Meniscal repair - what now?

[DaMan]

Lateral meniscus torn, had it repaired (not removed), now 8 weeks into recovery.

I'm slowly starting to squat again and did a VERY comfortable 125lbs on the smith machine (I felt like I could have gone waaaaayyyy higher but played it safe).

Doc says NEVER to squat beyond ca. 115 degrees anymore, my entire life. Also says no more kickboxing ever, my entire life. All due to risk of re-tearing that pos.

Thoughts?

Physician perceived relaity doesn't necessarily coorelate well to individual reality. People break the odds all the time. However, your probably not at a point yet where you should be slapping heavy weight.

Take is slowely with that kneew. You probably shouldn't be squating below 100 degrees. You really don't need exercises like an extension, given the sheer force created by that exercise. Your best bet is to find ways to strengthen the quads with the least amount of knee flexion possible.

Single leg, 20degree squats done in a triplaner fashion will help to strengthen VMO. Don't forget your posterior musculature. Equally strong, hams and glutes will help prevent further injury. A hamstring curl on a stability ball would work nicely. A reverse hyper would also be ideal for glutes and low back.

235lbs of Twisted_Steel and pure Sex Appeal!

[archive_Killer]

Well, consider yourself lucky becuse very few meniscus injuries can be repaired due to poor blood supply, but your rehab time will be longer due to the repair.

A sample rehab program would be to protect motion for 4 - 6 weeks in a brace that limits motion form 0 - 90 degrees. Motion beyond 90 may injure the meniscus at this time. You may perform active and assisted ROM exercises within this protected range. Isometric ex can also be used to keep muscle tone. Protected weight bearing is continued for 4 - 6 weeks. After 4 -6 weeks the rehab is progressed as tolerated to restore ROM and muscle function. Return to full activity generally occurs within 3 months.

My advise is to take it slow and perform many unilateral (one leg) exercises to straigthen out any muscle imbalances that can occur when immobilized.

How low to squat? That is up to the individual. The lower one squats, the more compressive force is placed on the meniscus, especially the posterior horn. But, I really don't see you injuring the repair itself by squating, as meniscal injuries are caused by rotation. Actually, if you had the meniscus taken out I would be more concerned with you squating low, as that may injure some the articular cartlidge.

Also, twisted is correct that leg extensions will cause shear force at the knee, but this should not be a problem for you, as you did not injure your ACL or PCL.

As far as not kickboxing, I think your doc is nuts. You had the repair so you could do the things you want to do. Everything should be fine as long as it is healed. BTW does your doc work with many athletes? I know many docs that work with older and normal individuals (non athletes) that would say the same thing. I knew one that thought no one should ever do a leg extension. It was as if the Devil created that exercise to him

[Billy_Bathgate]

I would advise in getting very good form down on the squat. You should have very little problems if in fact you do it correctly. Start off with box squats. Dont bend with your knees, bend with your ass first. This may not even apply to you, I dont know how your form is, so dont take this as an insult.

I would never use the smith machine personally. I have never been able to perform a correct squat with one, probally cause you cant since your locked into a plane of movement.

[DaMan]

<BLOCKQUOTE class="**-ubbcode-quote"><font size="-1">quote:</font><HR>Originally posted by Killer:
Well, consider yourself lucky becuse very few meniscus injuries can be repaired due to poor blood supply, but your rehab time will be longer due to the repair.

A sample rehab program would be to protect motion for 4 - 6 weeks in a brace that limits motion form 0 - 90 degrees. Motion beyond 90 may injure the meniscus at this time. You may perform active and assisted ROM exercises within this protected range. Isometric ex can also be used to keep muscle tone. Protected weight bearing is continued for 4 - 6 weeks. After 4 -6 weeks the rehab is progressed as tolerated to restore ROM and muscle function. Return to full activity generally occurs within 3 months.

My advise is to take it slow and perform many unilateral (one leg) exercises to straigthen out any muscle imbalances that can occur when immobilized.

How low to squat? That is up to the individual. The lower one squats, the more compressive force is placed on the meniscus, especially the posterior horn. But, I really don't see you injuring the repair itself by squating, as meniscal injuries are caused by rotation. Actually, if you had the meniscus taken out I would be more concerned with you squating low, as that may injure some the articular cartlidge.

Also, twisted is correct that leg extensions will cause shear force at the knee, but this should not be a problem for you, as you did not injure your ACL or PCL.

As far as not kickboxing, I think your doc is nuts. You had the repair so you could do the things you want to do. Everything should be fine as long as it is healed. BTW does your doc work with many athletes? I know many docs that work with older and normal individuals (non athletes) that would say the same thing. I knew one that thought no one should ever do a leg extension. It was as if the Devil created that exercise to him<HR></BLOCKQUOTE>

Good advice guys, thx a lot.

I've returned to kickboxing and so far so good.

Killer, my prob with my meniscus ("locking") would happen with flexion, not twisting... for example when I'd sit on my heels. I did the whole 0-90 degree thing quite a while back (I'm in week 11 after surgery right now), but I have yet to go past, I'm guessing, 150 degrees... my good leg can comfortably go to 170 degrees.

Doc thinks that too much flexion in my bad leg can cause it to re-tear (it "feels" like he's right), but his advice was to never sit on my heels again, which is just ridiculous. How long do you think till I can do that? I've slowly begun to stretch it (kindof a quad stretch) back a bit at a time...

BTW yes, he usually treats older people, although he says he's treated athletes before... though maybe none that use their legs as much as, say, a soccer player or a kickboxer.

Thx!

[archive_Killer]

As I said, Docs can be weird sometime. But that can be said of everyone in the health profession. Yesterday, I had to hear a Physical Therapist Assistant constantly tell fire fighters not to go below 90 degrees in the bench press. Yup, that sure will help their functional strength.

After the initial tear, it is very common for the knee to lock or click with no rotation. Many people lock up just walking around.

I would say start with mini squats, presses, and so forth. I think by 12 weeks you should be good to go as you wish. If you are concerned about reinjuring the mensicus, maybe squat a litle shallower than previously. Remember, the lower you go, the more compressive forces on the meniscus. Work on ROM as tolerated, but you do want to get it back to full.

Billy - I hate the smith machine too

I talked to a couple people today (physical therapists) just to see what they thought about your repair. They confirmed my advice. At 12 weeks you should be unrestricted. As far as not squatting or kickboxing, they really could not understand those contraindications. So, in the immortal words of Nike - Just Do IT

[This message was edited by Killer on 09-28-2002 at 12:45 AM.]

[DaMan]

<BLOCKQUOTE class="**-ubbcode-quote"><font size="-1">quote:</font><HR>Originally posted by Killer:
I talked to a couple people today (physical therapists) just to see what they thought about your repair. They confirmed my advice. At 12 weeks you should be unrestricted. As far as not squatting or kickboxing, they really could not understand those contraindications. So, in the immortal words of Nike - Just Do IT

[This message was edited by Killer on 09-28-2002 at 12:45 AM.]<HR></BLOCKQUOTE>

Dude, first of all, thank you SO much, you're an asset to this board.

Second, I have returned to kickboxing and it's all good. My ONLY concern at this point is the risk of re-tearing it with excessive flexion. This won't happen kickboxing, but, for example, while sitting on my heels or doing a quad stretch where my heel touches my butt. I can get my good leg back all the way (maybe 1 inch of), but the bad one about 10 inches off until I feel resistance. I COULD pull harder but I don't wanna risk... any good suggestions? (I'm asking because I've been meaning to take up Brazilian Jiu-Jitsu and now that I got laid off from my job have more than enuff time /infopop/emoticons/icon_biggrin.gif)

Thank you again!

[archive_Killer]

Getting ROM of back can be a bitch. Hard and painful. To get that quad back to your previous full ROM (the longer it has a shortend ROM, the more the muscle will accept this as normal) stretch the hell out of it. It also is more difficult to get back to normal after being immobilized, which you were. You may scream, some even tear or I have seen girls cry.

Always do a little warm-up, such as jogging in place. Then you are good to go. For the best self stretch, use a chair, table, bench, anything that you can stand in front off. Put your leg behind you (such as a terminal leg curl position) with the top of you foot on the table, chair, whatever. Lower yourself down and back, maintaining a straight or even a slightly rearward lean with the upper body (hits the rectus femoris). Hold for up to 30 seconds, rest, and repeat several times. Obviously, during and after a leg workout is optimal, as the tissue will be fully warm.

Another great time is couple hours after a leg workout. Your nervous system won't be so "jacked up" at that time, so you may be able to relax a little more and get a good stretch. Just remember, warm-up first.

If you have a training partner, you can try some PNF stretching (let's see if I can spell - Proprioceptive Nueromuscular Facilitation). Lay on you stomach. Have parnter push the hip opposite the knee to be stretched onto the table (this is called marrying the pelvis to the table). The person shouldn't let the hip rise. They could place a big towel, foam wedge, or something under your knee (to be streched)to get you in hip extension so you will also hit the rectus femoris. They push you heel towards your butt, hold for 15-20 secs, then they relax it a little. At this time you kick in your quad and perform a leg extension against their resistance for around 10 seconds. You relax and then they stretch you again. Go through the cycle several time. Always have the person finish you off (that didn't sound to good)with a stretch to reset the quad muscle. Of course, you could go without PNF and just have the person perform regualar stretching also.

Remember, your muscles are like rubber bands. If you stop stretching, they snap back. The more you stretch, the loser they become.

Good luck

Thanks for the compliment. Just trying to help the board that has helped me. Good luck with the Brazilian Ju-Jisu. I know extreme flexability will assist you in your efforts

[DaMan]

Cool, I'm gonna give it all a shot. (actually I'm seeing a PT next week too /infopop/emoticons/icon_smile.gif)

One last question - I have no problem with stretching to the point of pain, but what about the risk of re-tearing? When do I stop pushing myself?

Thx!!!