Knee injuries often happen without warning and can radically alter the life of an active individual. Getting back in the game is important, but complete rehabilitation is necessary to prevent further injury. Once you've exhausted the scope of physical therapy, you will have to take proactive measures of your own if you want to restore maximal stability to your knee joint.
Knee Anatomy
The many structures that come together and act at the knee make it vulnerable to injury when subjected to impact from outside forces. The knee is the meeting place of four bones: the femur, tibia, fibula and patella. Both the hamstring and quadriceps muscles cross over the knee. The medial collateral, lateral collateral and anterior and posterior cruciate ligaments function to hold the bones of the joint in place. The meniscus, synovial capsule and bursa allow for fluid movement and shock absorption.
Common Knee Injuries
Although fundamentally a hinge joint, the knee, when bent, has a slight rotational property. It is this property that helps prevent injury during everyday activities but also may contribute to sports injuries when strong rotational forces overstress and tear the supporting ligaments. Torn ligaments and torn menisci are the most common sports-related knee injuries. Because ligaments do not repair themselves, surgical intervention is usually required, although many people opt not to repair a partial tear. However, an untreated partial tear may compromise joint stability and could lead to further injury. Post-operative physical therapy should be pursued, but once completed, additional training will be required to attain pre-injury performance levels.
Rehab Protocol
In an article published in the January 29, 2010, issue of "Clinical Sports Medicine," authors M. De Carlo and B. Armstrong of the Methodist Sports Medicine Center in Indianapolis, Indiana, identified three phases of injury rehabilitation. Phase I focuses on reducing pain and inflammation, restoring range of motion and working on basic ambulation. Phase II includes continued gait training, strengthening, flexibility, cardiovascular conditioning and restoring proprioception. Phase III entails a supervised return to functional activity and sport- and occupational-specific training. The authors stress that the phases not be time-bound, but rather tailored to the recovery rate of the individual.
Exercise Progression
Once inflammation and pain have subsided and full range of motion has been restored, moderation is key in the initial return to exercise. Begin with body weight exercises like partial squats and box step-ups, gradually increasing joint angle to 90 degrees. Include hamstring exercises like standing leg curls with ankle weights. Progress slowly to unilateral leg presses and seated hamstring machine curls, loading the weight conservatively and increasing gradually. Flutter kicks, walking and leg extensions in a pool are also good choices. Reserve exercises that require balance or directional changes like lunges and agility drills for the latter phases of rehab. Daily stretching of the hamstrings and quadriceps will ensure balanced muscle tension.
Other Considerations
In addition to exercise, everyday behaviors can inhibit or facilitate recovery speed. Pay attention to postural habits such as standing with your knees locked or shifting your weight onto one leg. If the injury is in your right knee or if you drive a stick, excessive driving can impede recovery. When possible, use cruise control and minimize unnecessary stop-and-go driving. Supportive footwear is critical. Athletic shoes that stabilize the foot and ankle can facilitate correct knee alignment. Avoid high-heels, flip-flops and shoes that are worn or ill-fitting.
