Left Meniscus Repair - Rehab Advice

[Yog3nd]

Good day to everyone

A year back I had a left meniscus tear (left knee) after playing soccer. I went for surgery to get it repaired and was told that I was fortunate that the meniscus wasn't that damaged and it was sewn back in place. I went for physiotherapy for a few months but due to certain commitments back then, I could not attend the sessions regularly.

Now, I notice that the whole of my left leg is much weaker and my thigh muscles are much softer compared to my right. Previously my physiotherapist had told me that since my left leg is weaker than the right, I should build up more muscle by using a heavier weight when working out my left leg. She had mentioned the term "strength deficiency" or something of that nature.

My question is how do I know what is the exact weight I should attempt to train with in comparison with my right leg? And which exercises should I focus on? I humbly seek your expert advice . Cheers!

Yog3nd

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[Canuck Physio]

Good day to everyone
And to you!
A year back I had a left meniscus tear (left knee) after playing soccer. I went for surgery to get it repaired and was told that I was fortunate that the meniscus wasn't that damaged and it was sewn back in place. I went for physiotherapy for a few months but due to certain commitments back then, I could not attend the sessions regularly.
Very fortunate indeed!
Now, I notice that the whole of my left leg is much weaker and my thigh muscles are much softer compared to my right. Previously my physiotherapist had told me that since my left leg is weaker than the right, I should build up more muscle by using a heavier weight when working out my left leg. She had mentioned the term "strength deficiency" or something of that nature.
It appears simply that your left leg muscles are weaker than those of your right leg (possibly due to immobility? avoiding weight bearing?) I don't know what it means by building up more muscle by using a heavier weight, are you being prescribed exercises just for the left leg?
My question is how do I know what is the exact weight I should attempt to train with in comparison with my right leg? And which exercises should I focus on? I humbly seek your expert advice . Cheers!
There are several ways to go about finding a solution to this problem, but it also depends entirely on what equipment you have available.
I would be inclined to work the stronger limb first, and then work the weaker limb to its maximum capacity (this may be at lower weight, or lesser rep range). This implies that you are completing unilateral or single limb movements at the moment. Closed chain bilateral movements can be progressed to (e.g. squat) at a later time.

There are really many ways to go about this, but other factors need to be taken into consideration. Considering the one limb is weaker, has the therapist considered muscle balance issues. Does the weakness affect the way you walk? If so purely strengthening the muscle without taking into consideration the kinematics of current movement may compound further muscle imbalance and contribute to dysfunctional movement.

Additionally I would suggest performing exercise under supervision. You could progress much more quickly if you were able to do for example a leg press machine with the aid of someone who can help you match your left sided leg weakness to the performance of your Stronger limb

Yog3nd

As above, however more information would be useful

[Yog3nd]

Thanks a lot Canuck Physio

For your expert advice. There were quite a few aspects that I was totally unaware of, until I read your post.

When I was attending my physiotheraphy sessions, the physiotherapist prescribed exercises for just one leg. I guess that I had got it wrong about the part of using heavier weights to build more muscles on my weaker leg. Pardon me please.
The physiotherapist first asked me do a leg extension (one rep), using the max weight (about 60lb) and then she asked me to do the same on my left leg, on which I could only do like 20lb. So there was a difference of 20lb and since my left leg is way weaker, she told me to just concentrate on gaining strength on my left leg alone.

At this point, the weakness doesn't affect the way I walk though. I am not really able to see the physiotherapist regularly as the location is quite a distance from my place. But I do go to a gym located nearby with my cousin who helps me out. I was wondering whether I could attempt to improve my leg condition on my own for now rather than not do anything.

You had stated:

You could progress much more quickly if you were able to do for example a leg press machine with the aid of someone who can help you match your left sided leg weakness to the performance of your Stronger limb

I'll follow your instruction and work my stronger leg first and then focus on my left leg. So with my left leg if I can only lift a weight of 20lb, I'll stick to that and do lesser reps than my right?

Thank you so much for your reply and advice. Really appreciate it.

[hari priya]

closed chain exercises are as helpful as open chain where you keep the leg fixed and move proximal part as in half squats.while strengthening we can also determine the repitition maximum that is if you could lift 10lb to the maxrange for10 times it is your RM.start working from 5lb per set one set include 10 repitition then progress gradually increasing the weight and also the sets.

[Canuck Physio]

For your expert advice. There were quite a few aspects that I was totally unaware of, until I read your post.

When I was attending my physiotheraphy sessions, the physiotherapist prescribed exercises for just one leg. I guess that I had got it wrong about the part of using heavier weights to build more muscles on my weaker leg. Pardon me please.
I do not think I am trying to totally contradict your physiotherapists recommendations. Obviously if your Physio has observed your problem they should be able to examine your problems first hand
The physiotherapist first asked me do a leg extension (one rep), using the max weight (about 60lb) and then she asked me to do the same on my left leg, on which I could only do like 20lb. So there was a difference of 20lb and since my left leg is way weaker, she told me to just concentrate on gaining strength on my left leg alone.
Please see the research information below as to why I believe one should train both limbs during injury
At this point, the weakness doesn't affect the way I walk though. I am not really able to see the physiotherapist regularly as the location is quite a distance from my place. But I do go to a gym located nearby with my cousin who helps me out. I was wondering whether I could attempt to improve my leg condition on my own for now rather than not do anything.
I always recommend continuing hands on physiotherapy from a physiotherapist because they are highly trained professionals who can spot problems coming on. Just like a personal trainer at the gym, they understand which muscles work, and the biomechanics of muscle movement, and especially the soft tissue changes that may occur, or muscular imbalance. The fact is you have a significant difference in strength, and your body will attempt to 'compensate' by activating muscles elsewhere causing muscle imbalance issues, and altered firing of neural signals. Additionally a physiotherapist could help to facilitate appropriate movement to best aid the body to return back to 'normal' functional capacity. :-)
You had stated:

You could progress much more quickly if you were able to do for example a leg press machine with the aid of someone who can help you match your left sided leg weakness to the performance of your Stronger limb
By this I mean for example if you are completing muscle work on a machine, you would be closely monitored by a therapist for example who could aid you to move the weight in an equivalent fashion to the stronger limb.
I'll follow your instruction and work my stronger leg first and then focus on my left leg. So with my left leg if I can only lift a weight of 20lb, I'll stick to that and do lesser reps than my right?
If for example you complete a leg extension exercise: select a weight that you can use with proper form for each limb, while using the heaviest weight possible for each limb, again this is based on the article I posted below which suggests that one should train bilaterally. The neural response from the brain will be one that will attempt to equalize the strength imbalance but this will come moreso when you progress to bilateral closed chain exercises.
Thank you so much for your reply and advice. Really appreciate it.

Hello again, please read above, and see the following Ref:

Ref:
Have you ever injured a limb and been unable to train it for weeks or months? After the injury’s healed your left with one arm or leg a lot weaker and smaller than the other. Anyone who has experienced this knows how frustrating it is and how long it takes to rebuild the once injured limb to its former strength. However, there is some good news! If this ever happens to you, there are some definite steps to take to minimize the strength and muscle losses and get back on track much quicker.

First, scientists have known for quite some time that training one leg also improves the strength of the other. So rather than wait until your injury has healed, keep training using your good arm or leg. Working your good limb will increase the strength of the injured limb. Interestingly, most of the benefits are seen when heavy weights are used.

Based on the fact that heavy weight training involves a significant stretching component, Dr. Nelson and co-workers from Northern Arizona University examined whether a unilateral stretching program would increase the strength of an unused limb. The researcher got a group of college students to stretch the calf muscles of only one leg. After ten weeks, strength in both legs improved from stretching only one leg!

Similar to weight training, it appears that stretching can activate spinal reflexes enough to prevent a loss in strength and possibly increase the strength of an injured limb.

[physio.smith]

There are many things that you need to consider when trying to rehabilitate, here are a few things to think about (not meant to be definitive and just a guide that may help.

*what are your aims (what do you want to be able to do)
*short term / long term goal setting (useful to stay focused / motivated)
*what is your base line (what are you currently able to do)

You need to make sure that before you start doing too much that you have full range of motion at the knee. Also watch out for swelling, heat, restriction in movement, pain etc..post exercise, these are good indicators that you are doing too much (muscle ache relating to increasing activity is fine, just give yourself adequate rest between sessions)

Injury can leave muscles around the injured area, as well as those further away from the sight weakened. This is often compensated for by stronger muscles, which can leave the joint suceptible to further injury. Thus seeing a physio (sports rehab specialist) for functional assess / muscle testing and exercise program advise is a good idea. It is important to ensure strength of isolated muscles that may be weak, such as glut. max., glut. med., quads, calf, are strengthened before functional exercises are undertaken (thus leg press, leg ext, calf raise / press, glut. max prone, glut. med. side lying etc......before squats, lunges, step downs and running etc).

Clark, NC suggests using 2 tools for assessing strength..
*Limb Symmetry Index (%) =Injured Limb / Non-injured Limb x 100
(Barber et al, 1990; Daniel et al 1982...Normal 85-90%, Clark suggests >/= 90%)

Leg Press (single)
*Relative Strength Index (%)=Weight Lifted (Kg) / Body Weight x 100
Aiming > / = 125%

Ensure good technique when testing and maintaining alignment of joints. Speak to good sports physio / sports rehab. specialist / good gym/personnel trainer (who understands nature of injury and training progression in relation to this) for a good strength training program (not just weights work...don't forget glut. med etc)

As strength does not necessarily correlate to functional ability it is important to progress to functional activities when appropriate (Clark, 2001; Fitzgerald et al., 2001)

Progress functionally from non-impact, to low impact to high impact as able, ensuring good form and no adverse reaction before moving on...be advised by therapist.

God info in following articles...Clark (2001) Phys Ther Sp, 2, 91-105; Clark (2004) Sport Ex Med, 18, 16-21.

Some functional tests that may be useful to monitor progress, as appropriate...
*Single Leg Press Test
Predicting One-rep Max
Periodization Training

*Adapted Crossover Hop for Distance
Clark et al, 2001

*Step Down Test
Loudon et al, 2002

*Star Excursion Balance Test
Hertel et al, (2000); Lauren et al (2000)

*Figure 8 Shuttle Run
Keskula (1996); Anderson et al (1991); Tregner et al (1986); Risberg & Erkland (1994)

Couple of good courses therapists may be interested in...
*Functional Performance Testing Following Knee Ligament Injury
*Proprioceptive & Neuromuscular Control in Rehabilitation of the Lower Limb

Hope this was not too waffly and of some use....there is loads of stuff out there, best to see a good therapist for program with goals etc...should not need to see too often if initial time is spent assessing / forming your program.

Good Luck.

[Yog3nd]

Guys,

Thanks you so so much for taking time to explain to me. Really appreciate it a lot. Canuck Physio, I'll really do some reading up and I'll go back to the physiotherapist before I attempt anything. Physiosmith and haripriya, my many thanks also... I'll incorporate your suggestions at my own time.