Tag Archives: physical therapy

Rehabbing My Knee, Part 2

DISCLAIMER:  I am not a doctor, a physical therapist, or a rocket scientist… and whether I stayed in a Holiday Inn Express last night or not, you should still consult your own doctor for any and all specific advice prior to doing any of the exercises listed here.  This post is intended as a “what I did”, not a “You should do” post.  Thank you for your understanding.  Carry on.

This is a continuation of my previous post, where I discussed the Non Weight Bearing Exercises I used to rehab my knee.  If you missed it, you can check it out here. This post will be on the Weight Bearing Exercises I did.

Again, please note:  While I focused on my injured leg, it is important to do all exercises to both sides, to maintain balance throughout your body.  If you only do them to one side, you will grow massive muscles on one side and end up walking in circles and people will laugh at you.  Probably not that extreme, but you get the picture.  And no worries, they will still laugh.

Weight Bearing Exercises

Leg Extensions

Once I was allowed to start weight bearing, the exercises took on less of a stretching mentality and more of a muscle building focus.  One such exercise is Leg Extensions.  This is the opposite of the Heel Slides discussed previously, which worked out nicely to do both at the same time.  Leg extensions were used to help strengthen the muscles along the side of the knee cap and the big muscles at the back of the leg.  While doing these, I was instructed to keep my knee aligned properly with my body, not allowing my knee to fall to either side.  Honestly, these are much simpler than it seems.  Heel slide your knee up, then heel slide your knee down.

Sideways Step

Wanting to keep things starting simple, an easy exercise we used to help strengthen the sides of my knee was the sideways step.  And it is just that – facing a wall with hands against it, take small steps sideways.  I was surprised how difficult this was when I first started walking again.  However, due to the simplicity, this exercise was only used for a week or two, and phased to the Monster Slides below.

Telephone Book Step-Ups

These are really normal step-ups, but using a two inch telephone book instead of the eight inch steps to my apartment.  Believe me, two inches was MORE than enough.  In fact, when I started doing these, the wardens put a chair on either side of me, so I could use my arm strength to help me step up.  Thankfully, my leg quickly regained muscle and I was up to normal stairs within a month or so, albeit with some weakness the first step or two as the muscles get used to it.  Even now, this continues at times.  I did these both “walking forward” and as a side-step action, as each focuses on different muscles.

Calf Muscle Stretch

After not walking for so long, I found my calf muscle was extremely “tight”.  To help stretch it back out, we used a standard calf muscle stretch.  This is the same one you did in middle school gym class or before football practices.  You place your hands on the wall and slowly “walk” your leg backwards, keeping your heel on the ground.  Hold for a 10-count and release.  Repeat as much as you like.

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Step Machine / Leg Presses

As much as I have never liked working out in a gym, some of the machines were useful in my rehab process.  The step machine I used was a sit-down machine, so the resistance could be fully controlled.  At first, I was too weak to actually support my own weight, so this allowed me to do steps with a lesser weight.  The leg press machine was used to help build muscle in the same way.  Standard Operating Procedures for each machine, please.

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Squats

Once I could support my own weight, I was forced to do squats… against my will, and my better judgment.  Squats are surely an invention of Satan himself.  As if they were not hard enough, I had to do them with my back against a wall, while holding a 12” ball between my legs.  Jen, I still hate you for these.

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One-Leg Balance Stands

Again, this one is what it sounds like – stand on one foot and balance, holding for upwards of 30 seconds (or 0.3 seconds, as was the case with my uncoordinated butt).  I did these using each leg separately… mostly just to get a good laugh out of the staff.  This one was fun, though.  I got to pretend I was Daniel-Son from “The Karate Kid” movies, where he practices his crane stance.  Nancy was not amused when I took the same pose, though – apparently, I was not supposed to wave my arms around and try to kick the padded wall in front of me.  Oops. (Go to 1:19 on the video…)

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Marching Knees

Apparently, most of the exercises you do to rehab a knee are for the pure enjoyment of the staff.  Yes, I was forced, at (squirt) gun point, to march around the room, hiking my knees up as high as I could get them.  Jen said it was to strengthen some grouping of muscles, but I am pretty sure it was just so she could feel like a dictator.  Honestly, it was harder than I expected.  I have always had a lot of respect for our military, and even more now!  I still refused to salute her, though.

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Leg Extensions

Another exercise used to help build muscle is a standard leg extension.  Sitting on the edge of a bed or chair, use your knee muscles to lift your leg up so it is hanging straight out.  Hold for about a 10-count, then slowly lower your leg.  Repeat until you are bored (or about 10-20 times).  After these become routine, take my advice and do not tell your therapists so, or they will add ankle weights to increase the resistance.  Evil, I tell you, pure evil.

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Step Up and Over

Similar to the Marching Knees above, this exercise was simply a “step up and over”, giving me a target to get over.  Jen created an obstacle course of small orange cones, and I had to side-step to each cone, then side-step up and over.  This was also done walking straight ahead, only she would make me tap my toe on the top of the cone, to try to trip me up… or to help hone fine muscle skills.  Eventually, she also tied one of those colored rubber bands around my thighs, to create more side-to-side resistance.

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Monster Slides

These always got a chuckle from people walking by.  Think of yourself as an NBA star defensive player.  Yep, that was my role.  Squat down like you are guarding Michael Jordan, and slowly slide back and forth.  Key word: slowly.  Apparently, slowly doing a movement is more beneficial (or safer) than quickly doing it.  If you are real lucky, your coach will forget the rubber bands, which make this even more “fun”.  I was never that lucky.  But in reality, I noticed the benefits of these very quickly, especially in my knee strength.  Laugh all you want, but I am ready for Jordan.

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Touch and Ups

At one point in my rehabbing, I mentioned to Nancy that I felt like I was just “free falling” down stairs when I was walking down, not having much muscle control.  She said this was due to these small muscles being very difficult to strengthen.  One exercise she gave me to help, though, was Touch and Ups.

Touch and ups are simple to explain, not so simple to do.  You start by taking a step down a step.  Once your toe touches, you reverse directions and step back up to your original place.  Full weight is not put on the toe (unless needed for balance and safety… do not go tumbling down the stairs, please!), but rather just a light touch before reversing directions.  She had me do these with both legs, proving my “good leg” was not as strong as it could be, too.

Elliptical Machine

Plain and simple.  This machine was used to simulate the motion and muscle movement of walking without the impact of walking.  This was the first time I had ever used an elliptical machine, and it was harder to get used to than I thought, but it provided a good cardio workout while really moving and stretching the muscles.  I still use these from time to time when I am at the gym.

Zigzags (basketball squat jumps)

Here is another one to make people laugh.  In an attempt to make me overcome the mental roadblocks that being non-weight bearing for so long creates, Nancy had me do Zigzags.  Assuming the same basketball defensive stance from the Monster Slides, Nancy had me “hop” diagonally up and to the right, then back and to the right, continuing this zigzag pattern while pushing off with my left leg and landing on only my right leg.  The reasoning is that this would force me to “trust” my right leg without assistance of the left.  When I hit one side of the room, I reversed directions so that I could learn to trust my left leg.  While this did help some with the mental aspects of my injury, I will admit that this is still something I struggle with.  I am still working on it, though.

I hope my experience with rehab can be useful to you.  Again, please remember, I am NOT a doctor, and if you are in need of exercises to rehab any part of your body, please do see your doctor.

If you have any comments, advice, or topic suggestions, please use the comment box below or use the Contact Me page up top.

Until next time, remember to “Spin the Compass.”

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Rehabbing My Knee, Part 1

DISCLAIMER:  I am not a doctor, a physical therapist, or a rocket scientist… and whether I stayed in a Holiday Inn Express last night or not, you should still consult your own doctor for any and all specific advice prior to doing any of the exercises listed here.  This post is intended as a “what I did”, not a “You should do” post.  Thank you for your understanding.  Carry on.

As I have mentioned before, I am recovering from a pretty serious knee surgery last fall.  Serious in that it left me in a wheelchair for the better part of three months and completely changed life as I know it.  Not so serious in that it was a very low-speed, low-risk accident that to this day I am not 100% sure of how it actually happened.  I walked away almost immediately and waited another two days before seeing a doctor.  Yes, I am a stubborn man.  I get it naturally (thank you, dad).

To explain quickly, my injury was not directly muscle related.  In technical terms, I had a left lateral tibial plateau fracture.  That means the outside of my left leg, just below the knee, was shattered.  I now have a nice big plate and nine screws permanently holding my bone together.  And the surgeon confirmed, regardless of what anyone else says, that these screws will NOT come loose.  While it was strictly a bone injury, I was unfortunately non-weight bearing for over twelve weeks, which means I lost nearly all of the major muscles in my left leg.  Seriously, it was nasty.  I did not take a picture.  You can thank me now.

My physical therapy started pretty quickly, about three weeks post-surgery, even though I was in a solid knee brace for much longer.  Within the confines of this 24-inch brace, I was instructed by my Physical Therapist, Nancy, and her assistant, Jen, on numerous exercises designed to rebuild strength and flexibility in my ever-diminishing leg muscles.  I will do my best to describe them for you, as many of them are useful for working out the kinks after a long day of hiking, and some are well suited for prep work, as well.

One note to make, though:  While I focused on my injured leg, it is important to do all exercises to both sides, to maintain balance throughout your body.  If you only do them to one side, you will grow massive muscles on one side and end up walking in circles and people will laugh at you.  Probably not that extreme, but you get the picture.  And no worries, they will still laugh.

Non Weight Bearing Exercises

Quad Sets

Quad sets are simple.  You place a rolled up towel or foam roll (or the arm rest of your couch, not that I ever did this, Nancy…) under the heel or calf muscle of the affected leg.  Then you simply “push down” with your knee, trying to push your knee down while tightening the muscles of your lower thigh (quads).  Hold this for a 10-count, then rest for a 5-count.  Repeat this 10-20 times, 3-4 times per day.

This exercise was one of the first assigned to me, to help with blood flow around my knee and my surgery site, and ultimately, is one that I still do to this day.  It is a great “wake up” exercise to do while lying in bed, before starting the day.  For my knee, I can really tell the difference when I do not do this in the morning or throughout the day.

4-Way Leg Lifts

From:  http://physicaltherapy.about.com/od/strengtheningexercises/ss/QuadStrength_2.htm

From: http://physicaltherapy.about.com/od/strengtheningexercises/ss/QuadStrength_2.htm

This was another exercise I was able to start doing while still braced up.  Actually, I think the brace helped, because I did not have to worry about keeping the knee straight at first – that is what the brace was for!

To do leg lifts, you lay on your back, lock your knee straight (or put a long knee brace on…) and lift.  Simple as that.  Does not have to be real high, just six inches or so.  That is “Way #1”.  Then you roll 90-degrees so you are lying on your side, and lift your leg up in this direction.  Way #3 is to lie on your stomach and lift your leg up (backwards), and #4 is lying on your other side.  Hence, 4-Ways.

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At first, I was told to just lift, and lower.  But after a few weeks of this, the “Torture Chamber Maidens” (seriously, these women enjoy creating pain!) made me lift, then hold for a 10 count, and lower.  Thankfully, they did lower the repetitions once I started holding.  I think I started with a 10-count of lifts per leg, per direction.

One variation of this that I started a little later in the process was to “toe out” while doing the lifts, pointing my toe out instead of straight up, because it rotates the leg and focuses on different muscles.  And creates different pain.

Heel Slides

From:  http://physicaltherapy.about.com/od/strengtheningexercises/ss/QuadStrength_3.htm

From: http://physicaltherapy.about.com/od/strengtheningexercises/ss/QuadStrength_3.htm

When I was granted permission to start bending my leg a few weeks after surgery, Nancy added heel slides to my repertoire, and like the quads, this is one I still do almost every morning just to get the blood flowing and the knee moving.  This is a great loosening method, at least for me, because it does not force the knee to bend, but rather puts the leg in a position that uses natural body weight to bend it.

Heel slides are just that – lay on your back, legs extended, and lift your knee using your thigh muscles instead of knee muscles, letting your heel slide up.  The tricky part was getting the heel to slide back down without putting any pressure up the leg – an action that could have disrupted the internal healing process.  I started with 3 sets of 10 repetitions with a break between sets, but was eventually increased up to 4 sets of 20.

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Standing 4-Ways with Resistance Bands

Similar to the regular 4-Way Leg Lifts, standing 4-Ways was a way to increase the resistance by using resistance bands.  Tying a big colorful rubber band around your leg is apparently a favorite pastime of physical therapists, but it was worthwhile in building muscle back.

Standing 4-Ways are done by looping one end of a resistance band around your upper thigh (to avoid straining the knee) and the other end around a door knob, tree or car handle.  Then perform the 4-Ways, rotating around so that you are always “lifting” 90-degrees from your anchor point.  Use a chair or something else to help balance.

An added bonus of the standing aspect is that you are building strength and balance in your standing leg.  When I was allowed to start weight-bearing on my left leg, I did these to both legs, as it helped to stand on the bad leg while doing exercises.

To Be Continued…

I meant for this to be one big post, but realized that the Weight Bearing portion is nearly twice as long as what I have already written here, so I think it best to break it into two posts.  The remainder of this will post next week.  Thanks for your support, and remember to “Spin the Compass.”

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