Peak week of knee rehab so far

Below is a calendar representation of this week’s knee rehabilitation workout. As per hours, this is my peak week so far. Over fifteen hours. Feels like Ironman training hours. Then again my peak IM training was about seventeen hours. I am incorporating exercises as my body can handle. This week I started working on core and upper body strength workouts. Kept it simple with short reps. Also more flexion knee stretching was involved in the week as well. This concludes week seven post knee operation and week five of physical therapy. Three more weeks of physical therapy left to go. Hopefully flexion is the same as other knee by then. Fingers crossed!

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photo edited using iOS 5

Meniscus Repair Rehabilitation

Meniscus Repair Rehabilitation

(cited from the Stone Clinic

General Considerations:

• Weight-bearing as tolerated status. Walk with crutches
• Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4
weeks post-op
• Regular assessment of gait to avoid compensatory patterns
• Regular manual mobilizations to surgical wounds and associated soft tissue to
decrease the incidence of fibrosis
• No resisted leg extension machines (isotonic or isokinetic)
• No high impact or cutting / twisting activities for at least 4 months post-op
• M.D. follow-up visits at Day 1, Day 8-10, 1 month, 4 months, 6 months, and 1 year
post-op
• During the first 4 weeks: TWICE PER DAY: Without brace, allow GRAVITY ONLY to
bend knee back as tolerated BUT NO MORE THAN 90 DEGREES for a good knee
stretch without increase in pain. Relax knee and stretch for 60 seconds

Week 1:

• M.D. visit day 1 post-op to change dressing and review home program
• Icing and elevation regularly. Aim for 5x per day, 15-20 minutes each time. For ice
machine: use as directed
• Exercises:
1) quad-sets 10 sec. holds every 30 minutes
2) straight leg raise exercises (lying, seated, and standing): quadriceps/adduction
/abduction/gluteal sets
3) ankle pumps
throughout the day
4) well-leg stationary cycling
5) upper body conditioning and core strengthening
• Pool / deep water workouts after the first 8-10 days once surgical wounds are healed
and with the use of a brace
• Soft tissue treatments for edema / pain control and to posterior musculature, patella
and incisions
• Knee extension range of motion should be full

Weeks 2 – 4:

• M.D. visit at 8 – 10 days for suture removal and check-up
• Manual resisted exercises (i.e. PNF patterns) of the foot, ankle and hip. Trunk
stabilization program. Single leg balance exercises
• Continue with pain control, range of motion, soft tissue treatments and
proprioception exercises
• Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne
with uninvolved leg and arms only, pool workouts)

Weeks 4 – 6:

• M.D. visit at 4 weeks post-op, will wean off the use of rehab brace.
• Stretching, exercises and manual treatments to improve range of motion (especially
flexion)
• Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups,
proprioception)
• Stationary bike and progressing to road cycling as tolerated
• Slow walking on treadmill for gait training (preferably a low-impact treadmill)

Weeks 6 – 8:

• Increase the intensity of functional exercises (i.e. cautiously increase depth of
closed-chain exs.
• Shuttle/leg press). Do not overload closed or open-chain exercises
• Patients should be progressing to walking without a limp and flexion range of motion
should be at 80%

Weeks 8 – 12:

• Add lateral training exercises (side-step ups, Theraband resisted side-stepping,
lateral stepping)
• Introduce more progressive closed chain and agility leg exercises.
• Patients should be pursuing a home program with emphasis on sport/activity-specific
training
• Knee flexion range of motion should be equal to other knee

Weeks 12-16:

• Low-impact activities until 16 weeks
• Increase the intensity of strength and functional training for gradual return to
activities

Second Post Surgery Follow up

Today I had my second follow up visit with my orthopedic post knee arthroscopic surgery (meniscus repair). The main questions I had for him was namely when can I resume work and return to swimming. He was very impressed with my progression so far especially with my knee extension (flexion). An observation he was very worried about pre physical therapy and two weeks post surgery. So he gladly gave me the okay to resume both activities.

I have been using a cane for the last month since getting off the crutches, he said I should cease from using the cane soon as to not develop a limp while walkin. As per walk duration he also gave the go ahead not to restrict it. Biking in moderation for now as to not add too much strain on the meniscus. The swelling he said is not a concern and will still take time to completely lose the inflammation. Continue icing as much as possible. With his blessing today I will return to work and swimming in two weeks or so.

In all the three sports that triathlon offers, swimming I miss the most. Being in the water is so therapeutic to me. Can’t wait!

Tentative schedule to return to running may be February. With the NYC Half marathon in Spring I may have to cancel depending on my recovery and training leading up to it.

Next visit in two months. Four more weeks of physical therapy.

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