Its starts with an injury by
… Francis Connor
Recently I sustained a knee injury, and like many injured people it’s incredibly frustrating and difficult to deal with, we cannot do the sports we love, and feel like we’re losing all our fitness, it’s easy to get down about it.
However, there is often a way forward to help you get back doing the things you love. When it comes to visiting a swimming pool, I normally use the pool for swimming to supplement my training, it’s great for shoulder mobility. I don’t really use it for my rehab, and whilst I have and do recommend the pool for exercise and aqua classes I predominantly recommend home based exercise for ease and the convenience.
This injury has kind of given me a very different perspective as I went all in.
My injury is a grade II meniscus (cartilage in the knee) injury, something that can take several weeks and even months to resolve before I can get back training, this is sport/activity dependant. For me I need to fully squat with out pain and work in multi-directional movements to know when I can go back to training at Judo.
So, like many of my blogs the question was asked “How are you rehabilitating your knee?”
First a little about meniscus injuries
A meniscus injury is a common problem in the knee. It occurs when the cartilage-like shock absorber called the meniscus, which acts as a cushion between the thigh bone and the shinbone, gets damaged. Signs and symptoms of a meniscus injury often include pain, swelling, and stiffness in the knee. Depending on the actual damage you may experience a catching or locking sensation, where your knee feels like it’s getting stuck or making odd noises when you move it. These issues can significantly affect your day-to-day life, making it challenging to engage in activities like walking, running, or even climbing stairs, as the knee becomes less stable and more uncomfortable. It’s crucial to explore effective rehabilitation methods to address these issues and regain your knee’s functionality.
Meniscus injuries along with arthritic pain in the knee, running and walking injuries are fairly common here at the clinic, and whilst rehabilitation for each is different, they do share some of the same components to recovery.
A meniscus tear itself is a common knee injury, and recovery time can vary depending on the severity of the tear the treatment you receive along with compliance to a rehabilitation plan. Meniscus tears are typically graded as either mild, moderate, or severe.
Here’s a general break down to the recovery process.
Grading the Meniscus Tear:
Mild (Grade 1): Small tears on the edge of the meniscus. These often heal on their own and may not require surgery. Recovery can take a few weeks.
Moderate (Grade 2): Larger tears that may need surgery to repair. Recovery can take several weeks to a few months.
Severe (Grade 3): A complete tear that often requires surgical removal (partial meniscectomy) or repair. Recovery can take several months.
Its worth noting that whilst anyone including myself sustains an injured meniscus other parts of the knee may also be injured.
Recovery involves different stages, and it’s important to follow the right guidance from the right person to optimise recovery.
Here are the typical stages which should follow the healing cycle of the body so the best exercise can be given at the right time:
Immediate Post-Injury Stage:
Protect, rest, ice, compression, and elevation (PRICE) can help manage pain and swelling.
Using crutches may be necessary to avoid putting weight on the injured knee, gradual weight bearing is encouraged.
Early Rehabilitation (After Surgery, if needed):
Starts with regaining range of motion and strength.
Gentle exercises like leg lifts and ankle pumps help prevent muscle atrophy.
Rehab intensifies with exercises to improve knee stability and function.
Balance and proprioception exercises help prevent re-injury.
Gradual return to daily activities and low-impact exercises.
Strengthening exercises for the quadriceps, hamstrings, and calf muscles.
Sport-specific training, if you’re an athlete.
A gradual return to high-impact activities, under guidance.
Maintain a healthy lifestyle and stay physically active to support your knee’s health.
Use proper warm-up and cool-down techniques before and after exercise.
Regularly perform exercises that focus on the muscles around the knee to keep it strong and stable.
Recovery time can vary from person to person, but it’s essential to be patient and follow the advice. Meniscus injuries can be successfully treated, and with the right care, you can return to your regular activities.
So where does pool work come into it?
Much of the new developments in rehabilitation comes from research and clinical trials, and when it comes to scientific evidence there is plenty of support for the use of pool therapy for many injuries, often used for arthritic problems, however it is also valuable evidence in meniscus rehabilitation. Meniscus injuries often require careful and gradual rehabilitation, and water-based exercises can play a crucial role. Research, such as a study in the “American Journal of Sports Medicine” (Snyder, B.W. et al., 2009), has indicated that pool work can help individuals with meniscus tears improve muscle strength, range of motion, and knee stability while reducing pain and swelling. The buoyancy of water provides a gentle environment for exercise, making it easier for patients to perform movements that might be challenging on land during the early stages of rehabilitation. By reducing the impact on the injured knee, aquatic therapy can facilitate a smoother and more effective recovery process, as supported by scientific findings in orthopedic literature.
Secondly, scientific evidence also underscores the benefits of pool therapy for enhancing core strength and function, which is excellent as you don’t want to come out with strong legs but a poor core. The water’s buoyancy provides a unique environment for core-focused exercises. A study in the “Journal of Physical Therapy Science” (Lima et al., 2016) found that aquatic exercises can significantly improve core muscle strength. The water’s resistance challenges the core muscles, helping individuals develop stability and control. Moreover, the low-impact nature of pool workouts reduces the risk of straining the back, making it a safer option for those with existing core issues. Scientific support also suggests that water-based core training can contribute to better posture, balance, and overall core function, making it a valuable addition to rehabilitation and fitness programs.
In essence you can slowly and correctly progress through the stages of recovery to get back fit!
Now the next question you may ask before jumping into the pool is “what type of exercises should you do?”
Now a generic list would look like this
Walk back and forth in the pool, focusing on maintaining proper posture. The buoyancy of the water reduces the load on your knee while still providing resistance.
Leg Raises: Stand in chest-deep water and lift your injured leg to the front, side, and back. This helps improve your knee’s range of motion and strength
Perform partial squats in the pool. The water provides resistance, making it a safe way to strengthen your quadriceps and hamstrings without putting too much strain on your knee.
Use a stationary underwater bike if available, prior to this week I personally didn’t know anyone with one of these bike, with any access or even seen one, until Monday when someone who sees me told me all about them. Anyway however rare, cycling in water is an effective way to improve knee joint mobility and strengthen the leg muscles, personally a recumbent static bike would also be a useful substitute, as long as you don’t start thinking you’re Lance Armstrong, without the drugs that is….. LOL..
Flexion and Extension:
While standing in waist-deep water, perform knee flexion (bending) and extension (straightening) exercises. This helps improve joint mobility and muscle strength.
If you are comfortable with swimming, gentle laps in the pool can be an excellent overall workout while providing a low-impact environment for your knee.
Join water aerobics classes specifically designed for rehabilitation. These classes often include a variety of exercises to improve strength and flexibility.
Regular classes can also be incorporated but again with guidance.
All rehabilitation plans should have a plan and goals, with a commitment to achieving the right markers, whilst I cannot train at the judo club for a while I can still exercise/rehab my body to encourage recovery and maintain fitness, this way when I do go back I don’t feel like I have the lungs of a 100 year old heavy smoker.
You may have heard me say in the clinic, if you do not know where the goals are then scoring is hard. A couple of my personal goals for rehab are a full knee bend without pain, this includes a full squat. A single leg squat along with multi-direction hopping without pain.
Some of the exercises I carried out and progressed in the pool are:
Walking – forward/backward
Power walking – forward/backward as fast as I can
Walking – forward/backward as if stepping over hurdles
Walking has progressed to include;
Hopping forward and backward
Hopping forward and backward as if stepping over hurdles
Hopefully you can see the exercise intensity increases as my knee gets stronger with less pain, this is completed with swimming followed by stretching in the sauna.
The next phase is to progress the pool exercises and incorporate gym based exercise as the knee can handle a greater loads.
I do need to confess to using the kids pools as its so much warmer..
Overall, not a bad plan, really feeling the benefit and looking forward to getting back on the Judo matt.
If you have any questions fire them along, our expert rehabilitation therapist Mark Gallamore can help you create the best plan to get you moving pain free.
Keep Well, Stay Active