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Author Topic: Knee hyperextends after MPFL  (Read 2164 times)

Offline Jennifer34

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Knee hyperextends after MPFL
« on: June 07, 2010, 03:35:58 AM »
Hi

I had a MPFL about 2 months ago.  As I am getting more active and my knee is no longer in a brace, my PT and myself have noticed that my knee hyperextends or locks when I do stairs/inclines.  I am learning to not lock it but it hyperextends without my control.  I went on a walk today and went down a nice hill to the beach.  I did fine going down slowly but when I walked back up, it was a full time job to not have my knee hyperextend.  After a while, the back part of my knee was sore.  Any suggestions or ideas on how to prevent my knee from hyperextending.

thanks
Jennifer

Offline fraud_ninja

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Re: Knee hyperextends after MPFL
« Reply #1 on: June 07, 2010, 04:04:43 AM »
Unfortunately hyperextension is mostly from quad weakness.  I had the worst hyperextension ever with my left TTT revision and MPFL recon.  I would be walking on a flat, level surface and my leg would just give out and I would often fall over.  It was horribly annoying.  It was the worst coming down stairs.  I would have to hold onto my railing for dear life. 

I was still getting pretty bad hyper extension at 4 and 5 months after surgery.  Things I did to help build up my quads were pilates, yoga, squats, and the elliptical.  Now with pilates and yoga I could not do a lot of the moves in the beginning.  But slowly as time went on I could do more and more of the classes.  The elliptical was great because I could put it on a high resistance and it was no impact.  Squats are hard and even painful in the beginning.  If you can only go down a little bit, start with that.  There are a lot of variations to the squat which are helpful to know.  I watched some of the p90x workouts to learn some of the squat variations.

Its slow going and it takes so much longer than OS's and PT's realize to really regain quad strength and control after surgery.  But keep at it and you'll get there.
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline anniehine

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Re: Knee hyperextends after MPFL
« Reply #2 on: June 07, 2010, 10:08:28 AM »
Hi Jennifer,

So great to hear that you are moving around better and all without your brace-it didn't seem long ago when you didn't know how you were going to walk without it at all! 

I get the same hyperextension problems where my knee just snaps back and locks.  My OS told me to be aware of doing it all the time, and whenever I am standing I bend my knee a bit (although apparently this is when it is actually straight) and do a couple of dips to remind myself what position my knee should be going back to.

I think as Fraud Ninja says, the key is to get your quad strength back. I know how hard it is because I'm trying to do the same thing, but we'll get there in the end! At least you've got a nice beach to walk to!!
Left knee started dislocating at 7 years old
Hypermobile
Arthroscopic scope April 2009
Trochleoplasty at 28 years old (10.2.10)
Did 1st SLR 1.4.10 WHOOP!!
Walked through house without crutches (12.4.10) very pleased with myself!!

Offline Jennifer34

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Re: Knee hyperextends after MPFL
« Reply #3 on: June 07, 2010, 07:01:27 PM »
Hi

thanks everyone for reassuring me.  I will watch it more carefully when I am out walking around.  I am starting to wonder if I should wear the brace and unlock the flexion but lock the extension at 0-10 degrees when I am hiking so it doesn't do it.  It is really sore today and hard to bend it.  Plus, I have PT in a couple hours. 

I am able to do about 15 minutes on the ellipitcal machine and we are doing various squats on and off the wall.  I get about 10-12 minutes on the bike.

I guess I didn't think I would be getting rid of the dislocations only for my knee to know hyperextend and lock out.  I get rid of one problem and gain another.

Jennifer

Offline fraud_ninja

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Re: Knee hyperextends after MPFL
« Reply #4 on: June 07, 2010, 11:11:35 PM »
Wearing a brace will only slow the process of strengthening the quads.  The hinged brace for post-op really provides medial/lateral support but will do nothing for hyperextension due to weak quads.  I thought about doing this when I had a lot of hyperextension and I asked my PT about it.  She was adamant that I needed to not wear the brace.  You are better to be doing things that will strengthen the quad.
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline crankerchick

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Re: Knee hyperextends after MPFL
« Reply #5 on: June 07, 2010, 11:32:21 PM »
I agree with Brianne. This is just a aquad strength issue that you have to work through. I am 7 months post op and I still feel my leg about to hyperextend on occasion. Like today I was running in place and all three intervals when I first start I hyperextend every time! I can catch myself before it locks and hurts.

I guess for an activity like hiking, if it makes the difference in you being able to enjoy yourself, than maybe you should wear it, but really the only way you will teach your limb to behave as you want it to is to take control and work it through the activity.

As an aside, you mention 10-12 minutes on the bike at PT. Do you have a gym you can go to outside of PT? More time on the bike would really be beneficial. 30 minutes at a minimum for either elliptical or bike will go a long way. My doctor stresses 1 hour as the time to aim for. If you don't have a gym to go, perhaps you can ride the bike last at PT and just go longer? That is what I did sometimes when I didn't feel like going to my gym after pt just to ride the bike.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Jennifer34

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Re: Knee hyperextends after MPFL
« Reply #6 on: June 08, 2010, 05:09:43 AM »
Hi

After the hiking incident, I sent my OS an email over the weekend.  The PA called me back and reminded me that I am still healing and that I need to slow down.  He wants me to wear a brace if I decide to go hiking or any hills.  He reassured me that my quads are weak and what I am experiencing is common.  He wants me to continue to working more on strengthing exercises and continue with ROM.  I mentioned that I wanted to go up to Denali for a couple days.  He wasn't all for it but he did say that if I need to go, I need to have a brace on for the entire trip.  He mentioned that there are uneven surfaces and if I fall, I could do more damage.  He doesn't want this to be my 3rd surgery.  I am not really planning on hiking around up there.  I would take a tour or two into the park.  It's hard to slow down and let it heal.  It is hard for me to even get the idea that I am still healing 2 months post-op.  I would think that I am through the healing phase and on to the "let's enjoy life" stage.  The thought of going to Denali with a brace on is a step back, but I really want to go.  I have been out of the brace for almost a couple weeks now.  I could wait until the first week of July.

On the days that I am not in PT, I go to the gym in my apartment complex.  I do about 10-12 minutes on the bike and about 15 on the ellipitcal.  I am slowly increasing the time with both of those activities.  About 2 weeks ago, I was barely able to do 3 minutes on the ellipical with my PT behind me and I am up to 15 with no help.  The bike is still causing a lot of pain.  In my apartment, I work on wall slides, heal slides, SLRs, and bending my knee.

In PT, we do a combination of squats, stairs, marching, butt kicks, sideways walking with/without resistance band, squats holding a 4 lb ball out in front of me (that was fun), other exercises with the resistance band, bike/elliptical for 8-10 minutes, underwater treadmill (forward/backward and sideways walking with and without jets), stretching, E-stim with SLRs, TENS with ice.  It makes a long 2 Ĺ hour session.  Today, my PT tried stretching my knee while I was laying on my stomach.  Hurt like the dickens, but my knee is less tight tonight.  Yah!  Later, I found out that it is supposed to hurt and swearing is common.  I donít feel so bad for the words that came out of my mouth.

Jennifer

Offline Jennifer34

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Re: Knee hyperextends after MPFL
« Reply #7 on: June 08, 2010, 05:26:05 AM »
Hi

Forgot to ask something?  What other strengthing exercises can I do?  I do heal slides, wall slides, squats, bike/ellipical. 

With the brace, I can lock it out at 0 or 10 degrees for the extension piece and keep the flexion open.  Again, not sure if I want to step back into it for hiking.  I just may need to slow down.  Denali would be a safety issue at this point, so it was suggest to go into the brace for those 3 days.  Tough call.  I want to enjoy life without doing any damage.

Jennifer

 















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