Knee Rehab?

I've searched all of the past forums hoping to find something on rehabbing the knee after surgery. I do not have health insurance, so it's up to me to get it done. I had arthroscopic surgery nine weeks ago to repair a completely torn meniscus in my right knee. I've got the Ok from the doctor to continue "normal" activities, but no suggestions on rehabbing the knee other than riding the bike trainer. As you other cyclist know this is not fun, especially in the summer. If anyone has any suggestions, or has been through physical therapy for a knee injury I would certainly appreciate the info. Thanx in advance! England

sorry to hear about the knee, a few things that i have had to do on account of my knee surgeries that i remember from rehab... standing on a pillow one legged to get the proprioreceptor muscles to strengthen, work up to squat type exercises with no weight, flexion and extension stretches to get the range of motion back, light hiking when given the ok, time in the pool, "run" in the shallow end, and swim (easy on frog kick strokes).

No advice on knees, but I did break an elbow and didnt do any therapy and now I only have about 3/4 of the range of motion I used to have. So only advice I could give is try your best to do what you can, cause doing nothing will hurt you in the long run. Good luck with your recovery!

Sorry to hear that your having to deal with this.

First, take a big breath and relax ... you are going to get better and over time you will forget which knee it was. Take a long term view and take your time. It will be at least 6 months.

Right now the bike trainer is the best way to go. Set it up in front of a TV and catch up on all the movies you have missed. Don't use any type of clip in pedals. Just let your foot float around. As soon as it gets sore take a break. Any swelling, ice it... just be very patient and take your time. Start with a nice slow cadence and then increase the tempo and the friction as you go. Don't push it... I know its boring as hell, but think of it not as riding a stationary bike but as each day a step forward in your rehab. You will benefit greatly from it.

In another month or so start road riding, but absolutely no mountain biking and no clip in pedals. Toe clips will be okay at this stage. Just be very aware of your surroundings and don't push it.

In time your knees will start to feel great and you're be able to start using clip in pedals and mountain biking etc, just be realistic about how long it is going to take and take your time.

Hopefully, some docs or physio's can help you with a program if they see this post.

I was told by a couple of doctors that I would never ever walk without a limp, wouldn't be able to ski again, etc... I ended up skiing 250 days a year (two winters a year) for many years and I don't have a limp. So stay positive and get on the trainer!

Thanks again for the great advice. John the suggestion of using flats in lieu of clip-ins was extremely helpful.

The most important issue I saw, in both myself and others (having had my knee rebuilt twice), was full range of motion, particularly being able to extend your knees completely.

Good advice about easy pedaling on the bike without cleats. Also remember to doing some hamstring specific exercises, whether on a machine or swiss ball. Wobble boards are good. Also a straight leg raise with about 10 lbs. of ankle weights works well. RICE too. Got to keep that inflammation down.

All in all, you should be fine.

Keep the suggestions coming. The more exercises I have in my arsenal, the better the chances I will stay motivated. Good advice Fat Dad, for keeping the hamstring in mind, and RICE. I just got off the trainer (30 min.), and my knee is sore, but feels like it has healed.

I had a similar surgery and here's what helped me:
Lay on your stomach and do the swimmers move - kicking your legs, one at a time, holding each leg for a few seconds. This is a good one to strengthen your hamstrings - which will, inevitably, be tight.
I also recommend Bikrim or a Bikrim-type yoga. It was developed for someone with a serious knee injury and has helped me tremendously. Just make sure to tell your teacher so that they can help modify. It was months before I could kneel without hurting and that makes many of the poses challenging.
Another good one, especially if you drive a lot, is to place your foot against a wall, leg of a table, etc, and try to push out against the resistance. This is a nice way to strengthen the lateral areas of your calves and involves no impact.
I think the other thing is that as you start to heal up, do use clipless pedals. This was a good recommendation from my doctor - it helps strengthen the hamstrings, rather than just your quads, which will help keep things even front to back. I'm not sure why to avoid it post-surgery but it was a tremendous help to me after I had healed a bit.
Just some thoughts. Hope it helps!

Sara B- I will definitely go back to my clip-in pedals as soon as I've got some flexibility back. I just started the road to recovery yesterday, and will certainly do the belly leg lifts. Thanks for the additional info on the yoga. I hope you have fully recovered. Good luck.

Probably not something you want to be doing until you've got your range of motion and confidence in the joint back, but single leg deadlifts (no weight), and single leg squats (also no weight) are good ways to work the quad, hamstring, and stabilizers.

Scroll down to the second video for a good description of single leg squats: physicaltherapist.com/artic…

Here's an ok demo of the deadlifts (you want to keep your back flat and off leg pretty much straight): youtube.com/watch?v=0v-NDdm…;feature=related

TP in SLC wrote:Had full ACL reconstruction with meniscus repair in March. I just started lead climbing last week. What makes my knee feel really good is hiking and climbing....seriously. If you have the range GO CLIMBING! Bring ski poles take it slow, be aware what moves will hurt and don't let ego get in the way of pulling on gear or the rope, hell, you're getting out right, who cares about "ethics". The one piece of advise my surgeon gave me is "do a bunch of squats". Best exercise I did during rehab IMO. Good luck!

BEWARE the lead if you got a new ACL- the new ACL tissue you have is at it's VERY WEAKEST at 3-4 months, as the dead tissue put in is a conduit for growth, not a replacement. It decays and new tissue replaces it. At 12-16 weeks it is most likely to tear becuase you have significant decay of hte graft and not a lot of replacement tissue yet. You might FEEL strong, but that doesn't mean you won't screw it up in a lead fall.
That said, ACL + meniscus is not the same as meniscus.
But either way, ice and ice long and hard every time you exhaust the knee, regardless of which you did.
Do leg-press and hamstring curls (though no heavy weight on a repaired meniscus for 4+ weeks, but you are past that) but NOT lifts. Eccentric quads are OK, but do not "lift" the foot to straight with weight on it (sitting foot raises AKA reverse hamstring curls) unless there is pressure underfoot.
Etc etc etc...

For me, things went poorly in rehab- I ended up with patello-femural syndrome something awful... It very much appears that doing an excercise with pressure on the kneecap started it, but once it came, it would NOT go away! Had it for 6 months of knee-locking antrophy and pain.

Tony B- Good info, and a good reminder to take it slow. CERTAINLY no lead climbing for me for a while. That just seems a little risky to me at this time, especially since I had to pay over $5000 out of my pocket for the surgery, and don't want to f**k that up. How are you doing now ??? Have you recovered ??? I think I'm going to be OK with a little time, and patience. I would like to head up to Boulder sometime, and have a beer with you. I'm guessing you have some good stories to tell.

EDIT: For you guys with the squat suggestions... I really like that exercise, but I'm going to wait a couple of months just to be sure.

England wrote:Tony B- How are you doing now ??? Have you recovered ??? I think I'm going to be OK with a little time, and patience. I would like to head up to Boulder sometime, and have a beer with you. I'm guessing you have some good stories to tell.

Well, doing better, but recovery is very slow- because the knee had dislocated, there was apparently a lot of soft tissue damage beyond the ACL.
Anyway, climbing a bit again as of May, but not leading anything I think I could fall on and hit the foot or knee. Mostly taking it easy on cruiser runs, unless it's overhanging so there's naught to hit but air. Still can't highstep, back-step, or heal-hook to the right, etc... But at least going up stairs is possible again!
Patience is a virtue, I guess.

I had my ACL replaced and meniscus stitched, and had to do about 6 months of therapy. Here are some of the things I did:

Stretch to regain range of motion.
Start with just doing leg extensions in a seated position and leg curls lying down with no weights. I then started biking on a stationary bike with no resistance. First I had to start biking backwards because I could not go all the way around forwards. Eventually (within a week of starting to bike) I could bike forwards.
Once I had some range of motion I found the following two stretches to be very helpful. Get a 5 lb weight for you ankle. Lie down on a bed or some chairs on your stomach letting your leg hang out over the side. The weight will help straighten your leg. I found fully straightening my leg to be the hardest thing after surgery.
Just let your leg dangle straight for a long time while watching tv or something and curl it up once every 30 seconds to a couple of minutes to not strain it.
Another great stretch to work on bending your knees is to kneel on a chair with your feet over the edge and then basically "sit" so that your body weight is being pushed towards your heels. Do not push this too hard, but slowly increase your range over weeks until you can fully bend your knee.
Another thing that really helped me straighten my knee was walking backwards on a treadmill. Set the treadmill to a slow speed. Holding the side rails, start walking backwards. The treadmill basically pulls your foot forward, making you straighten your leg.
I also recall doing lots of balance exercises in PT.
Stand on your bad leg and hold your other leg straight. Bend at the waist and pick up a ball on the floor, then put it back down. Balancing on a spongy surface is also good. Try balancing on one leg with your eyes closed.
When you start to improve, add hopping exercises like up and down from a step. I used a trampoline in PT as well. I don't know how much of an issue it is with just meniscus repair, but it took a while to trust my ACL while jumping.
I also did lots of biking to rebuild muscle. After 2 weeks on the stationary, I got toe clips for my bike and started road biking. Within one month I switch backed to my clipless pedals (I usually do long distances, not in the city, so I might unclip only once or twice during a ride... initially the twisting motion hurts, so it is best to wait for the clipless pedals.)
And swimming also really helps. Lots of water resistance. Walking in the pool... walking sideways, etc. Eventually go to the gym and start with leg press, leg extension, leg curl, etc with light weight and gradually building back to a normal weight.
I did about 6 months of PT, so there were a ton of exercises, but these were some of the more major ones.

really sorry to hear about the knee. im dealing w/ rehab for acl surgery done back in april. torn almost in half along w/ my meniscus. i ride my bike as much as i can to keep it moving otherwise it tends to hurt. i also climb to remove the scar tissue otherwise it gets pretty stiff. rehab deff isnt fun but my pt has me doing half lunges on my bad knee to get it used to down hill hiking again. it still hurts pretty bad. but the bike is the best rehab from what ive been told. good luck and hang i there

chelsea

Lunges and quad sets do hurt a little, but I have found that I feel better when I am done with them than when I started- it gets the muscles balanced and all firing again and realigns things where tehy belong.

Hi England - I've had two meniscus surgeries, one where the meniscus was repaired (stitched) and the other 10 years later when the stitches blew out, and the offending torn flap was removed. I am not a doctor, so take all this with that in mind.

I think you should be cautious if you had your meniscus stitched: if you tear it again, you will find yourself back on the operating table. If you had a piece of your meniscus removed, get out there and work the knee; 9 wks is plenty to heal the surgical wounds, and it's time to strengthen the knee.

Range of motion: you probably won't get it all back. But it'll be close to your good knee if you put in the time. I don't recall any trouble straightening my leg; it was bending it all the way (sitting on my haunches) that gave me the most trouble. I like laying on my stomach and having my kids push my foot to my butt, with the goal being to touch the heel to the butt (that won't likely happen at your stage, 9 wks after surgery, but that's what you want to be aiming for). Make sure your kid (or whomever you elect to help) understands that it's not a jumping game. Slow and steady pressure until it hurts, and then back off a bit and hold it. Repeat several times every day. My PT also did this in the early going. I still do this (2-3 yr after my last surgery) to keep my knee (and attendant muscles/ligaments) limber.

I think it's your quads that suffer most. Leg extensions with increased weight every week helped me to regain my quad strength. The other exercises people have suggested sound good, too. Gym exercises and biking probably won't do much for the small stabilizing muscles. My advice for those: go find a long run of steep talus on Pikes Peak. Hike up a half mile of it (or a full mile if you wish), and then back down (ski poles for stability are wise, especially on the downhill). Next week do it with a 15 lb backpack. Then 25 lb, etc. Once you get confident, go for maximum burn in your quads on the way up. The varied angle of foot placements on talus will do a lot for all the muscles in your leg, and will help with balance and stability. Plus you'll be outside, which is a lot better than hanging out in a gym or your basement, and you'll be getting ready for what you want to do anyway: approach a cliff for climbing. Messing around in a gym only goes so far for re-training your leg to do what it used to do.

I was climbing again once my doc said "go," and I don't think you can hurt your knee if you had the meniscus removal (other than aggravate it from overuse). Climbing moderately should help with all of the above: range of motion, strengthening, and stabilizing.

I had some difficulties with my IT band on the outside of my leg above the knee after my second surgery -- it was stiff and sore for quite some time. Once again, I enrolled the kids for help: they stand on my legs (hamstrings while I'm on my stomach, and the sides of my leg above the knee with my leg bent out to the side) for deep massage. Massage therapists would probably wince at my Neanderthal methods, but it helped break down tight tissue (and kids are cheap; I can get a 15 minute massage for a tootsie roll or two).

Good luck recovering.

Bernard Gillett wrote: Leg extensions with increased weight every week helped me to regain my quad strength.

Remember- that's god for post meniscus surgery and a HUGE no-no for post ACL, as the ACL is the tissue being stressed the most with an extension unless you have high weight under the heel, like a leg press.

All such great advice! I definitely have to agree with the idea of taking your rehab slow just to be sure you're completely ready to return to your activities and to prevent any further injuries. I've had two ACL replacements, one with a miniscus repair and am now recovering from a third surgery (chondroplasty, microfracture, and lateral release). Seems I'm a glutton for knee punishment. Anyway, definitely keep riding the bike to improve your range of motion. If squats are still too difficult then another way to strengthen your quads is to do step-ups (like walking up stairs) using a box or a single stair. You can also do a double leg squat and, if necessary,hold onto a railing or something to stabilize yourself. Although it would be expensive, you might consider meeting with a physical therapist just to have them lay out a rehab plan and exercises you can do.

Good luck to you!

The response to this forum has been wonderful. I've read each post many times. Like I've said before, I was really surprised to find no previous forum on the subject. I suspected many users of Mountain Project, would have a wealth of information on the subject, and you have not disappointed. I've found that the bike trainer IS my best friend, and light backpacking trips very helpful in keeping me outside. I've also found that top rope aid soloing quenches my strong desire to get back out climb, and place gear, but in a more controlled environment. My hope is that current, and future Mountain Project users can look to this forum for some ideas on rehabbing an injured knee, or our country gets it's s**t together, and we all can have health care. Take care, and climb safe.

I had my meniscus removed (90%) two years ago (7/5/07). I echo the range-of-motion work; this will go a long way towards returning you to "normal". I used resistance bands, stretched daily, and iced regularly for at least 6 months following surgery. I got back in to cycling within 4 weeks of surgery and was climbing within 2 weeks after that. Shortly after surgery I bought a pair of hiking poles and use them every time I approach with a pack. My knee does not feel the same, probably never will. I have found that glucosamine works for me (keeps my knee from feeling stiff), my doctor says it works for some, not for others. It could be placebo, but it does work for me. I still feel like my knee is a work-in-progress, and continue to do strength and flexibility training.