6 months ago initial injury, 14 days ago arthroscope - m I right?

Post arthroscope I usually put my pats on an icing regime, with using a tubigrip to control swelling. This continues until swelling settles. Plus-minus anti-inflammatories for pain relief and swelling control. I usually prescribe this in the first 7-14 days post arthroscope. If your knee is still puffy, I strongly suggest ice EOD and to use a tubigrip around knee during the day while walking around or at work.

Following that - depending on what has been done at athroscope. If there has been any meniscal or ligament repair, then more care to be taken to ensure that stitching and graft holds. If not (as in your case), then rehab can progress according to patient tolerance (and any Wbing restrictions, which is uncommon post arthroscope if there hasn’t been a repair or graft).

WIth the rehab prog - I will usually try and challenge my pats as far as possible. I tell them that as long as what they are doing does not (1) increase their pain; (2) increase knee swelling; (3) affect their function, they should be right.

Immediately post-arthroscope, they;ll be doing isometric quads tightening n ankle pummping in bed.

Week 1: test for quads lag (physios can do that, basically to determine if there is a deficit in end range quads control which determines the ability of quads to hold the knee straight). If there is no quads lag, commence the following bed exercises (provided that there are no contraindications (CIs) for open-kinetic-chain (OKC) exercises:

- isometric quads (in full extn focus on VMO)
- straight leg raising (SLR) : basically lying in bed propped up on elbows if desired, keep leg straight with kneecap and toes pointed directly to ceiling, tighten quads first to keep leg straight then slowly lifting leg off bed. Keep opp leg bent with feet on bed
- S/L hip abduction: lying on side with exercising leg uppermost, bend up bottom leg for stability. Keep kneecap and toes pointed directly forwards (therefore controlling hip rotation). Tighten quads first to keep leg straight then slowly lift leg up in air.
- Bridging: lying on back with both knees bent up and feet on bed. Lift bottom up in air

If pat hasn’t got WB restrictions and is ambulating without aids, commence gentle WB exercises as tolerated:

- short range squats with both legs, back on SB at wall
- double leg calf raises at wall

Week 2: continue with bed exercises and WBing exercises as above. If Wbing ex not commenced in week 1, then start here. New bed ex:

- In prone lying, hamstring flicks. Simply bending and straigtening knee slowly controlling movement. Practice slowly through range movements and quick short range flicks.

- In prone lying, glutes. Bend knee up to 90deg. Maintain 90 deg and lift leg up toward ceiling by squeezing glutes.

WB regime – continue as above, maybe increasing depth of squats and adding isometric holding. I will still keep exercises to bilateral only and not single leg at this stage.

If pat is comfortable at this stage with exercises, ie no problems with flareups and with good control of movement, start gentle cycling – low resitance thru available knee range.

Week 3: continue bed ex as desired.

WB regime:

  • Inc knee squatting range
  • Hip ER against ball @wall (sorry I cant really describe this!) – this is an isometric single leg ex
  • Double calf raises, trial single leg raises if able
  • Continue cycling – inc resistance


Week 4:

WB regime:

As Week 3, adding on
  • Static lunges
  • Low step ups
  • Cycling – inc resistance


Week 5 and on:

Rehab Progression to work toward:
  • High step ups
  • Step downs
  • Step lunges
  • Full squats
  • Impact tasks – jumping, running, changing directions
  • Specific funtional tasks


Its harder to detail a timeline for Wk 4 on as it is dependent on how one porgresses and on one’s ability. Having said that even the first 4 weeks r also guides only, still dependent on each ind case. As long as exs r not flaring up knee condition, ie the 3 things stated above, its usually ok.

Being a pilates instructor, I also utilise a lot of pilates based ex to improve on core stability as a lot of probs arise in the first place due to poor core control. A lot of daily tasks can also be improved with improving core stability.

Hope this helps!!

Elin

PS: u noticed i havent included swimming. Its a funny one cos its highly dependent on what u intend 2do in the pool. I usually advise no breaststroke kicks for knees.