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Author Topic: Advice Requested - Pre-ACL tear excercises.  (Read 1365 times)

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Offline trooper_conboy

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Advice Requested - Pre-ACL tear excercises.
« on: August 01, 2006, 05:36:42 PM »
Hello all.  First post.

37 y/o male

Last week I tore my ACL (L-knee) playing basketball.  Also damaged the meniscus.  I see my doctor again in two weeks.  Surgery is immanent. He told me to keep the knee loose via riding a stationary bike with no resistance.  A Couple of questions to any of you with knowledge on the topic.

Can you recommend any other activities to increase strength and mobility while I wait for a surgery date?

I don't want to use crutches if I don't have to.  I can hobble around just find.  Any negative consequences in NOT using the crutches.

I am athletic and want to stay proactice. 

Thanks, Bill

Offline Heather M.

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Re: Advice Requested - Pre-ACL tear excercises.
« Reply #1 on: August 02, 2006, 06:22:12 AM »
Bill,

I would be very concerned about doing further damage to the other structures in the knee by walking around without crutches.  Even though you've already torn your meniscus, you can actually make that tear larger or cause it to flip over on itself and lock the knee up--I'm told the pain from this is almost unbearable.  Instant trip to the ER for most folks....

If your knee is perfectly stable and pain free, then I guess it's your call...but even one tiny mis-step or wobble can lead to further tearing of the meniscus, punching a divot out of the articular cartilage, or even tearing other ligaments and soft tissues in the joint.  It would probably help to know what kind of meniscal tear you have--is it a chunk torn off the tip, is it a large tear that could be unstable, etc. 

So perhaps the best person to answer the question about using crutches or not would be your surgeon?  Maybe a physical therapist that you trust?  I know you mentioned something about two weeks, but in truth if you do have a torn ACL the surgeon should wait until the swelling is resolved and your full range of motion (bending and straightening) is restored.  That will take as long as it takes, usually about 4-6 weeks....

Perhaps a brace might be in order to provide support for the joint and offset any wobblies...?  If you work hard doing pre-hab or PT exercises several times a day you really won't have to worry about the muscles being weakened by using assistive devices.  It's better to keep the knee stable and prevent any further injuries, if possible.

Here is a great article about ACLs--everything you could want to know about pre-hab, surgery, and rehab.  Hope this answers some questions.  *It's always a good idea to speak to a doctor or PT before embarking on ANY new exercises!  I'd really encourage you to ask your doctor--even pester him/her if necessary--to get you into physical therapy BEFORE any surgery.  That will help you get in the best shape possible and give you some ideas of what to expect following any procedures.  It's a big boost to you mentally and physically, IMHO.

http://www.drmillett.com/image/59/acl.doc  (Large document--may take awhile to download on dialup or slow connections--well worth the wait).

A great, brief overview of all things ACL:  http://www.steadman-hawkins.com/acl/overview.asp

Here's some info on meniscus injuries, which often accompany ACL problems--if you have a small tear, it could be made worse by walking on it, or falling if you are unstable....not something you want to mess with if you can avoid it, which is why walking with crutches or a brace may be recommended in the interval between injury and surgery:  http://www.steadman-hawkins.com/acl/overview.asp

Here are some more links explaining why it's good to wait between the time of injury and the date of ACL reconstruction--it avoids a lot of problems. 

This article specifically addresses why it's best to wait following ACL tears, instead of rushing into surgery:  http://www.webmd.com/content/article/17/1676_50305
http://www.physioroom.com/experts/expertupdate/interview_dshelbourne_20030701_2.php
http://72.14.203.104/search?q=cache:vLm2PoTm5rEJ:www.orthorogerson.com/Shelbourne%2520rehab.pdf+donald+shelbourne+knee+arthrofibrosis&hl=en&gl=us&ct=clnk&cd=21

Anyway, I know you're concerned about losing muscle and coordination, but if you focus on pre-op exercises you won't need to worry too much about losing strength or anything like that prior to surgery.  It's important to know that some loss of strength post-op is inevitable--but this is TEMPORARY and can be overcome with GENTLE, targeted exercises when the time is right.  Usually, the immediate goal post-op is to control swelling and restore ROM (especially extension) as soon as humanly possible.  Once swelling & pain are under control and the patient has nearly full range of motion, then the targeted strengthening work can begin; usually it is a 6+ week lag to begin even the most gentle of strength exercises, so be prepared! 

Just focus on you approved exercises, which will target the muscles you need to get through this with flying colors.  Also, the first link (article by Dr. Millett) has range of motion exercises.  It's important not to force your leg to bend or work through sharp pain--this can lead to swelling and may well delay your rehab.  Take the bending to the point where it starts to hurt and then back off until you have an intense stretch--hold this for up to 2 minutes.  This is much more effective than cranking on your poor leg and forcing it to bend through agonizing pain.  Straightening your leg is likely to be pretty painful, and a PT can help guide you through what is good pain and what isn't in this case.  There are also multiple threads on this topic in the soft tissue healing problems section under the "specialists office" heading.

Heather
« Last Edit: August 02, 2006, 06:38:59 AM by Heather M. »
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