Week 3 was a big week. Definitely one of those “turning a corner” phases. Week 3 was the first time I got in the pool, first time on the elliptical for a meaningful duration, first time I added weight to the strengthening exercises, and the first time I walked!
As I mentioned, days 11-14 got pushed back to days 12-15. That pushed the next rehab phase to days 16-21. No big deal.
Here are some pictures at the 21 day mark:
I have to say, so far, I’m pretty happy with how things look. On to the rehab:
Post-op Day 16-21 (Week 3)
Routine schedule:
Day 16: ROM, Proprioception, Strength,
Day 17: ROM, Conditioning, Proprioception
Day 18: ROM, Proprioception, Strength,
Day 19: ROM, Conditioning, Proprioception
Day 20 ROM, Proprioception, Strength,
Day 21: ROM, Conditioning, Proprioception
– -> Again, the rehab gets fancier the further along it goes. Rather than every day be the same routine, week 3 begins different therapy on different days. Alternating between a strength oriented day and a conditioning oriented day.
ROM is performed everyday with no exceptions. I’ll talk more about this below.
Proprioception is performed everyday as well, but not because it’s as important as ROM. ROM is still the number one priority. Propriception is everyday so it can be performed at the beginning of a workout and at the end of a workout. Rather than do it twice in one workout, which I’ve done, I decided to put it in different places on different days. It’s not going to matter much though. The point is to do it while fresh and while fatigued.
Crutches
–Walking as tolerated. Crutches can be eliminated based on your comfort and ability to walk WITHOUT limping / pain. Don’t push this. Be honest with yourself.
->By half way into week 3 I was able to walk without crutches. However, I kept using one crutch primarily to keep people away from me. This informs my environment, and the people in it, to stay the hell away from me. Don’t bump into me, don’t pat me on the back to say hi, don’t…touch…me. I trust myself without the crutches but I don’t trust those around me.
Also, the crutch(es) are a great “opening line” with women. Might as well take advantage of it.
Bracing
-Locked at 0 degrees for walking. Unlocked at other times e.g. sitting.
-> Due to the meniscus repair, it’s advisable to keep walking with the brace locked until week 3-4. By the end of week 3 though, I was sick of walking like a penguin and unlocked the thing. It’s a lot more comfortable and feels better on my knee too.
It’s something to work up to though. Don’t unlock the thing and think you’re just going to walk with no problems. It took me a good day to get used to walking again. I also kept using a crutch when I unlocked the brace to be safe.
Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)
-Passive extension: To 0 degrees or 5-7 degrees of hyperextension.
— > I’m starting to find out where people mess this whole thing up.
Every couple of hours I perform passive extension to make sure I am maintaining full ROM. One day during week 3 I went out to dinner with a friend. I was busy for probably about 3 hours. When I came back it took me 10 minutes to achieve full extension again. I tightened up that much, that quickly. There is no doubt in my mind people don’t take this seriously enough and this sets them up with issues down the line. These are the people who 5 years later still complain they can’t fully straighten their leg.
-Passive knee extension with quad squeezes
-Flexion: Active flexion allowed 90 degrees. BUT, no RESISTED flexion allowed. Gradually work passive between 0 and 105 by end of week.
– -> Remember this is passive flexion to 105 degrees. NOT active! This was really easy for me. I accomplished it the first day of week 3. Flexion ROM comes back pretty easily.
-Patellar mobilizations
-Sitting hamstring stretch
-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.
The following are now part of the range of motion exercises instead of strength exercises. After a couple of weeks these exercises aren’t going to give much of a strength stimulus, but they are still valuable:
-Clamshells
-Straight leg raise
– -> Much like the extension ROM this is something I have to check constantly throughout the day. My quad is definitely prone to not being as active as it should be during this exercise. Again, I guarantee this is where a lot of people go wrong during the rehab i.e. they don’t do this enough. Or they don’t do it properly.
Here is my good leg:
Now here is my right after a few hours of not being able to perform my exercises. You can clearly see the quad struggle to stay tight as I lift my leg. Notice I can still lift my leg but it’s not in the fashion I want:
-Dorsiflexion / Plantarflexion
-Sitting knee extension 90-0 degrees
-Hip abduction / adduction
-Hip flexion
Strengthening (Barefoot)
Monday:
A1) Squat to 45 degrees: 4 x6-8r -> (5 pounds)
A2) RDL: 4 x6-8r (10 pounds)
B1) Single leg leg press to 30 degrees: 3 x10-12r (15 pounds)
B2) Glute Bridges: 3 x10-12r (Bodyweight)
C) Single Leg Calves w/Leg Press: 4 x6-8r (15 pounds)
Wednesday:
A1) Squat to 45 degrees: 4 x6-8r (10 pounds)
A2) RDL: 4 x6-8r (15 pounds)
B1) Glute Bridges: 3 x10-12r (BW)
B2) Single Leg Calves w/Leg Press: 3 x10-12r (22 pounds)
Friday:
A1) Squat to 45 degrees: 4 x6-8r (10 pounds)
A2) RDL: 4 x6-8r (20 pounds)
B1) Single leg leg press to 30 degrees: 3 x10-12r (22 pounds)
B2) Glute Bridges: 3 x10-12r (BW)
C) Single Leg Calves w/Leg Press: 4 x6-8r (22 pounds)
– -> The strength training got a lot more detailed in week 3.
How much weight used is really dependent on the person. I made roughly 5 pound jumps each day based on how I felt. When in doubt I erred on the side of not increasing the weight.
Also, I definitely could have used more weight. However, I am trying to make sure I err on the side of progressing too slow instead of too fast. Too slow means the process may take a little longer in the long run; too fast means I do the whole thing over again.
Proprioception (Barefoot)
-Weight shifts eyes open and eyes closed on both legs unsupported, forward/backward, diagonal, and side to side
– > Weight shifting is made harder by being performed with the eyes closed.
-Single Leg Straight supported
– > This turned out to not be a proprioception drill so much as it was me trying to regain the ability to stand on one leg. Supported means I held on to something while standing on one leg.
Conditioning
-Elliptical backwards
– > Day 17 was 10 minutes, day 19 and day 21 were 15 minutes.
-Pool: Backwards and sideways walking
– > Backwards and sideways before forwards. I did this 30 minutes each time.
Meds
Aspirin / Tylenol (ideally after exercises)
-> Still no need for these. At this point I think any medication taking is over for good. I have 79 percocets I’ll have to try and sell…
Nutrition
-Calories = Bodyweight x 15 * 1.10 on strength days.
-Calories = Bodyweight x 10 on other days.
-Protein always high.
– > Nutrition gets fancier in week 3 also. On the strengthening days a caloric surplus is eaten to facilitate muscle growth. However, there’s no need for extra calories on the non-strength days. Therefore, a slight deficit is eaten BUT protein remains high!
This isn’t rocket science: Eat more on the days you lift weights; eat less on the days you don’t.
Posted on January 19, 2012