems to be to much play in the joint still. I am waiting for another MRI as we speak.

Get the surgery if you are active. If that's you in your pic you are definitely far too young to not get it done IMO, but that is a choice you have to make. Its a day surgery and the pain did not seem as bad as the originaly tear. They took my graft from my hamstring but there is another surgery where the doc will take the graft from the patella tendon. The rehab process in a long one. Up to a year. I have lost at least 3 inches off my left quad and close to 2 on the calf from before the injury, but at least once this is over I will be able to fully function again. Not having the surgery was not an option for me.

If you want to chat further hit me up with a PM. I'm not an expert but I am living it! lol.
 
Sadie

Sadie

TID Lady Member
Oct 2, 2010
167
30
#4
Sadie...I am in the process of recovery from an acl reconstruct and meniscus repair. I also tore the mcl however the it apparently healed and required no surgery. The name of my injury was the terrible triad. (since I damaged all three - the acl was a grade III tear which means complete tear) You will be able to function without the repair however sports will be pretty much out of the question since without your acl you knee will have not stability front to back. So ROM will come back. Stablity will not. Do not let any one convince you otherwise. Strengthening and developing "quick" hamstrings will not compensate fro the lack of the ligament. Basically you will not be able to pivot and the knee will click out, sometimes you will even fall over. Unfortunately it looks as though I may have to get another surgery as there seems to be to much play in the joint still. I am waiting for another MRI as we speak.

Get the surgery if you are active. If that's you in your pic you are definitely far too young to not get it done IMO, but that is a choice you have to make. Its a day surgery and the pain did not seem as bad as the originaly tear. They took my graft from my hamstring but there is another surgery where the doc will take the graft from the patella tendon. The rehab process in a long one. Up to a year. I have lost at least 3 inches off my left quad and close to 2 on the calf from before the injury, but at least once this is over I will be able to fully function again. Not having the surgery was not an option for me.

If you want to chat further hit me up with a PM. I'm not an expert but I am living it! lol.
i have heard of the triad... the MRI tomorrow is to determine how bad the acl is and to see if the meniscus is torn also.. i have OK front to back stability but ZERO lateral stability... also it seems as tho my upper and lower legs arent moving together.. the slightest thing makes my knee "collapse" which sends burning shooting pain up my leg.. there is almost no question that the mcl is detached.. just need to find out about the other 2..

yes thats me in my avi.. im 32.. very active.. lift 5-6 days a week.. do kickboxing and jujitsu.. im gonna cross my fingers that the acl isnt totally detached and that meniscus isnt damaged.. im worried about the lateral stability but you have given me a little hope about the acl.. front to back i have control of my knee.. its side to side that is out of the question.. ugh.. guess ill know soon.. they mentioned grafting friom my hamstring tendon actually which in general just totally freaks me out.. that whole leg is just a train wreck. i got a grade II tear of that quad about 4 years ago and my ankle on that leg is train wrecked.. needed but avoided surgery on it for about 10 yrs now.. was hoping i could avoid this too.. thanks for the info and i hope everything works out for you hun
 
S

schultz1

Bangs Raiden's mom VIP
Jan 3, 2011
3,427
812
#5
I have just recently gone through a torn meniscus without any surgery. I was on complete rest from any training activity for about5 weeks ( probably a week to long ). Aftertha time i started a light rehab program of eliptical running and light squatting. It got better each week. after 3 weeks I was back to light activity and am now back to my normal activities at 100%. I am sure something will have to be done in the future as this is the second time it has happened. I will prolong it as long as I can.
 
biguglynewf

biguglynewf

TID Board Of Directors
Oct 11, 2010
693
141
#6
Keep us posted with your mri results Sadie.....As I said Anything you need just ask! I'll keep my fingers crossed for you!
 
jdjack

jdjack

MuscleHead
Sep 22, 2010
568
32
#7
Sadie. You sound like you may NEED surgery. You need lateral stability from the ligaments even more so than anterior to posterior, and vice-versa stability. I'd get everything fixed at the same time if I were you. No reason to have to go back in and cut more later down the line. Just make sure to get in rehab asap.
 
Sadie

Sadie

TID Lady Member
Oct 2, 2010
167
30
#8
Sadie. You sound like you may NEED surgery. You need lateral stability from the ligaments even more so than anterior to posterior, and vice-versa stability. I'd get everything fixed at the same time if I were you. No reason to have to go back in and cut more later down the line. Just make sure to get in rehab asap.
well the MRI showed a detached MCL a badly sprained ACl and no notable damage to the meniscus.. the doc said i dont need surgery but to expect pain for another 3-6 months... i HOPE within that time i get more lateral stability.. he thinks ill be back to normal and said to slowly start using my leg more.. the thing that scares me is this.. almost EVERYTHING hurts.. my knee gives out doing very basic things.. i was getting into the car last night after the gym.. i pivoted SLIGHTLY not even on purpose and it felt like i got hit in the leg with a baseball bat.. is it realistic to think that will get better in 3-6 months?? i dunno... the doctor also said there is nothing physically stopping my ROM but i still cant straighten or totally bend my leg.. there is still a band of rock hard swelling from where i assume the MCL attached to the shin all the way up to to the bottom of my quad... i sure hope its the swelling that is limiting the rom but if i dont feel lots better/more stable in a few months im getting a 2nd opinion..
 
IronCore

IronCore

Bigger Than MAYO - VIP
Sep 9, 2010
4,321
1,535
#9
sadie are you using any sort of compression braces? it may help to get you doc to prescribe you a good one for the next few months... i say prescribe so that your insurance will pay for it...

anyway good luck!
 
biguglynewf

biguglynewf

TID Board Of Directors
Oct 11, 2010
693
141
#10
She needs a custom fit brace that prevents the knee from moving a certain way. this will prenvent possiblitiy of further injury. A compression type brace will no doubt make it feel better and offewr some stability but with the main ligaments in such disrepair it needs to be structural. Expensive but insurance will pay. My ACL brace was $1500. MCL should repair itslef. And good to hear no acl nor mensicus damage. It will get better Sadie....It will just take some time. Be sure to rest it as it needs it.
 
Mindlesswork

Mindlesswork

Crusty Poo Butt
Sep 21, 2010
1,395
33
#11
I have a damaged and worn meniscus in my left knee and a frayed ACL in my right...thanks to playing football as a teen and also from stupid stuff I did as a kid. I sometimes feel the right knee giving out at times and my left is pretty bad too and never had surgery to clean these up.

well the MRI showed a detached MCL a badly sprained ACl and no notable damage to the meniscus.. the doc said i dont need surgery but to expect pain for another 3-6 months... i HOPE within that time i get more lateral stability.. he thinks ill be back to normal and said to slowly start using my leg more.. the thing that scares me is this.. almost EVERYTHING hurts.. my knee gives out doing very basic things.. i was getting into the car last night after the gym.. i pivoted SLIGHTLY not even on purpose and it felt like i got hit in the leg with a baseball bat.. is it realistic to think that will get better in 3-6 months?? i dunno... the doctor also said there is nothing physically stopping my ROM but i still cant straighten or totally bend my leg.. there is still a band of rock hard swelling from where i assume the MCL attached to the shin all the way up to to the bottom of my quad... i sure hope its the swelling that is limiting the rom but if i dont feel lots better/more stable in a few months im getting a 2nd opinion..
You should convince your doc to prescribe surgery to reattach the MCL, as you are quite active and which will help you regain stability in the knee. And as for the sprained ACL, you are quite lucky there as it's not torn just strained so all it needs is time to heal. Good luck and hope everything will be put right
 
Last edited:
jdjack

jdjack

MuscleHead
Sep 22, 2010
568
32
#12
She needs a custom fit brace that prevents the knee from moving a certain way. this will prenvent possiblitiy of further injury. A compression type brace will no doubt make it feel better and offewr some stability but with the main ligaments in such disrepair it needs to be structural. Expensive but insurance will pay. My ACL brace was $1500. MCL should repair itslef. And good to hear no acl nor mensicus damage. It will get better Sadie....It will just take some time. Be sure to rest it as it needs it.
Well maybe if there was universal coverage, but til then.... who knows.

You icing it? You MUST do this as often as you can for 20-30min at a time. But not directly on your skin or you can give yourself frostbite.

You should convince your doc to prescribe surgery to reattach the MCL, as you are quite active and which will help you regain stability in the knee. And as for the sprained ACL, you are quite lucky there as it's not torn just strained so all it needs is time to heal. Good luck and hope everything will be put right
The only problem is that in order to get to the torn area, and tie it back together, and help it heal properly, the surgeon must CUT through good tissue, which then needs to heal as well. You can strengthen it and keep it strong til you mess it up again. Its not exact until there's a major or complete tear.
 
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