Author Topic: 1 year post ACLR but still a few issues/advice ? (Read 2260 times)

the_player · « **on:** January 10, 2007, 06:45:06 PM »

Hi everyone,

Is it me or is everyone on this board recovering quicker from their ACLR than me

Just wondering if anyone else is still having issues after 1 year. I have been back to my consultant who told me that the knee is stable, the operation is a success and I can be discharged yet I am still getting a pain right in the middle of the knee when doing a one legged squat. I have been told by my PT (in fact two of them) that this is down to the quad not being strong enough and causing the kneecap to track incorrectly hence causing the pain but I just cant seem to get past this last hurdle. Physio has said to continue doing the squats, leg press and all of the usual stuff but the next day it just hurts even more. It's not like I've been lazy down the gym either but I just feel so disillusioned with it at the moment....

Any pointers tips much appreciated....

Ben

Kai · « **Reply #1 on:** January 10, 2007, 06:56:31 PM »

Its tough to comment... I can certainly appreciate your frustration and disillusionment tho... If I was having problems after a year I think I would definately go to my OS and complain like mad. If i got the "you need more physio" crap I would get a second and third opinion until someone told me something that made sense. If you know that you have made and honest effort in PT then I would stop blaming myself. Sounds like you have a complication of some kind. Tough break. Good luck to you.

sparkle999 · « **Reply #2 on:** January 10, 2007, 09:35:34 PM »

Hi there.

I had my ACLR october 2005, 15 months ago and i still have kneecap pain and cannot kneel symmetrically. It really does get you down,but I think it's normal. Recently I decided that I needed to stop 'actively rehabbing' my knee and just do sport and exercise as noramlly as possible. I find this quite liberating and even though my knee does not yet perform 100%, it IS coping with what I ask it to do.

xx

loz8 · « **Reply #3 on:** January 10, 2007, 10:09:44 PM »

Hi,

I am not sure i agree with Kai...it is not unusual to still have some issues 12 months on and certainly everyone recovers at very different rates. Can i ask if when you do the squats you feel totally balanced and in control and how it feels when you run...does that impact give you pain too?

Loz

celinenj03 · « **Reply #4 on:** January 10, 2007, 11:00:30 PM »

I had that pain too. That patella tendon is so sensitive and can easily flare up. Then you're caught in a cycle... I can only recommend from experience to rest your leg awhile, then start ever so gradually building the muscle up WITHOUT irrating the patella tendon or you're back at square one. I went through this cycle for months. I am just now at 8 months, able to do a one legged squat using my muscles. You also have to consider that the correct muscles have to be recruited to do a one legged squat without pain. If you do one with your good leg you see just how many muscles are used as you feel the burn.

One good baby step exercise I did for awhile was bending my leg ever so slightly and holding it for 15 seconds, then 30 seconds. If you get pain STOP. Only do the number of seconds you can tolerate even holding on to something if that helps. Just put as much weight on the leg to get you to that healthy muscle burn and hold it there. Don't hold with patella pain or you will pay later, trust me I've been there.

I think of it as having to jump start your leg. Once you get those muscles recruited and working the rest is down hill. I tell you though, it's very tedious and it takes a long time and you can really set yourself back if you push it. NEVER finish the exercise if you get even the slightest pain in the tendon.

Also remember to ice after exercise even at that point because you are still burning the muscle. I find if you really control any inflammation it helps to feel the muscle "burn" better.

Oh I remember them wanting me to do wall sits at 6 weeks post op. Oh gosh, the pain. I knew it was too soon for me so I told them no. It took me really until 7 months almost 8 months to do them without pain.

Once you build that muscle that is lacking (could be your VMO) you'll see a total difference in your knee. Don't stress over the time frame either. Everyone builds their muscle back differently. Besides if you're not doing the right exercise or if you are pushing it or overdoing it that time doesn't really count as you are only setting yourself back. I think you can turn your situation around in a few months if you really, really do it almost perfectly. Remember, never ever work through patella pain. Good luck!

henri · « **Reply #5 on:** January 11, 2007, 09:25:36 AM »

I am 6 days from being 1 year post op.And yes, i also have issues. I was also told by my doctor, that the graft is intact and working,altough i find it very hard to believe. And i have the same problem as you, pain right in the middle of the knee. I dont do one legged squats, as those hurts, but i do squat machine with 2 legs, and yes, i also get this pain. I have been quite lazy going to gym, so my muscle is still quite wasted. And yes, therefore i think it could be because of my muscle strenght. I was snowboarding for a week, and after that i had quite some pain in the middle of the knee, even when doing stairs,something i didnt find difficcult before,but this thing avaded with 1 week of resting the knee. I am now banned from exercises for 3 weeks because of health issues, but if this ban is taken off, i will return to gym and start doing more leg work and hopefully when muscle tone is better, the clicking and pain in the knee goes away. I am sure that everything is fine in your knee, it really could be something that easy, as weak muscles in your knee. If your OS and PT-s assure you , that its not the graft that is causing the problems, then most likely they are right.Maybe you should take squats easier or with lighter weight. Hope that everything goes alright.

the_player · « **Reply #6 on:** January 11, 2007, 09:47:07 AM »

Cheers for all of the advice guys - I am certainly feeling a little bit better about the whole situation now. I think I am probably getting upset with the whole thing as I really wanted to go skiing this season and I just don't think that it is going to be possible now

Looking at what everyone is saying I think I have certainly been guilty of training through the pain of the patella which I guess hasn't helped. Its just such a vicious circle.... I really thought I was improving in November and was running around 4K without pain, but it all seems to have flared up again now. I have read a few articles about building up the VMO - what have people found the most effective way of doing this ?

Also, what would you say would be the best approach for me now for the next few weeks. I'm guessing I need to rest it a bit but is there anything that I could be doing just to keep things going

In response to Loz, when I do I squat (one or two legged) I certainly feel in control (other than the knee pain) and my balance is always very good. Running does give some pain, but only really after I have been doing squats etc - the running itself doesn't seem to cause it any problems.

loz8 · « **Reply #7 on:** January 11, 2007, 10:34:18 AM »

Given your response and the fact that your balance and control are good and that your running is not proving troublesome. I would also recommend that you cut down a little and see if it settles. Keep icing too. I bet you find you are not far off being able to ski in the next 6-8 weeks...
Loz

the_player · « **Reply #8 on:** January 11, 2007, 11:09:30 AM »

Ahh, that is one thing that I have not been doing - icing that is. When should I be doing it ? After every session or every day in general ?

loz8 · « **Reply #9 on:** January 11, 2007, 11:22:20 AM »

I would recommmend Icing after a session particularly if you are still seeing a reaction of sorts. I went skiing last week 14months post op and although i had no reaction i still iced after a days on the slopes...still use my cryocuff after playing footy too. Certainly cant harm and i have always found it really helps.
Loz

celinenj03 · « **Reply #10 on:** January 11, 2007, 12:50:25 PM »

Look at it this way, your ACL situation is probably very good if not excellent, but you have developed some side effects from the surgery such as tendonitis, maybe even chondromalacia at times. It doesn't mean the surgery was not a success, but because of the surgery and the weakened muscles these "other" issues have arisen.

So you need to treat them now and deal with them, specifically for you that tedious case of tendonitis. I always ice after a pretty good strength training session. I am sure my knee still swells a tiny bit inside, though I can't see it, I can feel it, specifically when I kneel on it and it's all squishy at times. So I will ice and even take ibuprofen at times to keep that tendonitis in check.

Don't despair, it's not going to be permanant once you break the cycle. The cycle gets broken when you rebuild the muscle and when you "maintain" that muscle. In henri's case I think the muscle starts to atrophy again and the symptoms flare up again. I'm sure we will have to be concious of keeping our legs strong for quite some time, but that is a good thing.

What I have found really helps my VMO and keeps the tendonitis at bay is my stationary bike, elliptical machine, and the leg extension. I started on leg extensions with no weight at first and worked my way up slowly and gradually. I stretch very very well before I even attempt it as that is important too. I would spend a good 15 minutes stretching before the weights and sometime stretch in between sets like doing a stork stretch to keep that tendon elongated.

I am very cautious with squats. My personal trainer had me doing them and added too much weight too soon and my tendon flared up so I immediately backed off for 2 weeks to let it settle. I still worked out, just stayed away from the squats. Remember, it's a very "gradual" process. If you get too "cocky" you will pay for it later. I say that from experience as I have had 2 or 3 tendonits set backs during the past 8 months. It is VERY normal. Good luck!

P.S. You could always consider getting back to PT just for tendonitis this time. They can probably teach you how to break the cycle. You might try it on your own first, but it's always an option down the road.

jb-knee-geek · « **Reply #11 on:** January 12, 2007, 10:10:55 PM »

Hi Player, I'll just add my 2 cents to the excellent posts.

You don't mention what graft you had, if it's patellar autograft some of the pain may be due to the donor site. Just a guess on my part.

However, I had a similar source of pain due to a lack of 100% extension while I was attempting to gain strength at the 2-3 month post-op mark. I was given quad flexibility routines to do and the patellar pain cleared in a couple weeks.

I am amazed how just a little lack of extension can affect knee-mechanics, especially when trying to gain strength.

Just though I'd throw that possibility out there for you to check out.

checoski · « **Reply #12 on:** January 13, 2007, 05:30:02 PM »

Hi Ben,

I have also had some of the discomfort you describe. I am almost 4 months post op a patellar tendon recon and when I told my OS about the pain, he seemed to feel that it was the patellar tendon graft and told me not to worry about it as it was still so soon post op. I don't know if it would be the case 1 year post op, but I have certainly heard that some people with a patellar graft may have long term discomfort at the site. Did you have a patellar graft?
Having said that, I also have been told by the PT that I should watch for patellar tendinitis and am working hard on my VMO by doing sumo squats which seem to be helping build the muscle up again.
I think everyone on the site has given you excellent suggestions. Good luck on your progress.

By the way JB, what do you do for quad flexibility exercises?

Connie

jb-knee-geek · « **Reply #13 on:** January 14, 2007, 03:48:53 PM »

Hi Connie, try these for quad flex:

http://www.exrx.net/Stretches/Quadriceps/ProneLying.html

or http://www.youngwomenshealth.org/fitness/st_quad.html

If you think you're not at 100% extension, speak to an PT for more options.

the_player · « **Reply #14 on:** January 14, 2007, 06:43:18 PM »

Well I've had a few days going to the gym now and have changed my training a bit as per some of the suggestions on here. Im now doing a lot more stretching and spending a lot of my time on the elliptical machine as well as the bike which I can do for 20-30 mins without any discomfort at all. I've knocked the squats on the head for the time being to let the thing calm down.

By the way, it was a patella graft that I had. I've not tried any of this quad flexibility stuff either ? Did you find it helped ?

Ben.

checoski · « **Reply #15 on:** January 14, 2007, 07:53:29 PM »

Thanks JB ,

I have been doing the quad flex lately and working at sitting on my heels with flexion. It does seem to be fine.

Hope these exercises help you too Ben.

Connie

the_player · « **Reply #16 on:** January 15, 2007, 12:57:44 PM »

Ahh, all makes sense now - I've started doing these stretches and they are defo helping.

Interesting what you say about the sumo squat building up the VMO though... With me it is the squat that seems to cause the pain, so how could I incorporate this excercise into my routine ? Also, can you just clarify what exactly a sumo suat is ?!?

Thanks

Ben.

jb-knee-geek · « **Reply #17 on:** January 15, 2007, 07:21:46 PM »

ben - at around 2 months orso, as I was just starting to strengthen the leg muscles I had patellar pain after workouts.

Quad flex helped within weeks. I was told to do the quad stretches 6-8 times per day, in addition to the "light" strengthening program I was on at the time.

The other issue with my patellar pain had to do with my 1 or 2 degree lack of extension, which I went back to basics and used extension stretches from my initial rehab and some of feeny's basic mobility exercises as well.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29810.0

the_player · « **Reply #18 on:** January 16, 2007, 09:15:19 AM »

Cheers JB

I've certainly incorporated a lot more stretching into my routine now. I have not however been working on my hyperextension in my leg (which I know isn't 100%) do you think this may be related to the patella pain... ??

Ben.

jb-knee-geek · « **Reply #19 on:** January 16, 2007, 08:28:27 PM »

I was short a couple degrees of extension, stretching had a beneficial affect on patellar pain for me. You should see some beneifts soon if you are stretching daily or on a regular basis.

A conversation with an experienced PT and/or OS may be in order to get to the bottom of it.

Hard to say whether lack of extension or surgical outcome of using the patellar tendon may be the cause.

checoski · « **Reply #20 on:** January 17, 2007, 10:23:08 PM »

Hi Ben,

I am also doing the quad stretches more religiously and hope it starts helping. I also lack a few degrees of extension, so I wonder if what JB says maybe part of both our problems.

As for sumo squats, they're squats with both your feet pointed more outwards and then squatting. You really feel the VMO more than when you do a traditional squat. I started with 1/4 squats first. The other exercise I do for the VMO is on a machine at the gym that allows me to put light weight on the foot or ankle and do extensions and then again extending just the foot laterally to work on the VMO. Very light weights to start.

Hope it helps.

Connie

jb-knee-geek · « **Reply #21 on:** January 17, 2007, 10:44:53 PM »

the quad stretch was an routine given to me by a PT for patellar pain, here's some stretches I do from feeny's post for extension work:

b) rolled up towel under the heel, leg straight out with knee back and calf off the floor - contract quads trying to push the back of the knee into the floor whilst the leg is straight - hold contraction for 10 seconds

c) no towel for this one - leg straight out whilst sitting on the floor, as straight as it will go - push the back of the knee into the floor, contract quads and try raise the heel of your foot 1cm or so off the floor whilst your knee back is touching the floot - hold contraction for 10 seconds

d) lying on y our stomach - no towel required - stretch out both legs so you are flat on the floor, put the ball of your foot on the bad leg on the floor, and whilst keeping your hips on the floor contract the quad muscle which feels like your leg is almost "arching" straight up - hold contraction for 10 seconds.

Try to do 2-3 sets of about 10. All of these exercises must be done using the quad muscles in the legs. The objective is to teach and regain quad control evenly in both legs.

Basic quad and hamstring stretches. Always, and lots of them!

the_player · « **Reply #22 on:** January 21, 2007, 10:04:17 PM »

Cheers again for all of the info - I've started religiously incorporating more stretching into my routine now as well. I've been doing a lot on the elliptical machine, bike and light weights. I really want to start doing squats, but the minute I go into a one legged squat I can feel the patella pain, almost like its digging in. I just wish it would go away as I can't do any squats without feeling it...

What exactly is the VMO machine that was mentioned btw..

Thanks

Ben.

the_player · « **Reply #23 on:** January 21, 2007, 10:23:03 PM »

Oh, also. Ive seen these Patella straps that you can get that are supposed to improve the tracking of the kneecap.

Would it be worth investing in one of these to use temporarily whilst I work on my squats to build up the leg ?

As usual any advice MUCH appreciated!

Thanks

Ben.

jb-knee-geek · « **Reply #24 on:** January 22, 2007, 03:16:05 PM »

best to get advice from a PT or OS on this.

raquetball1 · « **Reply #25 on:** January 22, 2007, 07:50:19 PM »

Re patellar strap: if you had autopatellar recon, this could prove problematic. Studies have shown patellar tendon regrowth still going on in many patients for over two years post-op. As jbknee said, pt or os should advise.