Rehab ACL Strain

[brian]

The diagnosis for my knee injury was a strained ACL. There is also a possibility of a meniscus tear. I had e-rays, not a MRI. This occurred 4 weeks ago. The swelling lasted a week.

My Ortho prescribed PT. I have been attending PT for two weeks, twice per week.

The last three sessions included: electronic stim, cortisone creme rubbed into knee with ultasound, assisted stretches, 10 minutes on an elliptical trainer, and strength training.

The strength training consisted of: wall squats (static)with ball between knees, leg press (both bilateral and unilateral).

When I do the leg press, I feel the effort in the glutes, not in the VMO.

I asked my PT (she's about 70!) about this and she looked perplexed. Shouldn't the glutes fire first?

Should I alter my foot position on the platform? Or, should I avoid the leg press entirely and try to do lunges or half-squats?

Thx in advance.

Brian

[Bill Hartman]

brian,

You're getting physical agented (is that a word) to death...e-stim, phonophoresis with cortisone (that's useless by the way)?? What ever happened to plain old ice, ice, baby?

What the heck are they stretching and how is that supposed to help and ACL Sprain (strains are muscles and tendons) and meniscus tear.

If there is concern over damage to the ACL supported squats on the wall are not a good choice. The hamstrings don't fire effectively and the quads will create a drawer effect which tenses the ACL.

Step-ups at a pain-free level, posterior chain exercises (glutes and hamstrings), unilateral bridging, sled drags/pushes, and squat variations to comfortable depths are good choices depending on symptoms.

If you have any effusion in the joint, your VMO may be inhibited. Does the joint feel really tight when you bend all the way? Most leg press variations in clinic will have a high foot placement on the footboard which emphasizes posterior chain. Lowering your foot placement may load the knee quite a bit. I personally don't use a leg press for any rehab patient.

Take everything I've said with a grain of salt (except for the phono thing...useless ) as I have not examined you. Your status, pain level, and actual diagnosis will drive your rehab.

When do you follow-up with the doc? Have you improved?

Bill

[brian]

There isn't any swelling in the inside of the knee (VMO). Is that what you meant by "effusion"?

The knee feels pretty good during the strength exercises. I am able to simulate skipping rope without pain.

I do feel some discomfort a few hours after PT. I am unsupervised when doing the leg press. I have a "more has to be better mentality". I'm better at giving advice than following my better judgement.

The therapist wants to put me on the Cybex machine next week. I asked her if that would place too much shearing stress on the knee. She told me the machine has a tibia guard.

My Ortho told me to come back if I continued to feel discomfort so he could prescribe an MRI.

I am prety sure the medial meniscus is torn. I been this route before.

The Phy Therapist told me to avoid surgery like the plague. She told me the operation could do more harm than good. She told me the strengthening exercises would help. Also, the meniscus would eventually "smooth", causing less irritation.

Does all this make sense? Or, should I see some one else?

Brian

PS:

Get some sleep.

[Bill Hartman]

Why do they want to put you on the Cybex?

The effusion would be in the knee joint. It has a tendency to inhibit VMO function.

Per your therapist..."Also, the meniscus would eventually "smooth", causing less irritation."

Uh, what??

While you may end up not being a surgical candidate, I'm not certain where your PT gets her info. If your meniscus is torn, it can create a situation that will progressively destroy your articular cartilage (although the same can be said about surgery).

Do you have any locking or giving way?

Bill

[brian]

Bill:

I appreciate your opinion, as well as your time. Thank you.

I have had 3 'scopes on my left knee and one on my right ('82, '97, and '02). Thus, I have been through PT a number of times and have a "gut" feel if the treatment is appropriate or not.

My current therapist is the owner of the facility. While clearly experienced (40 yrs is my guess), I wonder if she is as current as some of the other PTs.

As a patient I have a right to question the treatment. I will see if I can get another therapist (one that has workewd with me before) and explain my concern.

To answer your question: there is some "grabbing" toward the inside of the knee, below the VMO (medial meniscus?. I also feel some tightness at the back of the knee and along the outside. I do not know if the outside tissue is a tendon or a ligament, but it is feels less than a centimeter in diameter when my femur/tibia are at right angles.

Would you mind if I spoke with you on the phone? These e-mails are probably very time consuming for you. I may also fail to provide you with enough info.

Best regards,

BR

[Bill Hartman]

Brian,

I don't know what "grabbing" means.

Locking = the knee either won't straighten at some point or won't bend at some point, but by moving it around, it can sometimes free up.

Giving way = usually happens when quads need to activate like when you go down stairs.

Does either occur?

Just a thought...if symptoms haven't changed all that much...why not get the MRI? With your extensive history, you may just be predisposed to such injuries. At least you'll know.

Bill

P.S. Check you PM

[brian]

Bill:

I sent you a PM.

I forgot to mention that a few hours after my work out my knee gave way while coaching a soccer game.

It was weird. I was standing on the sideline, no obvious discomfort, and all of a sudden it felt like someone came up behind me and pushed my knee forward.

Looks like I'll scedule an MRI next Monday if this happens again between now and then.

BR

[Bill Hartman]

Your workout looked much better. How'd it feel?

Bill

[brian]

Today it feels as if I have some swelling behind the knee. Knee is stiff. Feels like tendonitis.

[Bill Hartman]

Too much too soon?

Bill

[brian]

I think you are right. When left to my own devices I tend to push a little more than I should.

I'll wrote down my Saturday routine for the PT. Hopefully, if I back off an exercise or set, I'll find the happy median.

It is so easy to give sound advice versus following it.

BR

[Bill Hartman]

Be sure to read through the "Statute of Fitness Limitations" post as a reminder for your progression.

Bill

[brian]

Thanks, Bill.

I will tape them to my wrists.