Range of Motion

[Jack Moroney (RIP)]

I have a question for you medical folks. I tore my left knee quadracep tendons in September and since then they have been reattached. I have gone thru the no movement, no weight bearing, no bending regimen since then and have, since about 5 weeks ago been allowed to start to bend the knee and as of two days ago have been allowed to put full weight on it. No walking yet and when I move around I have to wear a brace that is set for 90 degree flex and must be using the walker, crutches or wheel chair. I can now flex this thing about 82 degrees and the goal between now and 12 Jan 05 is to get to 90 degrees and or beyond. To stretch the tendons and flex the knee I usually sit on the edge of the hospital bed or in a chair and let the knee hang and place my better leg over the foot of the cut on leg and gently apply pressure. Now I know I have to do that gradually but my question is how often during the day should I be doing this and for how long for each session? In addition, I am not sure how far I should try and push the flex point beyond where the knee just sort of wants to stop. The other aspect, is having to sit up in the bed and pushing down on the leg to try and straighten it out so it goes flat against the mattress at full extention. Same question as to repetitions, duration and frequency throughout the day. I am a little tentative about getting too aggressive as the prognoisis for being able to repair this thing if I screw it up again is not good. On the other hand I do not want to be too damn tentative. Any thoughts? Thanks.

Jack Moroney

[Bill Harsey]

Good morning Jack,
You've seen the grand total of all my medical creds over in the knife area here.

I look forward to seeing what more learned people post here.

I don't assume we had the same injury in the knee.

Here is my experience recovering from a single tendon re-attachement then a multiple tendon re-attachment and a major knee surgery that included zero weight on that leg for six weeks then "go ahead and try to move it."

For my knee I used continual pressure in the direction of intended range of movement to be recovered. Sometimes this hurt, sometimes it hurt a lot and I thought I'd screwed up everything but never did. By "continual" I mean as often as I could. My knee surgeon told me that my causing swelling that went down after 24 hours was ok. If the swelling lasted longer that was a sign to back off.

For the knee, there is a time curve that you have to respect. There is nothing you can do in one minute that will speed up the healing over months. You already know that.

I think I gained range of motion back sooner than some because I worked at it all the time. For my tendon reconnections progress was tracked by the plastic/reconstructive hand surgeon who did the work and he thought I made above average "time to full range of movement." Strength comes with time. Scar tissue inside breaks down over a longer time but seems to go away so you don't notice.

The tendon stuff taught me the time curve that helped my patience for my knee healing.

Keep on it Sir!

[Jack Moroney (RIP)]

Thanks Bill. Patience with my own maladies have never really been one of my strong points, but I definitely got that message from the doc that worked on me.

Jack Moroney

[NousDefionsDoc]

The Docs will be along, but this is what I would tell you.

You know you're body. You have spent yours training it and have no doubt been injured before. Listen to your body, not your mind.

I would tell you to do it a couple of times a day. To stop at the point of "uncomfortable" not pain.

Watch for swelling and pain after working it - if you see either, you are over training it.

Take it slow, as the recovery after a set back will be significantly longer.

No extra points are awarded for over doing it.

[lrd]

While you all are answering Jack's question could you help me with mine?

After 2 months of exams and an MRI, we found out Friday that my 17YO has a torn meniscus and has to have surgery. He's on the waiting list, so it could be February or later before they get around to him. We got very little instruction on what he should/should not be doing. He works weekends at Ruby Tuesday's and is on his feet the whole time. He tried a brace but said it hurt worse than going without.

Any advice on what we should be doing now for pain and to keep the muscles in his leg in shape? or any other information I need to know for this? He wants to be ready for baseball in the spring...

(Thanks for sharing your thread, Jack. :) )

[swatsurgeon]

First Jack....google 'PNF' = proprioceptive neuromuscular facilitation, it is a method to 'pre-stretch' muscle fibers and fool the brain on muscle contraction. The example for you r quads would be sitting on a table, dangle legs...extend up until some discomfort, then have someone put their hands behind your ankle and now SLOW and STEADY flexion until you feel some discomfort...no pain! and hold this 'isotonic' position for 12-15 seconds and release, relax and re-try the extension....repeat several times and you'll see that you can extend further each time...I learned this one in the martial arts....can get most people more 'flexible' in 30-60 minutes than they have ever been before. Can do this for every major muscle group. I'm doing this now for my wife who is recovering from elbow surgery and her physical therapist and ortho doc are amazed at her progress.

Second as far as a meniscus tear, a brace that prevents lateral rotation will make it feel better, not perfevt...other than that ask an orthopod....sorry, not my main area.

[Kyobanim]

While you all are answering Jack's question could you help me with mine?

After 2 months of exams and an MRI, we found out Friday that my 17YO has a torn meniscus and has to have surgery. He's on the waiting list, so it could be February or later before they get around to him. We got very little instruction on what he should/should not be doing. He works weekends at Ruby Tuesday's and is on his feet the whole time. He tried a brace but said it hurt worse than going without.

Any advice on what we should be doing now for pain and to keep the muscles in his leg in shape? or any other information I need to know for this? He wants to be ready for baseball in the spring...

(Thanks for sharing your thread, Jack. :) )

My experience, FWIW. . .

I had a torn meniscus repaired just about 2 years ago. After the injury first occured, I continued martial arts activities for 5 months before I went to the Doc. After the diagnosis I continued reduced activities for 3 months before it could be repaired. Reduced activities was exercise to keep the strength up. No full extension of the leg, no deep stances or knee bends without support, pretty much reduced stress on the knee. Ice on the knee after activity and meds for reducing the swelling if needed.

After the repair which included removal of existing miniscus, repair of a torn ligament and cleaning up arthritis, I was on my feet with a crutch 2nd day after surgery, no crutch on the 3rd day and back to work. 3 weeks after surgery I was back teaching classes and fully active. I attribute that to the fact that I kept the knee in shape prior to surgery and, most importantly, started riding my bike religiously after a week with the Docs approval as well as his approved exercises.

I was 47 when I had this done. I'll bet your son will have an even easier time of it. But bottom line, it's like what NDD said, listen to the body, not the mind. And ask the Doc what to do. It's his responsability to look out for his patients welfare.

Oh yeah, don't take pain meds prior to work or any other activity. They can mask further damage being done to the knee.

[lrd]

Thanks, SS & Kyobanim. He got whacked on both sides of his planting leg during a punt, finished the game, and couldn't figure out why his knee looked like a grapefruit.

Kids.

[TitratetoEffect]

Mr. Moroney prior to becoming an 18D I did a little work in outpatient ortho. I would have to say that a torn quad tendon is a pretty serious injury and I have only had 2 patients that I treated with such an injury. Both were as a result of major trauma. Although I don't know a lot about your present condition or some of the obstacles you may be presented with on a daily basis, (ambulating around the house or on uneven terrain also stairs, etc.) here are some exercises that may improve your ROM (range of motion) and a little strength.
1. Heel slide - on your bed while you are watching TV lying on your back with your shoulders and head raised and involved leg straight uninvolved can be bent , put a sock on your foot on the involved side. Try to actively (using your muscles) slide your heel toward your buttocks. You can use a sheet to assist you in gaining some more ROM by looping it around your ankle and gently pulling with your hands.
2. Straight Leg Raise - While in the same position as above, keep your involved leg as straight as possible and lift it off of the bed 6 to 8 inches and repeat. Try sets of 10 or 20 to start. :lifter
3. Quad and Hamstring Isometrics - Using the same position as above contract your quad muscles without moving your involved leg and hold for 10 seconds. Relax, and then contract your hamstrings by trying to dig the heel of your involved leg into the bed and hold for 10 sec. Try 2 sets of 5 to 10.

These should get you pointed in the right direction, however you should be going to a Physical Therapist, right? I saw my patients for at least 15 - 20 visits with that diagnosis. (If I remember right) I hope that helps. Let me know how things go!

[TitratetoEffect]

A torn meniscus can pose problems especially to an active 17y/o. There are a few factors involved like mechanism of injury. Where is the tear, inner or outer meniscus? Medial or lateral? Large or small? An orthopedic surgeon must take these and other factors into account when treating this diagnosis. Bottom line is that working at Ruby Tuesday's is going to aggravate it and possibly make it worse. Swelling and pain is an indication of aggravation an worsening of the injury. It is hard to give you a definitive answer without knowing all the info. But, the best resolution is to have the surgery as soon a possible so he can get into rehab and into playing baseball. In the mean time try to decrease the activity as much as possible so as to avoid further injury.

[Jack Moroney (RIP)]

Appreciate all the input. Physical Therapy starts on 23 December-as long as I can get thru the snow from the house to the car.

[Sigi]

lrd,
I have had three meniscus surgeries (and actually need a fourth) and throughout that time - prior to the surgeries - a brace has never made the pain better. I can see how a brace may stabalize the ligament injury, but the meniscus is a little different. If I stand on one leg (the injured one) and twist my body around the knee it hurts. Moving it side to side - not so much.

So I can see where your son, after being on his feet all day, is seeing no relief from the brace. I don't want to tell him not to wear it because I am not a doc, but it never helped me.

A waiting list for a meniscus surgery? Wow.

JM,
Good luck with the recovery, Sir.

[Kyobanim]

Colonel, I'm jealous of that view. Good luck with the knee.

[TitratetoEffect]

Good Luck Colonel, I hope that helped some.

Phil

[ccrn]

Sir,

My ortho experience is limited mostly to clinicals While in school I did do a rotation on the ortho floor with mostly knee replacement.s and repairs.

As far as rom the nurses and therapists used a gauge that actually measuered the ROM of the involved joint and wanted pts to go a few mm past that.

I recommend you write these questions down on paper, and ask each and every one until they are answered to your satisfaction when you begin physical therapy. Also, I recommend keeping a diary of your PT and daily experience with your knee in general ie expercise done, pain including quaility and quantity, and set backs ie slips, litttle twists etc. This is especially useful if something happens or there are complications. They should give you several pamphlets of material too.

Google until you become a lay expert on your injury and repair.

And mostly, do everything they say, no less and only a little more-

ccrn

[Bill Harsey]

Great picture Colonel.

I'd hurt my knee helping a friend on his logging operation. The injury sheared all the cartilage off the inside 50% of the end of the femur. Much torn meniscus went with this. After the first doctor I saw about this didn't think I was hurt because I could walk even though it was owwy. I changed Docs to one who referred me to a knee surgeon.

When I went thru physical therapy knee surgery (6 weeks after surgery),
the first thing the therapist did to my knee caused us to have a conference meeting. We came to the agreement that if he didn't do that again he might be able to go home that night.

The physical therapist never knew or asked what had happened to my knee or what kind of work had been done.

Is this the normal procedure in therapy?

No one ever told me how it's supposed to work.

[The Reaper]

I'd hurt my knee helping a friend on his logging operation. The injury sheared all the cartilage off the inside 50% of the end of the femur. Much torn meniscus went with this. After the first doctor I saw about this didn't think I was hurt because I could walk even though it was owwy.



Bill:

I hate to tell you this, but I don't think that your logging boss qualifies as a physician, even if he gives you free medical advice.

TR

[TitratetoEffect]

Mr Harsey,

That is NOT SOP for a Therapist! A therapist should do a complete Physical Therapy Evaluation including a DETAILED history of every patient. You definitely need to find a different Doc and Therapist. If someone is walking (a normally painless event) and they have pain.... a few bells should be ringing in your healthcare providers head. It shouldn't echo, either. (a good selection criteria)

Phil

[Bill Harsey]

Thanks,
Maybe Jack can do better with his physical therapist than I did.

Col. Moroney is tougher than deep fried Mexican paving bricks, that physical therapist better have his "A" game going or the wrong person is going to have a health issue.