Knee injury – how to get back on the trail quickly?

Mike, it is difficult to find some "one size fits all" remedies for rehab after knee surgery. If you take multiple knee patients, all of the same age and stature, you will get different rehab rates, so you just have to take it as it comes. Almost thirty years ago I had a skiing injury to my right knee that was much more complex than a medial meniscus. Ten weeks after surgery, I was out of the hard cast, but the crazy surgeon did not recommend any PT at all (that was probably bad advice). Eight weeks later, and the knee flexibility was getting worse, not better. Finally I demanded PT and started into about five hours per day of it. There was little success for six weeks, and then all of a sudden things started to work again. I felt that and tried to push it farther than what the physical therapist recommended. I pushed too far, and within 30 minutes I received a setback of six weeks worth of progress. So, you have to let the physical therapist assess progress as you move along.

If the physical therapist understands how you are motivated, it is likely that they can make better recommendations. For example, you may be better off seeking long-term results rather than short-term results.

–B.G.–

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Mike,

Sounds like you already know what to do. Rehab "slowly and sensibly". Be patient but stick with the proper strengthening exercises when your knee is ready.

Go to your PT and do what they say. explain that you are a hiker and want to get back as soon as you are able.

however, Meniscus injuries are slow to heal due to poor blood supply. It also means you need to follow the surgeons protocol so that the repair is not messed up. The initial rehab is going to seem like it was made for someone 90 because you need to be careful to not screw up what they just fixed.

Everyone wants to get back but they are the medical professionals, not you. They aren't there to screw you over and keep you out longer than you need to be. they are there to help. Timelines are vague because everyone is different. you're a person not a Chevy, they didn't change your oil.

" Past experience with injuries like this have proven that I tend to push too hard, too fast and inevitably cause myself to recover slowly because of re-injury so this time I'd really like to get moving but would like to do it sensibly. "

sounds like you should listen to the doctors and PT's and do it by the book.

No specific knee advice, but anytime there is any kind of injury or any kind of "dis-ease" in the body, it's important to keep the body as healthy as possible, so that it can heal as fast and efficiently as possible.

Diet is so critical in that, next to exercise and attitude too of course. More specifically, look up Alkaline-Acid theory for diet. Many people, especially in the western world eat an over acid reacting diet. Since virtually all of our metabolic and waste producing processes are already acid forming to begin with, eating a acid reacting diet along same can really stress the body.

I've been researching and practicing this for quite awhile now. As long as i eat a more alkaline, or at least more balanced diet, i don't even get a hint of the common cold let alone any other kind of sickness. I also tend to have much higher energy levels, better stamina and endurance, cuts heal faster, and it helps my mood as well among other benefits.

Generally speaking, it's primarily fruits and vegetables which are more alkaline reacting in nature (even if they are acidic in their natural state, like citruses–lemons are one of the most alkaline reacting foods there are, despite the high innate acidity). Generally speaking, most natural starches, grains, etc are mildly to moderately acid reacting. Generally speaking, most light proteins (like most legumes, regular yogurt, milk, etc) are mildly to moderately acid producing (there are exceptions like soy–very acid reacting).

Generally speaking, heavier i.e. more concentrated proteins (like meat, certain cheeses, etc) are in between moderately to very acid reacting.

Junk foods etc are always extremely acid forming in nature.

Then there is combinations. The least acid reacting and easiest to digest combos generally are non starchy vegetables with carbs/starches or proteins. Then easier to digest starches/carbs like brown rice with lighter proteins like lentils or yogurt are moderately acid reacting.

The most acid forming combos are things like heavy/concentrated proteins with amounts of starches/carbs, so the meat and bread is an extremely acid producing. Starches/carbs with amounts of sweets/sugars is very acid reacting, so a typical pastry is quite acid forming. Another bad, but common combo is coffee with amounts of sugar and/or milk, very hard to digest and very acid forming. Decaff black coffee is ok.

While fruits and vegetables are generally the most alkaline reacting and easier to digest foods, generally speaking combining them within the same meal is detrimental since they generally digest differently. There are exceptions of course, like in much of the above general outlines, like tomatoes with salads, or avocados with salads. However, most sweet and/or citrus type fruits don't combine well with most vegetables.

Anyways for myself, i just make sure i eat more fruits and vegetables, avoid certain combinations most of the time, avoid junk foods and caffeine most of the time, and avoid stress (stress is also acid forming for the body) most of the time and as long as i do same, i feel great, stay super healthy and vital, and allows my body to heal faster.

Btw, there are more studies starting to come out that point to positive visualization as having real merit and affect beyond chance in healing (something many top athletes in their fields have known and practiced for awhile for increasing performance). So taking a little time each day to calm your mind, and picture your knee healthy, strong, and working well might be a good idea–certainly couldn't hurt.

Thanks for the feedback/advice, much appreciated!

So basically, the consensus seems to be that I have to slow down and not rush it and listen to my PT when I see her next week (but I get BORED!!).

Anyway, sounds like good advice and so far everything seems pretty good. Very little swelling and a surprisingly good range of movement (however, it's not even been 24 hrs so once again, I have to be patient). I just wish I had gotten my surgery done in November… April is training time!

Mike, did they repair the meniscus or just cut out the tear?

If they just cut it out and didn't do anything else, by all means go to town. If you PM me what it says on the script I can probably help out a bit more…
But generally, we go all out with the menisectomies (just cutting out the tear, filing it down to a stable margin) and most healthy, relatively fit folks are back to normal within a week or two.

If they actually repaired it, you're in for a long haul.

Regardless. DO NOT use heat on it. You have a fair amount of inflammation in there and adding heat will just make it swell more and hurt a lot more.

Basically use ice a lot, elevate your leg to help the swelling drain (elevate it ABOVE your heart, not just on a chair out in front of you). Keep moving it as much as you can (again, as long as they only cut out the tear and didn't repair it).

Good luck!!

Had part of my meniscus removed, and something done for a chondral defect, back in January. Still trying to get back. The exercises are pretty simple, but when I did them religiously, I had less pain and felt better. I haven't had much pain, but I have tried to go very slowly. Waited about 3 weeks before I started going to spinning classes again, and went slow. Basically, if it hurt, I stopped what I was doing. If it hurt the next day, I knew I had overcooked it and took a few days off. It bothers me less on a bike than anything else, and I was able to do a 4 day, 200 mile road ride in Moab in early March. I seemed to do more things to hurt it just stumbling around, and ended up getting a brace to stop that. So……….like you already know, go slow, and listen to your body. It will be up and down. It can be depressing. Hang in there. I did 2 laps in a 12 hour mountain bike race last weekend, and it didn't bother me at all.

Jennifer –

I believe it was just cut out, no repair. I'll PM you with a few questions that you may be able to help me with… much appreciated!

There is no fast track – the body heals at its own rate. Try and go faster than that and you'll simply cripple yourself.

Put my knee through nearly 45 degrees – sideways – thirty years ago. Ripped the ACL in half and the meniscus. I had the bits of meniscus which were floating about inside the knee removed a couple of years later but I didn't have the ACL repaired until 10 years later. In the interim I walked everywhere – literally, as I didn't own a car. As a result, whenever I went to get the knee reviewed the surgeons would say "lock your knee", I'd tense my leg muscles and the big orthopaedic surgeons would literally try to budge it and couldn't (not sure about the US, but in Australia the orthopaedic surgeons are all really big guys, often ex rugby players). On that basis they said to leave it alone.

On the basis of my experience I'd say start walking – and do physio, ice, and elevate.

of course take it slowly, but cycling is good for knees. It provides movement, but no impact. You can build your hiking muscles up by cycling and spare your joints. Plus it gets you outdoors and mobile. Usually my only exercise in preparation for weeklong hikes is my daily commute by bike, which is only 3 miles but has a big hill on the way home.

Yes, cycling is good for the knees. If that is inconvenient, then a stationary bicycle is almost as good. If you keep adjusting the seat height, you can control how much flexion is applied to the knees, so you start easy with it and then gradually adjust it. Once you get the flexibility back, you can start working on muscle strength more. Then after a while it all feels normal again.

The problem with cycling is that it is very balanced from right to left. Most of the time when you have one injured knee, you need to apply more or different exercise to that injured knee as compared to the normal knee. To do that, do indoor weight exercises, depending on what your PT recommends.

–B.G.–

Just thought I'd provide an update for those of you that have kindly provided advise (and told me not to rush it… that's been good advise!).

I took it easy for the first 5 or so days and elevated, iced and light exercise. I'm now a week and a half in and have almost a full range of movement when there is no load on the leg… a bit stiffer under load but still surprisingly good and stairs aren't much of a problem anymore.

I'm walking without a noticeable limp and my PT has advised no more than 30 minute walks on flat terrain, so I'm still trying to be good and haven't returned to walking to/from work yet (a few more days needed… the knees still a bit "clunky" feeling but no swelling or pain). I head back to the gym tomorrow night for some (light) stationary bike riding and some upper body weight training. I'm looking forward to getting back to my regular gym workouts but my PT has advised me to avoid weight training on the legs for a couple of more weeks.

I think that the real key to success is having a good surgeon and being a reasonably fit hiker/backpacker to start with. I think having well used leg muscles prior to surgery has helped me recover my range of movement surprisingly fast… so it seems that doing the right thing "before" surgery may be just as important as the re-hab you do after… just my impression.

as you are building up your leg muscles and getting knee function back to normal for trail use, I am prescribing for you a recumbent trike, like a Catrike. You can totally get a leg workout, lots of knee movement and quad workout, but no impact. I do that, and do weights for other parts of my bod, but I rely on the bike for all leg conditioning. It totally transfers to hiking, and strengthens knees in a low impact manner. If I don't hit the bike hard enough, my knee can get weak and buckle on stairs. That tells me I have to not be such a slacker on the hill going home on the bike, and attach that hill more aggressively.

I've had several knee surgeries, and am currently rehabbing from some tendonitis in my foot, so I know a thing or two about rehab. If it has not already been said, make sure your PT understands that you are an athlete and not just some Joe off the street, and you want to be as aggressive as is prudent. Let him or her know you can tolerate some pain, as well. As has been said, cycling is a great way to go, as well. I started cycling again about a year and a half ago in part because I kept hurting myself in my other pursuits, and it is much easier on knees, ankles, etc. if done right on a bike that fits.

I'm coming up on 3 weeks since the surgery and I'm still working on the knee which is coming along very well. In the last couple of days I have managed 5 mile walks on moderate terrain and last night I rode the recumbent bike for half an hour at the gym as well as doing some light strength training with my legs (first night back on the weight machines with my legs).

I have to admit, the recumbent bike has been working really well (thanks for the suggestion Bob), but I have to say that Bob's bike looks like a lot more fun than the one I ride at the gym! My PT told me to try a bike and it seems to have really helped me regain a good range of movement.

I've planned a few days away camping/hiking/flyfishing in a week, so I'm hoping everything will be good by then. Hiking and wading on slimey boulders could be challenging but I can always sit back and watch the others fish if need be (beats sitting at home!).