Hi there,
You may or may not know that I'm recovering from a knee injury at the moment. The injury in itself (Feb this year, I slipped in the snow we had) is not too bad, but I had a major surgery on it seven years ago following a simultaneous dislocation of the patella, displacement of a lump of the right meniscus (cartilage) andafemoral fracture. As you can probably guess, this means it's not in particularly good shape [X(]
This time around, no serious injury has been sustained, it would seem I justtore my ligaments a bit,and since I came off the crutches they've healed because of the weightbearing. I'm having physiotherapy at the moment, but the problem is that I'm not sure the exercises I've been given are enough. I do trust my physio but quite frankly for the 10 mins I'm allocated, I never get the opportunity to discuss things in more detail-I tend to forget questions I've thought of, or feel pressurised into leaving quickly before I've had a chance to ask. The exercises I've been given don't seem to be very holistic...it's like you're getting the treatment for free on the NHS so they're only going to look into the immediateinjury rather than where the problem might be stemming from, and other areas of structural imbalance.[&o]
Anyway, bascially I've been told that I'm over-flexible and therefore I need to really tighten up everything that holds my knee cap in to prevent it from dislocating in the future. I'm working on building up muscle too (quadriceps), because I was non weightbearing for 10 weeks when I first injured and consequently the muscles just wasted away. The exercises I'm currently doing are the following:
1. Lying down on the floor and moving one leg straight out to the side at a right-angle. Repeating on the other side ( x5)
2. Sitting or lying down, pushing the backs of theknees into the floor. (x20)
3. Sitting on the edge ofa table with knees hanging off the side. Bending the knees backwards under the table (x10)
4) Sitting down in a chair, lifting the leg bent up in the air as far as poss. ( x5)
5) Standing with one hand on a chair for support and raising leg to the side. ( x5)
6) Lying on floor lifting one leg a little off the floor and holding for 4 seconds. ( x5)
I was also told to use low impact gym equiptment so as advised,I've been using the bike, cross trainer and treadmill for 10 mins each.
Does this sound enough? At this stage of rehabilitation, it seems pretty pointless doing 1) and 3) thoughtI suppose I should keep on with the rest.From a pilates point of view, would you suggest anything else? Ihave problems with my hips sometimes especially on the right side (probablybecause they dislocated it when operating.)I read yesterday that if you stand against a wall with your heels, calves, knees, bum and small of your back pressinginto it and you can pass your hand right through the gap created by the lumbar spine then you have bad postural alignment. That's me! I tried really hard to tuck my tailbone under to stop the forward tilt but it didn't do anything. Should I be concerned? Ask my physio if that could be a problem as regards my knees?
Hmm, this question is a bit jumbled but I guess what I'm trying to ask is how would you approach this? What type of exercises would you recommend, and looking at the structutal issues, i.e how the knees, hips and back are connected, what guidance could you give?
Of course, as with all info gleaned from the internet, I recognise that you will not be diagnosing and any guidance you give is not a substitute or alternative to conventional medical treatment;):D
RE: Advice: Are my physio exercises enough?
Sounds like prettyusual convalescent stuff - have you thought of investing in a couple of sessions with a private physio? He/she may be able to give you more advanced stuff to do, and will also take a lot more interest you!
My husband damaged his back last year, waited 4 months for a physio appointment at the surgery and was thengiven a sheet containing a list of recommended exercises andadvised to loseweight - at no point did he remove clothing, nor were the exercises demonstrated! Luckily, after the initial injury 4 months previously, he went to see a private physio who went over him with a fine toothed comb during daily 1 hour appointments for 4 days - he then went back every two weeks for 6 weeks. The pain subsided within a few days and (touching wood now) has not returned. His back feels stronger and his general muscle tone improved especially around the abs/back/buttocks and legs. As for weight loss - he is 6ft 4ins and weighs 14 stone - if he lost any weight, he would fall down drains!
RE: Advice: Are my physio exercises enough?
Hi azalia,
In my opinion as a sports therapist, I would say that you should be progressing your exercise by this stage to include weight bearing functional exercise, not using exercise machines which tend to isolate individual muscles, one of the most importtant exercises is a squat, ie sitting down on to a chair, use toewls folded on the seat to alter the height of the squat and repeat several times, no hands on legs and no flopping down the last few inches do a controlled movement all the way down. This assumes you are pain free doing this exercise, build up the number and frequency as appropriate, doing a 1/4 squat ie only 1/4 way down will strengthen Vastus medialis which has controlling infuelnce on the knee.
Hope it helps, feel fre to PM me if you want a rehab table of exercise, although away from today at london marathon.
Regards
GAz
RE: Advice: Are my physio exercises enough?
Hi [sm=wave.gif]
Thanks for your replies!
Jabba- unfortunately I can't affordprivatephysiotherapy sessions at the moment because I'm already having other private health treatments that I'm paying for.Your husband's physio treatment sounds familiar, although I was a bit more lucky because they did look at my knee properly (at first I was suffering paralysis which worried them a bit) and they brought a specialist in to do tests...who concluded that considering its trauma it hadn't suffered too badly and could be treated as a chronic knee injury. My physio is a nice bloke, and it's not through a lack of integrity that Ifeel a bit neglected butit is the NHS after all. I'm sure if I pressed him for answers about more specific exercises he would give them to me, it's just that you always feel like you have to fight for your own healthcare which wears you out[&o]
Gaz- thanks for that suggestion. I was pretty sure that wouldn't cause any problems so I gave it a go just now. I wasn't too bad at it but if we're looking forabsolute control then I have a bit of practising to do;)As you hinted, it's fairly challenging to keep absolute control in the last couple of inches. It's very kind of youto offer some further suggestions...I'll really grill my physio next Tues and see if he comes up with the goods, and if he doesn't I'll be in touch!
RE: Advice: Are my physio exercises enough?
Hi Azalia, really sorry to hear you are suffering. How did you sustain your original injuries? As a Pilates teacher I'm quite keen on keeping people within a normal range of movementand I'm careful with my hyperextensives -I give them strength work rather than stretches.
As aPilates teacher who deals with rehab (not all do btw) I would be looking at
1)the stability of your joint
For this I would give you exercises where you keep your leg straight as you move it from the hip
2) mobility of the joint - range of movement
3) relationship of the joint to the rest of the body
As you indicate, your physio has covered base on 1 and 2 but has not been able to go into much detail on 3.
You describe your lumbar spine as fairly curved inwards (called a lordosis). This often goes with medially rotated thighs. When you do your squats do your knees have a tendency to drop in to the mid-line? Are your arches low?
Try a small lunge by taking one foot three feet behind the other but keep them hip width apart. If you take your body weight forward can you keep your knee in line with your second toe (next to the big toe)? Don't let your pelvis rotate.
If the answer is no to these questions then practice the exerciseswith the knees following the line of the second toes. Watch how you climb stairs, cycle etc and keep those knees in place.
Small lunges are a good functional exercise as they are similar to walking and you can train your knees to track more correctly.
How about your feet? Can you spread your toes wide? Feet should be as wide and long as possible to give a good base. Where are you taking your weight on your feet? Not too far forward on the balls of the feet, nor resting into the heels, but centrally. Get your physio to check your gait, and your posture. Most people have bad postural habits.
Another nice exercise where you use your bum, inner thighs and feet is a standing walk. Standing on your left leg (in good posture, starting from the feet), let the right knee drop forward. Now check youhave not hyper-extended the left leg, and then squeeze your left bum cheek, and draw the left kneecap up towards the hip. And change - about 10 reps each side. You cna do the same exercise starting on tip-toes - a bit more difficult.
A nice book to read on myofascial continuity (ie how your knee can affect your shoulder, or your big toe can affect your hip) is [link= http://www.amazon.co.uk/Anatomy-Trains-Tom-Myers/dp/0443063516/ref=pd_bxgy_b_text_b/203-2689182-5259121 ]Anatomy Trains[/link] - it's expensive but quite a lot of bodyworkers will have a copy. There's a new edition coming out soon.
Hope you get it sorted soon,
Sharon
RE: Advice: Are my physio exercises enough?
Thanks for that, Sharon. I feel really well looked after now:)
Yep, my knees do want to fall in when I do squats and this problem has now become more pronounced on the right side, because the medial side of my foot is lifting off the ground when I try to get the correct alignment. You are also right about the low arches;)Things are starting to fit together now, actually, because when I used to do Trikonasana in yoga my right ankle used to rotate too much causing the foot to come off the ground.
I can't spread my toes, no. I looked at my flip flops last year to see whether I was distributing my weight evenly and I seem to rememberthe heels were quite worn down, more on the lateral side. I have great problems with hyperextension of arms and legs and can't actually stand 'normally' unless I apply great concentration and am standing up straight on both legs. When I get off the computer I'll give your suggestion a go though, I might suprise myself.
I have to say, I am nowslightly worried that I sound like a bit of a freak!In all seriousness,do you think these imbalances can be corrected in the long-term? I have managed to improvemy back throughyoga (specifically through adho mukh svasana posture,) as that's when I first noticed my hyperextension, my back was too flexible, and my shoulders were uneven.[:-] I hope I'm not a lost cause!
RE: Advice: Are my physio exercises enough?
Ah well, I don't stand properly if I don't think about it either!Just differently from you. No you are not a lost cause but you do need to pay some attention to how you move.
It sounds as if your ankle could do with strengthening up - I'd get you on a wobble board (again have a chat with the physio)Feet are very important and the broader and longer and stronger you can get your feet to be, the better the support. Do Mexican waves with your toes, and if you are doing standing exercises pick up all your toes and spread them wide before you begin. Pick up tennis balls with your toes and try to draw the ball up into the arch of your foot. I have several clients with shortened heels - ie not enough space behind the ankle, andI getthem to lengthen their heels backwards.
Don't worry - you are still very young and your youth will help you recover quickly. As you get older your body will stiffen up a bit anyway, particularly if you do strength work around a joint.
Are your shoulders still uneven?
Best,
Sharon
RE: Advice: Are my physio exercises enough?
Do Mexican waves with your toes,
This is some kind of cruel joke isn't it? [sm=rollaugh.gif][sm=rollaugh.gif]
The good news is that I found out I wasn't doing that test very well (the one that's supposed to indicate a curvature of the spine.) When I did it properly, hey presto, much better. I'll still quiz the physio about all of this tommorow because a) he's paid to do it, and b)I spend twice as long travelling to the appointment as I do actually having the treatment, so might as well make the most of it!!
My shoulders: I had better clarify here that when I said my shoulders were uneven, I didn't mean in a normal standing position (i.e one appeared higher than the other when I was standing.) My right one is just a bit 'tighter' than the left which is only noticable when doing yoga postures because they demand precise postural alignment. I've worked with that now, and although it doesn't feel right, I can easily adjust myself so both arelevelwhen I'm in an invertedposture or whatever.
Thanks for all the info, and I'll see if he comes up with the goods tommorow!
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