Rehabilitation of a knee injury – My Jouney – Knee Hab 2

Welcome back to Knee-Hab. If you’ve not seen the first post be sure to check out knee-Hab 1. 

This is where we get into the nuts and bolts of the program and my rationale. The initial injury occurred about 10 weeks ago. The most disappointing thing about this injury is the fact I had the best pre-season I’ve had for a good few years, was two tried in two games and was apart of an incredibly exciting project at Henley Hawks. However this is just the game of rugby and its a painful way to make firends. Twenty-four hours post I suffered a lot of joint effusion and had significant power losses on manual resisted prone knee extension. However I passed all major joint stress tests. This was great news. Being 30 and playing in my 13th semi pro season you can imagine this was a big worry to myself.

People ask me as a coach what if you get hurt? Doesn’t that effect your job? My answer….I don’t exercise for a living! Anyway I digress.

What I did immediately post.

Getting hurt is shit, it’s tough to deal with but an opportunity to rebuild.

Immediately post injury the aim wait to maintain as much function as possible and remove the physiological responses that impose restrictions. Within this I did the following;

• Got as much compression on as possible

• Iced up in the initial period – luckily the club I play for have a game ready.

• Got out and got moving – tried to keep my gait pattern as best as possible.

• Used electro muscle stimulation daily.

• Performed Isometrics within pain free ranges 2-3 times per week.

What is Joint Effusion?

Effusion is just a fancy way of saying a swollen knee. There are varing degrees like any form of swelling depending on the associted trauma to the knee. What is important to be mindful of is that this is the bodies natural reaction to protect and heal itself, so dont panic and respect the process. Depending on the severity of this will create limitations of range (because you have a fat knee) and with the associated swelling comes a decrease in proprioception. How I approached this is to be as active as possible. Use the circulatory system and lymphatic system as they are meant to. Im not a big fan of Ice long term as it is something the body doesnt understand in its natrual healing process. However there are ways to speed up the drainage of the effusion. Three simple ways are compression, elevation, massage. The key message within this is dont let it stop you from being active and using rehabilitation strategies.

What about Pain?

If you have pain within the injury sight you will also get what is known as pain inhibition. With pain you can suffer what is know as Arthrogenic Muscle Inhibition (AMI). AMI is a neural deficit which is most severe in the first few days post trauma and can persist for a long time. This is why you need to maintain activity and start rehabilitation as early as possible. As stated above you can start with low level long duration isometrics and use electro mucle stimulation. These can be performed 2-3 times a day as they are very low level. However these pay off long term.

My Training Program

Now that I am past this stage I am loading more aggressively. The video below is the workout I am doing right now. This was the first initial loading session. Remeber this diagram from part one?

I am not isolating the injury and expecting to solve my problems. Far too many ahtletes end up returning to sport becasue they are pain free and a relatively high level of function and just get injured again. Either in the same place or from and associated compensation mechanism. This happens at the top level too. Put this into context: I was offloaded from loadining for a significant period of time, do you think focussing on my pain sight is going to get the job done? I do not.

The approach I am follwing is a HIGH FREQUENCY HIGH VOLUME LOW INTENSITY Loading. The session in the up and coming video I am performing daily for 10 days and then taking 2 days to recover. With this early loading you can do this as it is not as taxing on the nervous system but provides enough mechanical stress to elicit strength gains, inter and intra muscular co-ordination and the most important WORK CAPACITY! Day 1 this session took me 60 minutes to get through with an average heart rate of 118 beats per minute. I found this session very hard and had doms in my uninvolved limb straight away as I suffered lots of peripheral fatigue. However I suffered no doms in my involved/injured limb. This is a product of pain inhibition. Therefore a high volume high frequency loadining is needed to re-educate the body into loading.

Almost 10 days later the session is taking me 30 minutes with an average heart rate of 127 beats per minute. This is telling me that I have adapted to this session. Cutting the session time in half and acheiving only a 9 beat per minute average heart rate increase. Another comparative metric for you is reps per minute. In the first instance I was performing 7.2 reps per minute, the later 14.4 reps per minute. This is without the timed hip work at the end. From this and the feel of the workout I know I am at a point where I can start intensifying load. First of all I need to conduct some force plate analysis. There I will test strength and look to compare limbs. So keep an eye out for the next installment.

From this video you can see that on the single leg squat knee tracking the right is significantly impacted. This is the representation of the lateral sling not performing to the level it should do. I will touch on this is a later blog.

Thanks for reading and any questions, comments, advise is welcomed.