wrist pain in the gymnast - consult Prep Performance Center in Chicago

Wrist Pain in the Gymnast

Gymnastics is an extremely intense sport both emotionally and physically. The physical demands of this sport unfortunately leave gymnasts susceptible to almost any injury under the sun. Wrist pain is very commonly experienced by gymnasts, males, and females alike. Distal Radial Epiphysitis, also called “Gymnast Wrist”,  specifically, is a common diagnosis that may explain this wrist pain amongst gymnasts due to the sport’s repetitive nature. 

Upper body injuries are more common in male and female gymnasts compared to other sports. The upper extremities are weight-bearing joints and absorb direct forces in all events of both men’s and women’s gymnastics. Acute injuries, such as a wrist fracture, often occur from a fall on an outstretched arm. However, injuries related to overuse and overtraining, such as Distal Radial Epiphysitis, are more common in gymnasts. 

The Diagnosis and How This Occurs:

– Distal Radial Epiphysitis, also known as “Gymnast Wrist”, is a growth plate injury to an adolescent gymnast with immature, growing bone structures
– The growth plate is prone to injury because the ligaments and joint capsule of the wrist are stronger than the cartilaginous growth plate 
– Repeated loading and wrist hyperextension cause the body’s forces to be directed to the radius bone which has not yet fused. This causes inflammation and widening of the growth plate. This often occurs with dorsal wrist impingement. 

Common Symptoms:

– Several weeks of unilateral or bilateral wrist pain 
– Usually occurs gradually, without history of acute trauma 
– Worsened pain with load bearing activities and when the wrist is extended 
– Pain relieved with rest 
– Range of motion normal or slightly limited due to pain
– Possible decrease in grip strength 
– Tender to palpation along the distal radius 
– Swelling may be present 

Differential Diagnoses:

– Dorsal Wrist Impingement 
– Scaphoid Stress Fracture 
– Carpal Ligament Sprains (Scapholunate and Lunotriquetral Ligament Injuries) 
– Triangular Fibrocartilage Complex Injuries 
– Ulnar Impaction
– De Quervain’s Tenosynovitis 
– Distal ulnar or radial stress fracture 

Pertinent Tests/Diagnostic Imaging:

– X-ray findings will typically appear normal
– In severe cases, a widening of the growth plate or ulnar variance may be visible
     – X-rays may be recommended 6-12 weeks post diagnosis or when symptoms subside to verify proper healing, but are usually not necessary if the initial X- rays appeared normal 
     – Routine X-rays may be recommended for about 6 months to one year post injury if the initial X-ray showed a lot of damage to the growth plate
– MRI is not usually necessary 

Risk Factors:

– Repetitive stress predisposes the wrist to acute injury, overuse injuries, and degenerative damage 
– Adolescent athlete with premature growth plates 
     – Adolescent gymnasts ages 10-14 are more likely to have wrist pain
– Recent growth spurt causing transient weakness at the growth plate

When to Seek Medical Attention: 

– Persistent pain that does not improve with rest over time 
– If this condition progresses it could lead to a fracture of the growth plate or ulnar variance 
– Ulnar Variance: if Gymnast Wrist becomes chronic and goes untreated, the growth plate may close prematurely resulting in cessation of radial growth too early, while the ulna continues to grow
     – Positive Ulnar Variance (the ulna appears longer): may result in altered wrist biomechanics, decreased wrist range of motion, and altered loading in weight bearing positions of the wrist 
     – Progressive damage to the ulnar side of the wrist may increase risk for chronic wrist pain and dysfunction

Ulnar variance - consult Prep Performance Center

Principles and Goals of Wrist Pain Treatment:

– Decrease the stress that is causing the pain
     – Stop weight bearing exercises for about 6 weeks or until symptoms subside 
– Wrist rehab to achieve symmetrical wrist range of motion and strength 
– Improve shoulder flexibility and thoracic spine mobility 
– Alternative training and conditioning aimed at improving upper body and core strength to decrease the stress on the wrist joint when returning to gymnastics 
– Stage 1: correct impairments in joint mobility, muscle length, and neuromuscular control in the spine, shoulder, and upper extremity joints
– Stage 2: continue manual techniques to correct impairments, progress exercises in neuromuscular control, introduce sport specific activities in limited weight bearing positions
– Stage 3: address impairments with manual techniques as needed, advance exercises in neuromuscular control, progress sport specific activities to full weight bearing positions  

Return to Sport:

wrist braces - consult Prep Performance Center in Chicago

– Once there is a decrease in pain, and range of motion and strength have been restored, the gymnast can begin a gradual increase in training load
– It is important that there is careful attention to sport biomechanics and proper form/ technique to limit further damage or re-injury 
– Wrist braces may also be worn to limit excessive wrist hyperextension 

Exercises to try if you may have Wrist Pain in Gymnast:

Wrist specific exercises 
     – Hand arch and splay 

Hand arch and splay - Prep Performance Center in Chicago
     – 4-way wrist strengthening (flexion, extension, ulnar and radial deviation) 

Upper body exercises 
     – It is important to have stabilization in proximal joints such as the shoulders and spine in order to improve stability and decrease stress in the elbow, wrist, and hand 
     – Scapular retraction and Shoulder ER at 90-90 
     – Planks and Side Planks 

Exercises to treat wrist pain in the gymnast - Prep Performance Center in Cebu
Training modifications 
     – Supported handstands on a wall, block, or table to decrease weight through the wrists and hands 

PT Role in Preventing Wrist Pain:

Overuse injury prevention
     – Limit excessive loading of the wrist
     – Maintain wrist joint flexibility
     – Incorporate wrist strengthening into training
     – Emphasize proper technique to reduce unnecessary stress 
     – Strengthen core and upper extremity joints to reduce stress on the wrist joints 
     – Wrist braces may be used in skeletally immature gymnasts to decrease the load on the wrist joints and help prevent early closing of the growth plates 

 

References:
Benjamin HJ, Engel SC, Chudzik D. Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete. Current sports medicine reports. 2017;16(5):322-329.
Boucher B, Smith-Young B. Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report. Physical Therapy in Sport. 2017; 27:38-49.
DiFiori JP, Puffer JC, Aish B, Dorey F. Wrist Pain in Young Gymnasts: Frequency and Effects Upon Training Over 1 Year. Clinical Journal of Sport Medicine. 2002;12(6).
Hart E, Meehan WP, 3rd, Bae DS, d’Hemecourt P, Stracciolini A. The Young Injured Gymnast: A Literature Review and Discussion. Current sports medicine reports. 2018;17(11):366 375.
Poletto ED, Pollock AN. Radial Epiphysitis (aka Gymnast Wrist). 2012;28(5):484-485.
Trevithick B, Mellifont R, Sayers M. Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics. Journal of Hand Therapy. 2019.
Written for PREP Performance Center by Gianna Scala, SPT

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Low Back Pain in the Gymnast - visit at PREP Performance Center in Chicago, Illinois

Low Back Pain in the Gymnast

Gymnastics is an extremely intense sport both emotionally and physically. The physical demands of this sport unfortunately leave gymnasts susceptible to almost any injury under the sun. Low back [lumbar] pain, specifically, is one of the many ailments common amongst gymnasts due to the sport’s repetitive nature. There are a number of diagnoses that may explain this low back pain experienced by so many gymnasts, but one of the most common diagnoses that may be relieved by physical therapy is Spondylosis or even Spondylothesis.

Diagnosis in Low Back Pain:

– Spondylosis is the degeneration of the spine due to overuse
This unilateral or bilateral overuse involves the pars interarticularis of the posterior vertebral arch. This pars interarticularis defect, also referred to as a stress fracture, consists of fibrous tissue. 85-95% of defects occur in the lower lumbar region at L5, with L4 being the next most common vertebra. 
Lumbar instability may progress to spondylosis or even spondylothesis
– Spondylolisthesis is a progression of spondylolysis leading to forward displacement of one vertebral body in relation to the one below it, usually secondary to a bilateral pars defect. This displacement is progressive, especially during rapid growth spurts of early adolescence. It is most common at L5-S1. 

Common Symptoms of Low Back Pain:

Gradual onset of pain, progressively worsens 
Pain is a dull ache and worsens with activity
Occasional sharp pain with certain activities or changing positions 
Pain with prolonged positions such as sitting or standing 
Pain restricts activities of daily living or sports performance 
May feel unstable or have a catching pain through motions not at end range
Rest usually relieves symptoms 
Possible history of local trauma or a previous injury, but usually not from a specific incident

How Spondylosis occurs:

Spondylosis occurs over time with a higher incidence in the young athletic population (gymnasts, football players, divers, wrestlers, weight lifters)
It is commonly from excessive or repeated hyperextension activities which are extremely common in gymnastics, along with generalized laxity and lumbar hypermobility
Weak core stabilizers, especially the transverse abdominis can also contribute to back pain. If the core is not stabilized with movement, the spine becomes the victim of excess motion and increased loading. 

Differential Diagnoses:

Spondylolisthesis 
Sprain/ Strain Injuries 
Disc Pathology
Facet Joint Pathology
SIJ Dysfunction
Stress Fracture 

Pertinent Tests/Diagnostic Imaging:

Referral to MD for further imaging and evaluation 
Spondylolysis defect is known as the “Scottie Dog” appearance on X-rays 
If it has progressed to Spondylolisthesis, the severity will be graded on a I-IV scale depending on the amount of forward displacement of the vertebra 
Clinical Tests in PT
+ Prone Instability Test
+ Gower Sign
+ Reverse Spinal Rhythm deficits 
Clinical Prediction Rule for Stabilization Protocol: aberrant motion observation, excessive flexibility in a straight leg raise (hamstring flexibility), 
+ Prone Instability Test

Risk Factors of Low back pain:

History of low back pain 
History of traumatic hyperextension 
Generalized hypermobility or diagnosis of a hypermobility disorder such as Ehlers-Danlos Syndrome 

When To Seek Medical Attention: 

Persistent pain that does not improve with rest over time 
Palpable step off along the back (if the vertebra has slipped forward, an indent may be felt along the lower spine)
Numbness or tingling sensation in the lower extremities (if the vertebra has slipped forward, it may be pressing on a nerve root and could cause sensation deficits) 

Principles of Treatment:

Course of anti-inflammatory medication may assist with pain relief and inflammation
Osseous healing is not absolutely necessary for excellent clinical outcome
Limit any activities that increase pain- modify practice/ training program, extension typically avoided 
Find rest and relief postures when sustaining positions that increase pain 
Spinal brace may be necessary if imaging suggests Spondylolisthesis
      – Prevent motion at that spinal segment to allow the bone to heal 
      – Possible 3 months in brace with no PT, followed by PT with progressive return to sport 
Focus PT on gluteus and core strengthening 
      – Strengthening, stabilization, and motor control is usually the focus of treatment 
Safe extension activities- limit hyperextension in practice 
Safe return to gymnastics and proper loading patterns
      – Movement analysis to address contributing factors 
      – Address movement deficits to prevent this from reoccurring 

Maintenance of strong supportive trunk muscles is very important, as well as sport specific training with a neutral spine, postural education, and sensorimotor control
Do not progress to new levels of rehab unless there is successful completion of the previous level without provocation of pain and normalized active range of motion
It is also very important to address any psychosocial components that could be contributing to the gymnast’s pain. Young gymnasts often train at a high intensity from a very young age and are under a lot of pressure from coaches and teammates 

Goals of Treatment to Low Back pain:

Decrease pain
Normalize tissue palpation and length 
Improve strength of individual muscles as well as overall functional strength  
Postural education and correction 
Improve dynamic stabilization 

Return to Sport:

Total rehabilitation time for return to sport is between 2-6 months 
Phase 1: Rest and Protect 
Phase 2: Static Stabilization 
Phase 3: Dynamic Trunk Stabilization and Coordination 
Phase 4: Athletic Enhancement and Gradual Return
Phase 5: Independent Exercise Program and Re-Injury Prevention Program 
Return to gymnastics requires:
      – Pain free ROM
      – Improved functional strength 
      – Proper spinal awareness and body mechanics 
      – Technique refinement to ensure proper body mechanics when performing skills repetitively or when fatigued 

PT Role and How to Prevent Spondylosis:

Improve core and lumbar stabilization 
Postural education 
Education on training modifications 
Education on proper technique and body mechanics 
Screen for psychosocial risk factors

 

References:
– Cavalier, R., M. J. Herman, E. V. Cheung and P. D. Pizzutillo (2006). “Spondylolysis and spondylolisthesis in children and adolescents”
Dankaerts, W., & O’Sullivan, P. (2011). The validity of O’Sullivan’s classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): overview of a series of studies and review of the literature. Manual therapy, 16(1), 9–14. doi:10.1016/j.math.2010.10.006
– Jackson DW, Wiltse LL, Cirincoine RJ. Spondylolysis in the female gymnast. Clinical orthopaedics and related research. 1976(117):68-73.
Hoffman, S. L., Johnson, M. B., Zou, D., Harris-Hayes, M., & Van Dillen, L. R. (2011). Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Manual therapy, 16(4), 344–350. doi:10.1016/j.math.2010.12.007
– McNeely, M. L., G. Torrance and D. J. Magee (2003). “A systematic review of physiotherapy for spondylolysis and spondylolisthesis.” Man Ther 8(2): 80-91.
– Newell, R. L. (1995). “Spondylolysis. An historical review.” Spine (Phila Pa 1976) 20(17): 1950-1956
– Winslow JJ, Jackson M, Getzin A, Costello M. Rehabilitation of a Young Athlete With Extension-Based Low Back Pain Addressing Motor-Control Impairments and Central Sensitization. Journal of athletic training. 2018;53(2):168-173.

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Stress Fracture Dancer - Prep Performance Center in Chicago, Il, USA

Stress Fracture in the Dancer

What is a stress fracture?

Stress fractures are one of the most common sports injuries that typically occur as a result of repetitive overuse that exceeds the ability of the bone to repair itself. High-impact activities like jumping can fatigue muscles and cause an inability to absorb additional shock or stress, which eventually transfers to the bone and causes microfractures, which without adequate rest can lead to a stress reaction and eventually fracture. The most common lower extremity stress fractures involve the tibia (approx. ½ of all stress fractures in children and adults) or metatarsal bones (25% of stress fractures). Less common stress fractures include the fibula, navicular tarsal bone, pelvis, and femur. 

Specifically, in the dancer population, the most prevalent stress fractures occur in the feet, particularly the second and third metatarsals, fifth metatarsal (Jones fracture), or sesamoid bones. Tibial stress fractures are the most common stress fractures that occur in the leg. 

Common Symptoms:

– Localized tenderness with palpation at the pain site, sometimes with swelling around the area

– Dull pain with a gradual onset that worsens during weight-bearing activity
– Pain that diminishes with rest
– Possible bruising around painful site

Differential Diagnoses:

Tibia
    1. “Shin Splints” (medial tibial stress syndrome)
    2. Compartment Syndrome 
Foot
     1. Plantar fasciitis
     2. Metatarsalgia
     3. Morton’s neuroma
     4. Posterior Tibialis Tendon Dysfunction
     5. Lisfranc Injury 
Pelvis
     1. Pathologic fracture
     2. Rectus femoris strain 
     3. Iliopsoas Syndrome

How Does it Happen?

Bone adapts to increased load in weight bearing through a process of remodeling, which speeds up as the load increases. Some bone tissue is destroyed (resorption) and then rebuilt during this process. However, when bone is unaccustomed to sustained forces without enough time to recover, resorption of bone occurs faster than the body can naturally replace it, leading the body more susceptible to a stress fracture.

Risk Factors:

– Dancers who dance > 5 hours per day (Ballet) 
– Hormonal or menstrual disturbances (long duration of amenorrhea) (Ballet) 
– Participation in running and jumping sports
– Rapid increase in physical training program
– Excessive physical activity with limited rest periods
– Poor pre-participation physical condition
– Female sex
– Hormonal or menstrual disturbances (long duration of amenorrhea) 
– Low bone turnover rate
– Decreased bone density
– Decreased thickness of cortical bone
– Nutritional deficiencies (including dieting)
– Extremes of body size/composition
– Running on irregular or angled surface
– Inappropriate footwear
– Inadequate muscle strength
– Poor flexibility
– Low levels of Vitamin D
– “Type A” behavior 

When to Seek Medical Attention:

Contact your doctor if pain becomes severe or you begin to feel pain at rest or at night
– If you have had a history of stress fractures you should consult your doctor to rule out an unhealed stress fracture
– Particular attention to the signs of Female Athlete Triad/RED-S (disordered eating, irregular or absent menstrual cycle, and low bone mineral density) in female and male athletes should be considered and managed with a multidisciplinary approach (sports psychologist or counselor, nutritionist, registered dietician, physician, PT, etc)

If You Suspect You May Have a Stress Fracture:

Modified activity
     1. Cross-training with swimming and cycling to maintain aerobic fitness while avoiding weight bearing stress
     2. Avoid continuous activity that provokes symptoms
     3. Seated exercises during dance class (prescribed from PT) 
Protective Footwear
    1. Stiff-soled shoe for walking 
    2. Removable brace
    3. Taping 
NSAIDS, cryotherapy 
Decrease weight bearing on painful area
    1. May need to use crutches to offload stress through injured area

How To Treat Stress Fracture:

– Maintain weight bearing restrictions as prescribed by physician 
– Active rest/modified activity without decreasing fitness
– Seated range of motion/strengthening: 
    1. Ankle exercises: ankle alphabets, seated plantarflexion/dorsiflexion/inversion/eversion with resistance
         – Foot intrinsic: marble pickups, towel scrunches, toe curls
    2. Knee exercises: eccentric hamstring and quad strengthening 
    3. Hip exercises: side lying abduction/clamshells, prone hip extension
    4. Core: Crunches, modified planks 
– Progress from isolated muscle strengthening to strength and form correction during routine 
– VIDEO TAPE MOVEMENT! Record self dancing and work with PT to identify areas to improve body mechanics  

Return to Sport:

– In most cases it takes 6-8 weeks for a stress fracture to heal
     1. DO NOT return to activity sooner than this! You increase your risk for larger, harder to heal stress fractures and chronic problems with a stress fracture that never healed properly
– More serious stress fractures take longer due to extended non-weight bearing status 
     1. Femur: 8-14 weeks
     2. Navicular: 16-20 weeks
– Doctor may confirm that the stress fracture has healed with X-rays and follow-up examination
– Weight bearing during single leg hopping (landing a jump) should be completely pain free 
– Gradual return to activity: alternate days of activity with days of rest
– Consider biomechanical analysis of dance movement pattern for long-term health and modifiable positioning to put less stress through joints

Prevention:

– Eat a healthy diet rich in calcium and vitamin D. Ensure adequate calories to replace energy expenditure. 
– Use proper footwear and replace worn out shoes (typically every 8-12 months). Avoid wearing flip flops and high heels frequently due to lack of support/stability
– Start new activity slowly and gradually increase time and intensity back in studio 
– Cross-train or rest at least once a week to avoid overstressing one area of your body 
– Add strength training to prevent early muscle fatigue and bone loss: use resistance bands, weights, or your own body weight 
– Proper warm ups and cool downs every practice! 
– If pain or swelling occurs, immediately stop and rest for a few days and consult doctor or orthopedic specialist if pain persists

Contributor: Erin Gentile, SPT 
Former Professional Irish Dancer 
PREP Performance Center Student Intern 

References:

– Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68(8):1527-1532.
– Kadel NJ, Teitz CC, Kronmal RA. Stress fractures in ballet dancers. Am J Sports Med. 1992;20(4):445-449.
– Schoene L. A guide to diagnosing and treating common dance injuries. Podiatry Today. 2013; 26(4):48-54.
– Laid JC, Kruse DW. Assessing readiness for en pointe in young ballet dancers. Pediatr Ann. 2016 45(1):e21-25.
– Tosi M, Maslyanskaya S, Dodson NA, Coupey SM. The Female Athlete Triad: A Comparison of Knowledge and Risk in Adolescent and Young Adult Figure Skaters, Dancers, and Runners. Journal of Pediatric and Adolescent Gynecology. 2019;32(2):165-169.
– Noon M, Hoch AZ, Mcnamara L, Schimke J. Injury Patterns in Female Irish Dancers. Pm&r. 2010;2(11):1030-1034. doi:10.1016/j.pmrj.2010.05.013.
– Albisetti W, Perugia D, De Bartolomeo O, Tagliabue L, Camerucci E, Calori GM. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers. Int Orthop. 2010;34(1):51–55. doi:10.1007/s00264-009-0784-3

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Sinding-Larsen Johansson Syndrome (SLJ) treatment and analysis contact Prep Performance Center in Chicago

Why Does my Knee Hurt: Sinding-Larsen Johansson Syndrome (SLJ) Edition

SLJ: What is it?

SLJ is a syndrome that can occur when the growth plate on your knee cap encounters excess stress. Children and adolescents have open growth plates on bones throughout the body, these growth plates (apophyses) are normal and quite literally the place where the bone grows. Apophyses can be especially susceptible to irritation because they are often also a site where ligaments and tendons attach. Because SLJ is a syndrome that affects the growth plate of the knee cap, those going through a growth spurt (ages 9-14) are more susceptible to this type of injury. The good news here is that once you are done growing, it is very likely your pain will resolve. But how can you manage these symptoms and stay active if you do have SLJ…? Keep reading! See related article from Cleveland Clinic.

What are some SLJ symptoms I might experience?

– Pain and swelling at the bottom of the knee cap

– Pain that worsens with running, jumping, stairs

– Pain increases with squatting or kneeling

I’m having pain that is starting to limit my ability to participate in activity… what should I do?

First and foremost, rest. In order for the body to recover and remain healthy, it must be given time to rest. So take a few days off from full participation in your sport or activity. Secondly, ice the painful area for 10-15 minutes following activity. Ice is a natural anti-inflammatory and analgesic. Third, consider making an appointment with your physical therapist at PREP Performance to create a plan for rehab and prevention.

What can I expect from physical therapy?

At your first visit, your physical therapist will administer a comprehensive exam of your strength, range of motion, muscle length and functional movement in order to identify all contributing factors to your symptoms. From these findings, your physical therapist will create an individualized plan of care to address these factors and start you on your path to feeling better. A typical session may consist of manual therapy to address tissue restrictions and inflammation, strengthening and stretching of specific muscle groups contributing to impairments, and discussing activity modifications when not in the clinic. At home, it is crucial to continue making progress by following the home exercise program created by your physical therapist!

What can I do to prevent my knee pain from returning?

Because SLJ involves the growth plate of the knee joint, a structure that will continue to be vulnerable as you grow.. it is important to continue being consistent and persistent with your home exercise program. This means being consistent even after physical therapy is over and your knee feels better. Prevention of reinjury is essential in order to remain pain free and healthy for full participation in your sport! Your physical therapist will provide you with all necessary resources to continue injury prevention interventions at home.

Contact Doctor of Physical Therapy, Mary Kate Casey at our Chicago, IL clinic today! Through our movement analysis, we can assess hitting and throwing mechanics and help you improve performance and reduce your risk of injury. Give PREP Performance Center a call at 773-609-1847 for more information on our movement analysis program!

 

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Crutches & Brace - How long does it need to use after ACL surgery

ACL Surgery: how long do I need to use my crutches & brace?

Following ACL reconstruction, athletes are always curious when they can ditch the crutches and brace and start working towards their previous activities.  The graft type, the complexity of your surgery (i.e. if/what other tissues were repaired), and your overall healing capacity are factors that help determine your timeline.  The following should give you an idea of what to expect whether you had your ACL repaired or your ACL and meniscus repaired.

If you had only the ACL repaired with crutches:

Initially use crutches & brace:

– You can expect to initially walk with the crutches and your knee brace locked in extension. Your knee lacks stability and strength as your new graft is healing, so one of the main goals for the first phase following surgery is to protect the graft.

Crutches:

– A bone-patellar tendon-bone (BPTB) graft is considered more stable than other options, so your surgeon may clear you to walk without crutches as long as you don’t experience an increase in pain. For many, this milestone is met in 7-10 days post-op – using crutches after ACL surgery.

– For those with a hamstring graft or allograft (harvested from a cadaver), your surgeon may prefer you to keep walking with crutches and partial weight-bearing progressing to weight bearing as tolerated for 4-6 weeks after surgery. In order to ditch the crutches, you’ll need to demonstrate proper gait mechanics and quad control. According to NHS website, your physiotherapist will advise you about what exercises to do.

Brace:

– Performing a straight leg raise without a knee lag (shown below) is usually a good indicator that you’re ready to unlock your brace (from 0-90° knee bend). That is, laying on your back and lifting your leg towards the ceiling while keeping the knee in full extension throughout the entire movement. When the quads are weak, you’ll see a compensatory bend in your knee as you lift (aka extensor lag) which may straighten out at the end of the movement.

– Individuals are often cleared to stop wearing their brace while walking around the house 6 weeks after surgery if they’ve achieved appropriate quad control.

– Regardless of graft type, your MD may clear you walk without the brace slightly earlier if you demonstrate good quad control and can walk without asymmetry and abnormalities (like limping).

But what if I had my ACL & meniscus repaired?

Menisci are cartilaginous crescent-shaped rings between your femur and tibia that absorb shock, distribute force, increase stability of the knee joint, and provide lubrication to promote long-term joint health. Naturally, concurrent injury to the ACL and meniscus means that your recovery is more conservative.

Initially use crutches & brace: 

– Similar to if you solely underwent an ACL repair, you will initially walk with crutches, partial weight bearing restrictions and your brace locked in extension.

Without crutches & brace:

– Protocols vary in their instruction based on surgeon preference and your progression through your recovery.

– It’s common to be restricted to walking with brace locked in extension, crutches and partial weight bearing for 6 weeks following surgery.

– Or you may get the okay from your surgeon between 2-4 weeks, to unlock the brace from 0-90° of knee bend (flexion) but maintain use of crutches.

– You may be instructed to begin weaning off crutches in 4 weeks. Again, this is usually dependent on appropriate quad control and gait mechanics.

**Please remember that your timeline can vary based on your recovery and the specifics of your surgery. Always consult your surgeon and physical therapist before discontinuing use of crutches or brace.

 

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Total Knee Replacement (Part 3) - Prep Performance Center

Total Knee Replacement (Part 3)

Phase II – Motion Phase (Day 3 – Week 3) Progression to OUTPATIENT PT 

Knee Replacement – By now you are starting to feel like you can get around your house and may have had some in-home physical therapy.  Your knee most likely still hurts and you have made some progress with your knee flexion and extension, but you still have a bit more to go.  You may have progressed to using a cane for in-home walking and stairs, but think about bringing your walker for walking longer distances outside.  

BASIC Home Exercise Program (Complete 3-4 times per day, approx. 10-15min) – knee replacement

– Walk 1x/hour (Make a loop on your first floor and aim to complete 2-3 times per hour)
– Heel slide
– Assisted Heel Slide 
– Quad Set with towel 
– Straight leg raises (SLR) 

Progressive Home Exercise Program (Complete 10 reps 1x/day near countertop for safety)

Complete these exercise with assistance from a family member for safety reasons

– Standing Hip ABD 
– Standing Hip EXT 
– Standing Heel Raises 
– Standing Toe Raises 
– Standing Marching 
– Standing Knee Flexion 
– Stairs 1x/day 
– Sit to stand 
– FSU 
– LSU 
– Sidestepping at Counter 
– Seated Heel Slides 
– Seated Knee Extension 
– Seated Marching 

Walk at least 800-1000 feet or around the block with an assistive device and wean off the assistive device as tolerated. (If limping occurs, use a cane to assist, opposite of the surgical leg. 

Check out our Total Knee Replacement Part 4 blog that will help you as you progress into the next phase of rehab.  

Check out our Total Knee Replacement Part 2 blog that will help you as you progress into the next phase of rehab.

Download our Knee Range of Motion Tracker, FAQ Page and Return to Sport Timeline

Disclaimer: This is not medical advice. Always reach out to your medical provider with questions and if you are worried at all about an infection, go to Immediate Care. 

 

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