It's four months post knee reconstruction and I couldn't be happier with the results. With the last month spent in Italy hiking and teacher training I know all the dedicated knee rehabilitation has paid off, and most importantly being in the encouraging and knowledgeable hands of Brooke, Anthony and Sam at DP Physio Gymea. The operation was unavoidable given the damage I had done to my knee cap and medio-femoral ligament, along with the fact I am predisposed to such a condition with my hyper flexibile ligaments and high sitting patellas. When I realised this and handed over the reigns to amazing surgeon Dr Leo Pinczewski I knew I had to commit there and then to the intense rehabilitation to follow. I know the results I want to get and know I won't get them if I go in half-hearted. It hasn't been easy fitting in 3-5 appointments per week plus several rehab sessions with running a business and family of 5 - but trust me it is possible, sometimes something has got to give, and I rely on my fitness and health to manage all the above in the first place, so it is up there at the top of my list every week.
My hope is that in sharing my tips and rehabilitation exercises below they can assist anyone wanting to strengthen knees, prevent knee surgery, or encourage anyone taking on a post-surgery program. However it is really important you seek personal diagnosis from a physiotherapist or exercise physiologist as to your own condition and what is recommended.
For the 4 weeks pre-surgery I practiced the Daily Knee Lovin' Practices listed below in my initial blog Time to Appease the Knees. Then post-surgery for the first 6weeks I could only do #1, #5, #6 - three to four times a day amidst icing every 2hrs (they were very busy days!). Possibly the most crucial was riding the exercise bike to help reduce the fluid and aid the bend. I didn't get a full cycle (I was doing 180 degree sliding feet back and forth) until week 7!!! (of course I didn't get frustrated at this...I meditate.....hahaahaa ;-) Then the day that full cycle on the bike came (aaaah huge sigh of relief that day was) it was game on with the rehab. From week 8 I started closed chain (something under foot) weights exercises to strengthen my VMO, calves, hamstrings and glutes - my thigh had wasted away in that time to 7cm smaller than my right thigh.
From weeks 8-11 I went hard at the below program, including the Stair Master and Exercise Bike for 20-30mins daily - these were both equally important in getting my knee bend progressing from 90 degrees to 125 degrees in that time, as well as reducing the fluid greatly. Which was perfect timing to fly overseas to Italy and gave me the ideal setup for all the teacher training 16-day intensive teaching (during which attending Lou's 2hr daily Yogalates classes really boosted my rehab progress especially in child's pose), and then lots of walking and sightseeing including hiking through the Cinque Terras - a dream come true (see pic above which is 3 months post-surgery 7 hour hike, 1000s of stairs and steep track). I am so happy I could do this, such a milestone in the recovery process.
From week 11 onwards I have been on 'Mission Child Pose' spending 15-20mins as often as possible at 8/10 pain threshold (this is one hard core meditation workout!) in Child pose to allow the gradual release into a complete bend. See pics wk 11 versus wk 17.
After four weeks off (weeks 11-15) gym exercises & the reformer, on returning from Italy I have hit the ground running back into the program below, and seeing the benefits every day, now at week 18 and weights training 3-5 times a week. I found the work I've done on the Pilates Reformer with Cathy Smith has been paramount to working into the stabilisers of the knee and hip area, in particular my weak Glute Medius that plays a big role in knee joint alignment. If you are needing to work on your knees I can highly recommend having regular sessions on the Pilates Reformer as part of your program - Cathy is fantastic. Ongoing I expect to be working with the program below until Xmas which will be my 6 month mark. If you intend to try any of these exercises below, and it's your first time I would highly recommend you work with a Personal Trainer or someone who can guide you into proper alignment so you don't cause injury.
I hope reading my story gives you motivation to do the work anytime your body is needing recovery and LOVE! If you have any questions or feedback please post your comments below or feel free to email me, especially if you are wanting to discuss impending surgery and what to expect, I am happy to share.
All the best in your health,
Post-Surgery Knee Rehabilitation Program
Weight Program is care of Anthony Rodier at DP Physio
Reformer Program is care of Cathy Smith at Body Awakenings
Special thank you to Adam at Gymea Bay Fitness & Cathy Smith for giving me access to the gym and reformer whenever I need, and filming ;-)
As I look at the picture above, I have knee envy of myself. How I would love to fold into a shoelace pose right now. I have had reasonably happy healthy knees for 24 years, I definitely didn't get any pain to warn me there was a real problem. But there were signs, the silent kind where we can just carry on and don't pay attention to because they are not loud enough. Well it got loud (in a very very poor teacher's dismount from Cobra pose) and here I am in knee-hab one week post surgery (yes I did a very good job of it) taking this opportunity to share all that I have on knees with anyone who cares to listen.
Perhaps it was a little noisy when I bent and straightened, when I sat cross-legged the right would sit for 4hrs without complaint, the left knee would feel stiff within half hour (symptom of fluid in the joint - Sukhasana Option 3 & 4 below always helped), there was a noticeable imbalance of tone between my inner & outer thigh muscles, and in the last week prior to the kneecap dislocating I happened to notice a definite outward pull of both my kneecaps when contracted. Now I am putting all my attention (finally) on getting my knees happy, and I am excited about it. I am on a knee-hab mission - Toe Stand Pose by NYE!
There doesn't have to be pain for your knee to be telling you something isn't right. Tightness in the joint, inability to fully flex when seated (usually indicates swelling, perhaps tissue damage), pressure at back of knee or behind knee cap, appearance of fluid or lax muscle tone in quad above or the inner thighs, noisy knees ...... they grind or clunk when you bend. They are all signs your knee would like some attention please. So good for you, you're reading this blog!
Lets face it, with any of the subtle symptoms listed above we know they are not going to improve in 10-20 yrs time if we ignore it, nor is it going to be easy to heal then either if it's got worse and a condition has developed. So, I invite you to come on a journey with me and give your knee some love now - and I guarantee in 20yrs you will be pleased you turned your attention to them, there is no doubt about that.
If the condition is acute (there may or may not be pain), particularly if there's a lot of restriction, I highly recommend attending to it with a Practitioner to assist sorting out what the real problem is so the rehabilitation is perfect for you (Brooke Cranney (& Sam!) at DP Physio are my fave and I credit her with some of my exercises below, but also to her knowing exactly what to do and who could help me as soon as possible. She put me in the best surgeons hands immediately). Alternatively an Exercise Physiologist (Brent Collier at Peak Health is fantastic and will be coming in handy a little further down the track for me). Both these Practitioners specialise in targeting the source of the problem and creating balance, and not bandaid solutions like creams, pills, massaging nor the tips I have given below to modify (these are to 'make do', they may not be enough to resolve the issue if it is acute).
Truth be known, it usually isn't your knee joint that is the problem - a knee issue often develops because of the way you use your feet (in gait) and/or the balance of stability & mobility of the hip joint (the Glute Medius plays a huge role in knee joint alignment). Your posture also plays a role in wear and tear on the knee joint - ie. over hyperextending the knees (often includes a sway back posture (aka "pelvis against the kitchen sink stance") is common and over time can cause imbalance and instability in the knee, but also back conditions.
Tips to modify your Yoga practice if you have knees (click to view);
Daily Knee Lovin' Practices which will improve your knee stability, mobility and alignment;
As I am currently limited to 1 & 6 for the moment, these exercises will increase in intensity very soon - but the basics are so important, skip these and we will only compensate with our imbalanced habits for the big moves. Do not underestimate the power of these simple practices, I strongly believe if I had been doing these for even 3 months prior to May such a simple move (i.e. a badly manouvered floppy feet twisted half cobra left knee loaded dismount) may not have caused my injury.
Along the way there will be a lot of focus given to correct gait and use of feet, stability of the hip (esp. Gluteus Medius) exercises, knee alignment and correct loading - with much patience and persistence we will be toe standing by NYE!
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