ACL Rehab: The Final 3 Keys to Returning to Your Sport

This year 250,000 ACL injuries are estimated to occur in the U.S. Unfortunately, only 63% of athletes ever return to their sport after ACL surgery. Also, in the first 2 years after surgery, 30% who return to high level sports sustain a second injury.  These high level sports are those that require jumping, pivoting and hard cutting.  A few examples are basketball, football, and soccer.

So, what can you do to increase your likelihood of returning to your sport?  Also, what can you do to reduce your risk of re-injury when you do return?  In previous articles we mentioned several big factors like committing to prehab before surgery, aggressive early post-op rehab, heavy strength training, and doing a lot of single leg exercises.  This article highlights the last 3 keys you have to understand in order to return to playing.

#1 You Must Confidently Hop and Land on 1-Leg

Multiple studies suggest your ability to hop on 1 leg predicts your ability to get back to your sport.  A 2020 study of 64 athletes who underwent ACL reconstruction surgery investigated a battery of tests to identify those who safely return to their sport. Athletes who returned to their sport within 2 years of surgery performed better on 3 separate single leg hop tests.  These are the single leg hop test for distance, the side hop test, and the triple hop test.

How well you do on the triple hop test is also associated with suffering a re-injury after returning to your sport.  A 2017 study out of the Cincinnati Children’s Hospital found performance on the triple hop for distance test is the most important of the various single leg hop tests.  Both distance hopped and your performance on your injured compared to your uninjured leg helps identify if you are at a high risk for a second ACL injury.

Plyometric exercises are started when you have adequate strength and confidence on your injured leg.   Plyometrics start with landing on 2 legs and progress to jumping and landing on 1 leg.  It will take several months of plyometric training for you to develop the necessary strength, stability, power, and confidence to return to some type of sport practice.

#2 Wait 9 Months or Longer to Return to Your Sport

In the first 2 years after ACL reconstruction, 3 out of every 10 athletes who return to their sport will sustain a 2nd ACL injury.  This should get your attention!  But there is hope.  A 2016 study published in the British Journal of Sports Medicine shows delaying your return more than 9 months since surgery reduces your risk.

ACL injury
Waiting at Least 9 Months Reduces Your Risk of Re-Injury

Specifically, for every month that you delay returning, until 9 months after ACL reconstruction, your rate of re-injury by goes down by 51%.  Some experts even recommend athletes who are 18 or younger should wait 2 years until returning to high level sports.

We have found most young athletes who pass return to sport testing get back to playing within 1 year after surgery.  However, not all athletes are able to pass their testing within this time period.  Inadequate quadriceps strength, poor performance on single leg hop tests, and a lack of confidence are what holds most athletes back.

#3 Your Mindset is the Most Important Factor of All

ACL rehabilitation
ACL rehab will challenge you mentally and emotionally

You probably have high expectations for a smooth recovery after your ACL surgery.  The majority of athletes expect good knee function and a return to the pre-injury level after surgery. However, these high expectations are not always fulfilled.  Many athletes do not return to their pre-injury level of sports.  The biggest reason why is the grueling mental and emotional rollercoaster you will ride while trying to get back.

The biggest key is to remain motivated throughout your rehab.  It will not be smooth.  And it will not be without mental and emotional challenges.  A 2017 study of 65 athletes who underwent ACL surgery found those who returned to their sport at 1 year were more motivated during rehab.  They were also more satisfied with their activity level and knee function.  In other words, they had more confidence in their ability to perform at a high level.

It is no easy task to stay motivated during a year or more of rehab.  Your physical therapist will help you set realistic goals and expectations.  It is going to take a team approach.  You cannot do it alone.

Prepare Yourself for the Marathon of ACL Rehab

We have had some tough love conversations with athletes who expect to return to playing 6 months after their surgery.  Yes, professional athletes can sometimes return to their sport earlier than 9 months after surgery.  This is no way suggests you should rush yourself if you are not ready.

The truth is you are ready to go back to your sport when you prove it to your physical therapist and surgeon.  You have to check all the boxes.  This includes being physically, mentally, and emotionally ready.  Let our physical therapists take you through the return to sport testing process.  Give us a call when you think you are ready.

ACL Surgery Rehab
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The Key to Returning to Sports after ACL Surgery: Get Strong on 1 Leg

Persistent quadriceps and hamstring weakness after ACL surgery delays an athlete’s return to sport.  Weakness of your injured leg will also predispose you to future injury.  To combat these problems you need to get strong on one leg.  This means your left and right legs are equally strong.  Also, to be at your best and reduce your risk for future injury, your quads and hamstring will have to be trained to work together.  The exercises in this article will get you strong and ready to return to your sport.

Quadriceps and Hamstring Weakness is a Big Problem 

A 2021 study out of New Zealand looked at athletes 2 to 10 years after ACL surgery. Compared to athletes without an ACL injury, the post-surgical athletes had lower activity levels, quality of life, and greater fear of re-injury.  Side-to-side thigh muscle (quads and hamstrings) differences were found in the post-surgical athletes.  Their quads were 11.9% weaker on the injured compared to their uninjured side.  Their hamstrings were 7.9% weaker on the injured compared to uninjured side.

This study shows a potential link between persistent thigh muscle weakness and quality of life up to 10 years after ACL surgery.  It is important to restore your quadriceps and hamstring strength within the first 9 to 12 months after your surgery.  The right ACL rehab program will get you strong enough to return to your sport and keep you healthy for years to come.

5 of the Best Single Leg Exercises after ACL Surgery

An estimated 70-90% of ACL injuries occur during rapid change of direction, landing, or decelerating on one leg. Decreased strength of your quadriceps and hamstring muscles increases your risk of sustaining these types of injuries.  Also, delayed hamstring activation during rapid change of direction contributes to this increase risk.  Therefore, exercises that activate and strengthen your quads and hamstrings together are ideal to protect your healing ACL graft after surgery.

Single leg exercises promote co-activation of your quads and hamstrings.  The 1-leg Romanian deadlift, band crossovers, and the single-leg squat all fit the bill. Perform these exercises with slow and controlled movements.  Maintaining a stationary trunk and avoiding knee collapse is important.  Do 3 to 4 sets of 8 to 12 reps.  Over time, increase the load and decrease the number of reps you do each set in order to maximize strength on one leg.

Sports are played in multiple planes.  This means you will be moving forward, backward, side to side, and in diagonal patterns. This requires reactive strength and stability on one leg. This is challenging to replicate during rehab.  Performing multi-plane lunges and hops are implemented before progressing to more challenging plyometrics.

Take the Next Step to Get Strong After ACL Surgery

We have witnessed several athletes try to return to their sport before restoring all their strength.  Against our recommendations, these athletes returned to their sport with poor results.  One young girl re-tore her ACL.  Another gentleman winded up tearing his other ACL.  Unfortunately, this happens all too often.

You must commit yourself to get strong.  This takes time.  Don’t rush back.  Some athletes don’t build up enough strength until well after 1 year from surgery.  Prehab, starting post-surgical rehab early, and taking your strength training seriously will set you up for success.  That is, an early and safe return to play.  Call our office to schedule an appointment with your physical therapist and get started on your road to recovery.

ACL Surgery Rehab
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ACL Rehabilitation: 3 Reasons Why You Need to be Doing Heavy Strength Training

There is no guarantee you will return to your sport after your ACL reconstruction.  In fact, 1/3 of athletes never return to their prior level of sport.  Pre- and post-operative ACL rehabilitation can be the biggest difference-maker in getting you back to playing.  And heavy strength training is the backbone of a successful rehab program.

Here are 3 reasons why you should be doing a progressive heavy strength training program for the bulk of your ACL rehabilitation.

#1: Greater Quadriceps and Hamstring Strength is Associated with Athlete Function 6 Months after Surgery

Restoring the strength of your thigh muscles within 6 months after your surgery is a critical component of rehabilitation.  Researchers from Ohio State University investigated thigh muscle strength and perceived function in 30 athletes 3 and 6 months after their ACL surgery.  Athletes with smaller side-to-side differences in quad and hamstring strength were functioning at a higher level.

Your strength training program begins once your pain, swelling, range of motion, and walking are back to normal.  For many athletes, this is about 6 weeks after surgery.  Delaying the start of strength training will only prolong your rehab and decrease your chances of ever getting back to playing.  It is important to follow the advice of your therapist before surgery (ACL prehab) and immediately after your surgery (early ACL rehab).  This way you can start your strength training on time.

#2 Greater Quadriceps Strength is Associated with Passing Return to Sport Tests

In order to be cleared back to your sport, you will have to pass a battery of tests.  Testing includes a series of surveys, hop tests, and strength tests.  Specifically, the strength of your quadriceps muscle must be at least 90% of the strength on your uninjured side.

Being stronger is going to make you feel more confident about your ability to return to playing.  Greater quadriceps strength is also going to boost your running, jumping, and cutting during your sport.   A 2012 study of 50 athletes showed those with stronger quads scored higher on return to sport testing.  Specifically, these athletes did better hopping and landing on their injured legs.

If you want to pass return to sport testing and get back to playing, you have to take your strength training very seriously from day 1.

#3 Quadriceps Strength Predicts Function 10 Years After Surgery

If you want to continue to play for years after your ACL injury, your quad strength has to be restored.  Researchers from the University of Kentucky investigated a series of performance tests in a group of athletes who underwent ACL surgery 5 to 20 years earlier (average of 10 years ago).  They found quadriceps strength to be the single best predictor of function in these athletes.

These research studies suggest restoring your thigh muscle strength early after surgery helps speed up your rehab, gets you back to playing, and keeps you healthy for years to come.

The Basic Components of Your ACL Strength Training Program

Your physical therapist will determine when you are ready to start your strength training program.  Improving hip, hamstring, and quadriceps strength is a big emphasis here.  The bulk of exercises are done standing with dumbbells, kettlebells, and barbells.

Proper exercise technique is mandatory.  This restores balance between both legs. Single leg exercises improve your strength, balance, and coordination.  Exercises done with 2 legs are loaded with more weight for maximum strength.  However, it is important that you don’t compensate by overusing your uninjured leg.  Your therapist will watch for this very closely.

Your hamstrings and glutes are strengthened with exercises like leg curls, deadlifts, and hip thrusts.  Your quads and glutes are trained with different squat and lunge variations.  Start with 3 sets of 8 to 12 reps 3 days per week.  As your program progresses, you will increase the load and number of sets but reduce the number of reps each set.

ACL Rehabilitation: Don’t Go Light with Your Strength Training

Getting strong after ACL surgery is not easy.  But neither is excelling at any sport.  There will be some speed bumps and setbacks along the way. Your physical therapist will help you overcome these.

Your road back to playing will be a long one but hang in there.  Stay focused on your end goal.  But also learn about yourself throughout the process (your rehab).  Call our office to schedule an appointment when you are ready to start on your road back to playing.

ACL Surgery Rehab
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ACL Rehab: 4 Steps for Early Success

ACL rehab is a grind after surgery.  Your recovery will be slow and full of ups and downs.  Only 63% of athletes will ever return to their previous level of sport.  However, you can be better. This article tells you what to do during your first few weeks after surgery to help get you back playing quickly.

Early Accelerated ACL Rehab is a Proven Approach

Most athletes have their injured ACL reconstructed with a graft from their patellar tendon. The patellar tendon graft heals quickly to your bone.  This allows accelerated rehabilitation soon after your surgery.  Early accelerated rehab results in quicker return of your full range of motion and strength.

A 2015 study published in the British Journal of Sports Medicine compared an accelerated progressive rehab program to a standard slower rehab.  Progression through this accelerated program is based on athlete’s ability to pass several different functional tests.  Two years after surgery, these athletes reported superior knee function, sport abilities, and quality of life.

To get off to a good start it is important to concentrate on 4 different aspects of your early rehab.  They are:

1.       Control and reduce your swelling

2.       Get your knee straight

3.       “Turn on” your quadriceps muscle

4.       Lose your limp

Step 1: Get Your Swelling Down

Immediately after surgery, it is normal for your knee to be swollen, stiff, and painful.  It is important to manage the swelling in your knee.  A light compression wrap is helpful for the first 7-10 days.  We recommend icing your knee several times per day for 10-20 minutes until the swelling is down.

Gentle range of motion exercises will help move the swelling out of your knee.  But you do not want to be overly aggressive with stretching your knee, especially with bending it.  Gentle stationary cycling is performed daily.  Also heel slide and wall slide exercises are done 3 times per day until you have full range of motion.

Step 2: Get Your Knee Straight

Properly managing your knee swelling will assist with straightening out your knee.  However, you will also have to work at restoring the last few degrees.  It is important to be able to fully straighten your knee to the same degree as your uninjured knee.

If you do not get your knee straight it will be nearly impossible to get all your strength back.  Also, you will walk with a limp and develop problems that affect your hip and back.  Be diligent with performing these knee straightening exercises at least 3 times per day.

Step 3: “Turn On” Your Quadriceps

Persistent quadriceps weakness plagues many athletes for years after ACL surgery.  It is important to get this muscle firing early after your surgery.  Controlling your swelling and getting your knee straight must occur in order for you to get your quad going.  Your quadriceps muscle strength will be one of the keys for you getting back to sports.

Straight leg raises and knee extension exercises are performed early after surgery without any risk to your healing ACL graft.  Your physical therapist will also supplement these exercises with neuromuscular electrical stimulation.  This gives your quads a little boost until they are firing on all cylinders.  Weight bearing exercises like partial squats and step ups are gradually introduced provided your swelling is under control.

Step 4: Lose Your Limp

If your swelling is down, your knee is straight, and your quad is firing then you are ready to walk without crutches.  You will not be cleared to walk without crutches until you can do so without any limp.  It is important that you are walking normally without any compensation.

Losing your limp will require some assistance from your physical therapist.  Several hands-on exercises are used to retrain your walking pattern.  Also, cone and hurdle drills assist with bending your knee and promoting stability on your injured leg.  Expect to be walking unassisted without a limp within 2 to 3 weeks of your surgery.

Your Physical Therapist Will Keep You Motivated and On-Track During Your ACL Rehab

ACL rehab is time-consuming as well as mentally and emotionally demanding.  It starts before your surgery and can last for up to a year.  Follow the 4 steps outlined in this article and you will set yourself up for success.

You are going to need some support and guidance.  Your physical therapist is your guide and will help you through the rough patches. Give us a call to get started with your rehab.  The doctors of physical therapy at BSR have been helping injured athletes get back to their sport since 2007.

ACL Surgery Rehab
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ACL Prehab: Increase the Chances of Returning to Your Sport

An estimated 250,000 anterior cruciate ligament (ACL) reconstruction surgeries are done each year.  Unfortunately, surgery does not guarantee a return to playing sports. Rehabilitation after surgery is a grind.  And only 63% of athletes return to their pre-injury level of sport.  Thankfully, pre-surgery rehab or “prehabilitation” will accelerate your recovery after surgery.  Read on to learn how ACL prehab will help get you back to playing your sport.

Get Back to Playing with ACL Prehab

A 2016 study lead by researchers at the University of Delaware compared return to sport rates in athletes who underwent extended prehab to those who did not.  All athletes completed the same post-surgical rehab program. After surgery, athletes were tracked for 2 years. A significantly higher % of athletes returning to their pre-injury sport completed extended prehab (72%) compared to those who did not complete the extended prehab (63%).

What is ACL Prehab?

Extended prehab focuses on decreasing knee swelling, restoring range of motion, normalizing your walking pattern, and returning at least 70% of your strength.  The progressive prehab program also includes retraining your balance.  You are advanced only after meeting specific criteria.  You are finally cleared for surgery once all these criteria are met.

The exercises that follow are a few that we prescribe at BSR.  Perform your exercises daily for the best results.  Remember, everyone progresses at a different pace.  Some athletes meet all milestones in just a few weeks.  Others take a few months.  Your physical therapist will help you determine the best way to progress your program so you can get back to playing.

Range of Motion ACL Prehab Exercises 

You don’t want to develop knee stiffness after your ACL surgery.   This leads to a slow and frustrating recovery.  By restoring full knee range of motion before surgery, you will significantly reduce your chances of running into this problem.

Fully straightening your knee is crucial for your recovery.  Be diligent with these exercises.  Perform range of motion exercises at least 3 times per day until your mobility is equal to your other knee.

Strengthening Prehab Exercises

The strength of your quadriceps muscle is one of the biggest keys to you getting back to playing sports after your surgery.  It is common for quadriceps weakness to persist for 1, 2, or even 10 years after ACL surgery.  Start exercising this muscle early!  Straight leg raises and partial squats are not the most glamorous exercises, but they are a first step in the right direction.

Neuromuscular Training Exercises

You should be able to easily stand and balance on your injured leg without difficulty. Before advancing to high-level sporting activities, you will need single leg balance and stability.  Get good on 1 leg before you go in for your surgery.

Begin neuromuscular training after you have full range of motion, no limp, and good strength.  Start by practicing single leg balance for 30 consecutive seconds.  Then your physical therapist will advance you to more challenging exercises like band kicks or drills on a wobble board.

Start Your ACL Prehab Today

Don’t put off your rehab until after your surgery.  Your rehab starts before your surgery!  We have watched too many good athletes neglect this phase of their rehab and never return to their sport.  Get a head start with the ACL prehab exercises in this article as soon as possible after your injury.  ACL injury recovery is a marathon full of ups and downs.  Be proactive from the start.

For help getting started, call our office to schedule an appointment with one of our doctors of physical therapy.  We have been helping injured athletes of Southern Ocean County get back to their sport since 2007.

ACL Surgery Rehab
Download this Free Special Report to Learn the 7 Keys to Returning to Sports After ACL Surgery

Meniscus Repair: Easy and Proven Rehab Exercises

An estimated 850,000 meniscus surgeries are done each year in the U.S. Previously, we reviewed the keys to recovery after menisectomy surgery.  Menisectomy is the most common type of surgery for meniscus tears.  With this procedure, your surgeon removes the torn portion of your meniscus.  Recovery is quick and straightforward.  However, this type of surgery is associated with accelerated knee arthritis and knee replacement surgery.  Therefore, the preferred surgery is a meniscus repair.

With a meniscus repair, the torn edges of your cartilage are sewn back together.  Repair of your meniscus leads to a decreased risk for arthritis.  It also leads to improved outcomes compared to meniscectomy.  An individualized rehabilitation program is crucial for the best results after a meniscus repair.  This article highlights who should get their meniscus repaired and how to best recover.

Who Gets a Meniscus Repair?

Your surgeon considers many different factors to determine if you are a candidate for a meniscus repair.  This includes the following factors:

  • Younger (usually < 40 but not always) active person
  • No significant medical problems
  • Not overweight or obese
  • Smaller tears
  • Tears located in areas with good blood flow (for healing)
  • Tears < 3 months old
  • Minimal to no arthritis in your knee
  • Willingness to comply with a slower rehabilitation (read on for more about this)

Meniscus Repair Recovery: Slow or Fast Rehab?

Historically, there has been very little consensus on how to best rehabilitate after a meniscus repair.  Now, this is changing. Recent research offers guidance on how to best get back to your favorite activities.

The key questions to consider after surgery are:

  • How much weight is safe to put through your healing meniscus?
  • How much knee bending is safe for your healing meniscus?
  • When can you progress through your strengthening program?
  • When can you safely return to sports?

Conservative rehabilitation restricts knee range of motion and weight through your injured leg.  Restrictions last for 4 to 6 weeks.  With this slower approach, you will wear a locked knee brace.  Also, you will walk with crutches until cleared by your surgeon.

Prolonged time in a brace with restricted weight-bearing leads to stiffness and weakness.  Accelerated rehabilitation avoids these problems.  However, some question the safety of this approach on the healing meniscus.

Accelerated Meniscus Repair Recovery: A Proven Approach

A systematic review done by physicians at the Rothman Institute investigated the safety and effectiveness of various rehab protocols after a meniscus repair. They looked at 15 different studies.

In their review, restricting the range of motion and weight-bearing showed no benefit over an accelerated approach.  Long-term results (1 to 2 years after surgery) are similar for the conservative and accelerated approaches.

Early weight-bearing and a full range of motion avoid the unnecessary decline in strength and function that happens with restricted rehabilitation.  We advocate for an accelerated approach.  However, pain and swelling have to be respected during the process.  Your rehab is progressed based on meeting specific milestones.  These include full range of motion and walking without a limp.

3 Easy Exercises to Start Early After Your Meniscus Repair 

Regardless of which rehabilitation approach your surgeon allows, you want to begin exercising your knee right away.  Start non-weight-bearing exercises from your home the day after surgery.  Focus your efforts on straightening your knee fully, activating your quadriceps, and slowly progressing your knee bending.

3 Weight-Bearing Exercise Progressions

Weight-bearing and advanced exercises come in later during your rehab.  Your physical therapist walks you through these exercises.  Avoid deep squats or knee bends until your physical therapist clears you.  The following 3 exercises are a safe way to start.  Focus on improving your single leg balance and avoiding compensations with your other leg.

Don’t Delay Your Rehab After Surgery

Meniscus repair is preferred over meniscectomy surgery.  Rehab is slower after a repair.  However, if you start early and commit to your exercises, the long-term results will make it well worth it.  Early on it is important you minimize knee stiffness and loss of your muscle strength.  As you progress in your rehab, your physical therapist will specifically target your exercises towards your movement patterns and goals.

meniscus repair recovery
Your physical therapist will develop and progress your rehab based on your goals

A progressive rehab program is so important for your recovery!  Some people ignore their surgeon and physical therapist recommendations.  Unfortunately, we see this too often.  This results in a rollercoaster rehab with inconsistent improvements.  More importantly, this also leads to a knee that continues to be painful years later.

If you are looking for help after your meniscus repair surgery, call our office to schedule an appointment.  Our doctors of physical therapy have been helping people in Southern Ocean County move without pain since 2007.

Meniscus Surgery: Simple Exercises for Your Best Recovery

Meniscus surgery is the most common orthopedic procedure performed in the U.S. According to Harvard Medicine, 750,000 meniscus surgeries are done each year.  However, when it comes to a pain-free knee, surgery alone is no guarantee.  Several studies show similar results with either surgery or conservative treatments.  The best results occur when surgery is combined with an individualized exercise program.

Most people who have arthroscopic meniscus surgery undergo a partial meniscectomy.  This involves removing the torn portion of cartilage. Your surgeon will also smooth out any rough edges of the tear.  The remaining healthy meniscus is preserved as much as possible.  However, even when surgery is well done, many people still report ongoing pain.  Also, if you undergo meniscus surgery you are more likely to develop arthritis and undergo a future knee replacement.

Your Rehabilitation is the Key after Meniscus Surgery

A 2014 study from Europe compared the results of surgery alone versus surgery plus rehabilitation.  The group of people who received rehab after their surgery achieved more than 3 times the improvement in pain and function 3 months later.  The improvements were still 2 times better in the rehab group 1 year after surgery.

Another large systematic review looked at the benefits of home exercise instead of supervised physical therapy in an outpatient clinic.  Both home and supervised exercise were superior to not doing any exercise after surgery.  However, those who receive outpatient physical therapy showed better improvements in knee range of motion and function.

For the best results, both home and in-person physical therapy exercises should be done.  We recommend exercising at least 3 times per week after surgery. Rehab usually lasts 4 to 8 weeks.  After this time, your therapist and surgeon may clear you to perform gym-based exercises.

Components of Your Meniscus Surgery Rehab

Below is a brief overview of how to progress your rehab.  Everyone improves at a different rate.  Don’t compare yourself to others who claim to have had the same surgery.  Instead, focus on making small improvements every day.  Here’s how.

1. Control Your Pain and Swelling

The easiest way to speed up your recovery is to keep your knee swelling down.  We recommend frequent icing 3 times per day for the first 7 to 10 days after surgery.  You only need 10 to 15 minutes each time.  A light compression sleeve or ace wrap is also helpful for the first few days.  It is always best to elevate your leg when resting.

Keep moving.  Get back to light regular activities as soon as possible. But don’t overdo it until the swelling is down.  Stay away from any deep knee bends or squats.  Don’t force any range of motion.  Gentle movement will help your pain and swelling.  Aggressive stretching will not.

Start some gentle heel slides and quadriceps isometric exercises on post-op day 1. Start with 10 to 20 reps each session.  Do these exercises 3 times per day until you see your physical therapist.  You can also start light stationary cycling without resistance within a few days of your surgery.

2. Restore Your Range of Motion

After your swelling is nearly gone and your pain is minimal, you are ready to push your range of motion a little more.  Getting your knee fully straight is extremely important.  Heel propping exercises and quadriceps isometrics are very useful.  Perform these at least 3 times per day until your knee is fully straight.  You must have a straight knee to walk properly.

You do not want to be overly aggressive with bending your knee.  It takes a little longer to regain full knee bending.  If you are too aggressive you can irritate your meniscus and stir up the swelling again.  Heel Slides and quadriceps stretching exercises will get the job done.  Be consistent with daily stretching.  But also be patient.

3. Begin Strength Training

After surgery, your quadriceps muscle is going to shrink and weaken.  This will happen fast.  Doing quadriceps isometric exercises immediately after your surgery will help.  But you will also have to perform progressive strengthening exercises to get this muscle back up to speed.  Weak quad muscles will cause more stress through your knee joint.  Excessive loading will increase your chances of developing arthritis in your knee.

Once you start to regain some of your quadriceps strength, you want to transition to weight-bearing exercises. This is when your physical therapist will prescribe step-up exercises and modified squats.  With these types of exercises, it is important that you relearn how to use both your hip and quadriceps muscles together.  When done right, you will minimize stress through your knee.

4. Return to Your Activity or Sport

During this phase, your physical therapist will help you develop a plan to return to your favorite activity or sport.  The specific exercises are dependent on your goals.  For athletes returning to competitive play, performance testing will determine your readiness to return.

Even for recreational athletes, you must meet specific criteria to gain full clearance.  This includes no pain or swelling and an adequate range of motion and strength.  Your therapist will help you develop an exercise program to keep you strong and at your best as you transition back to all aspects of your life.

Meniscus Surgery: Start Your Rehab the Right Way

Exercise is a crucial part of your recovery from meniscus surgery.  The exercises you perform are matched to your phase of recovery and long-term goals.  The 6 simple exercises included in this article are only samples of those we commonly prescribe.  At BSR, your doctor of physical therapy will individualize your program so you can get on the fast track to recovery.

It is important to get started soon after your surgery.  If you would like help from the experts at BSR, call one of our offices to schedule your initial evaluation.  We have been helping the people of southern Ocean County move without pain since 2007.  We look forward to helping you next.

5 Easy Hamstring Stretches to Help Your Knee Pain

Pain or tightness around your knee can be from poor hamstring flexibility.  Research proves tight hamstrings contribute to knee pain.  However, many people struggle with how to best stretch their hamstrings.  Do you find it painful to stretch?  Or are you stretching day after day and see no improvement?  This article will show you how to do hamstring stretches that are easy and proven to work.

Proven Hamstring Stretches 

Several different hamstring stretches are proven to improve flexibility and knee pain.  A 2020 study published in the journal Sports Health looked at 46 people with knee pain.  One group performed strengthening exercises and a traditional seated hamstring stretch held for 15 seconds.  The other group did the same strengthening exercises but different dynamic hamstring stretches.  These dynamic stretches are described below (active hamstring stretches).  After 12 weeks, people performing the dynamic stretches reported 3x more improvement in knee pain.

Hamstring exercises
Active Hamstring Stretch in Supine

There are other proven methods to improve hamstring tightness.  These include foam rolling, proprioceptive neuromuscular facilitation (PNF) stretches, and sciatic nerve stretches.  These methods are different than traditional static stretching exercises.  Static stretches improve flexibility in the short term but do little to sustain gains over time.  Instead, try any of the 5 hamstring stretches outlined here.  This will give you more lasting pain relief and mobility.

Active Hamstring Stretch in Supine

The active hamstring stretch is done easily on the floor or in your bed.  Lie flat on your back.  Grasp the back of your thigh with both hands.  Hold your thigh so it is pointing straight up to the ceiling.  You want your hip flexed at a 90-degree angle.  Then, actively extend your lower leg until you feel a mild to moderate stretch.  Only hold this position for 1 second.  Perform 3 sets of 15 stretches once per day.

This is our preferred way to stretch your hamstrings.  When you actively straighten your knee with your quadriceps muscle, you are relaxing your hamstring muscle on the other side of your thigh.  This will allow you to stretch with a greater range of motion.  It will also retrain your hamstrings and quadriceps to work together.  This results in longer-lasting improvements in flexibility.

Active Hamstring Stretch in Standing

If you don’t like the lying stretch, try this one.  Stand holding on to a chair or wall for balance.  Tighten your abdominal muscles so your low back doesn’t round.  With your knee straight and toes up, raise one leg straight out in front of you.  You want to feel a mild to moderate stretch in the back of your thigh.  Only hold this position for 1 second.  Perform 3 sets of 15 stretches once per day.  You don’t have to do both the supine and standing stretches.  Choose whichever you prefer or alternate each day.

Hamstring Stretches with a Foam Roll

Sit on the floor with a foam roll under 1 thigh.  Support yourself with your hands.  Move your body up and down so the foam roll contacts the length of your hamstrings.  Apply pressure from your buttock down to the back of your knee.  If you find a tender or tight part of the muscle, spend a little more time there.  Perform 3 sets of 30-second bouts on each leg.

Longer durations do not lead to any additional benefits.  Also, there is no need to be overly aggressive or beat yourself up with crazy versions of foam rolling.  Keep it simple.

Contract Relax PNF Hamstring Stretch

Lie flat on your back.  Wrap a stretch-out-strap, belt, or towel around your foot.  Hold an end of the strap in each hand.  Next, passively raise your leg with your knee straight.  Hold the stretch when you feel a mild to moderate pull in the back of your thigh.  Then, contract your hamstrings by gently pushing your leg back down towards the floor.  Push your leg into the strap as you resist.  Your leg does not move.  Hold this muscle contraction for 6 seconds. Relax for a few seconds.  Then pull your leg up a little bit further holding for 10 seconds.  Repeat this sequence 5 times on each leg.

This stretch works better when you have a partner or your physical therapist to assist.  It is challenging to really relax your hamstrings when you are by yourself.  Give it a try on your own and let us know if you need more help.

Slump Slider and Tensioner

The sciatic nerve stimulates and travels close to your hamstrings.  When you stretch your hamstrings you are also stretching your sciatic nerve.  However, you can bias the stretch to move or pull on your nerve more.  This influences the blood flow to the nerve.  Changes in nerve blood flow can cause the muscles it supplies to relax.  It is amazing how this can cause profound changes in hamstring flexibility very quickly.

We recommend starting with the slider technique in this video.  If your improvements start to slow down, mix in the tensioner.  However, if you have a history of back pain, be very gentle with the tensioner.   We recommend you do 3 sets of 10 to 15 repetitions once per day.

How to Get Started with Hamstring Stretches

Let’s face it, stretching is boring. Holding stretches for 30 seconds or longer takes time and often leads to only short-term improvements.

The 5 hamstring stretches included in this article are dynamic and take much less time.  Even better, research studies prove they are effective for decreasing knee pain and improving flexibility.  You don’t have to do them all.  Try a few and pick the 1 or 2 you like the best.

If you are unsure about which hamstring stretches are best for you, give us a call.  Our doctors of physical therapy will perform an examination and help you develop a plan to move without pain.

Lunge Exercises: How to Modify the Lunge if You Have a Knee Injury or Pain

It can be frustrating when knee pain or an old injury interferes with your workouts.  This is especially true when knee pain prevents you from exercising your lower body.  Some people give up and avoid exercising all together. However, there are ways for you to exercise and move without pain.  This article shows you how to modify lunge exercises so you can keep training.

The lunge exercise is a great way to train your lower body muscles from your glutes all the way down to your lower leg.  The lunge is closely linked to everyday walking, running, stair climbing, and balance.  Lunge exercises also help train athletes for changes of direction common in sports.  Just about everyone will benefit from doing some type of lunge exercise.  This article will teach you how to modify lunge exercises so you can have a great workout without pain.

The Basic Mechanics of Lunge Exercises

Lunge exercises involve coordinated movements between your hips, knees, and ankles.  Also, control of your trunk position influences how your lower body joints will move.  The greatest amount of joint movement occurs at your knee.  However, during the lunge the greatest muscular demands are placed on your glutes.  Therefore, performing lunge exercises in a way that increases your glute muscle activation will theoretically reduce the stress on your knee.

muscles during lunge
Lunges are primarily a glute dominant exercise

The lunge is a movement pattern that many people struggle with.  It is a challenge for some people to control the position of their trunk.  We see people leaning or falling to their left of right all the time.  It is important that you maintain a relatively upright and stable trunk throughout the lunge.  Don’t add any weight or resistance until you can master this important part.

Just as important is the position of your knee relative to your hip and ankle.  When your knee is bent during the lunge it should not collapse towards the middle of your body.  Instead, keep your knee in line with an imaginary line from your hips down to your second toe.  Think about pushing your knee out (not your foot) as you move up and down during the lunge.  Learn more about this here.

Lunge Regressions and Progressions

The exercises that follow are part of a simple progression. Start with the basic split squat and go from there.  Many people also benefit from performing other corrective exercises to strengthen their gluteus medius and maximus.  These corrective exercises are based on your physical therapists examination of your strength, mobility, and movement patterns.

Split Squat Exercises

The simplest way to minimize knee stress to your knee during the lunge is to control the depth.  Deeper knee bends increase stress around your knee cap and within your joint.  Deep squats or lunges increase stress to your meniscus, ligaments, and joint surfaces.  Controlling the depth of your lunge is easy to accomplish when you are starting from a static position like in the split squat.  We recommend starting without any weights or resistance.  Instead focus on maintaining balance and control of your trunk.

The split squat also allows you to adjust the position of your feet. A good starting point is to begin with your feet split about 60% of your total height.  This distance places the greatest demands on your hip muscles.  For more challenging variations that require greater knee flexion try the rear-foot elevated split squat.

Reverse Lunge Exercises

The reverse lunge involves a backward step instead of the more traditional forward step.  The reverse lunge loads the hip more than the knee.  Therefore it is a more knee-friendly option than the traditional forward lunge.  This makes it an excellent option for people with arthritis or those with a recent knee surgery.

Lunge exercises
TRX Assisted Lunge

Begin with both feet together holding a suspension trainer in each hand.  This will help maintain your balance during the exercise.  Step back and lunge down into a comfortable depth.  Keep a neutral spine with good upper body posture. Think about pushing up with your glutes and extending through your front hip.  Finish with both feet together. At first it will be easier to perform all repetitions on one side first.  As you gain confidence, alternate steps with each leg.  Perform 2 to 3 sets of 8 to 12 repetitions.

After you are able to perform the assisted exercise with good technique you are ready to progress to a traditional reverse lunge. Another progression is the deficit reverse lunge.  This exercise uses a small step of 4 to 6 inches.  The elevated position will load your hip and glute muscles more.  It will also increase your available knee range of motion.  This increases the training effect to your quadriceps muscle.  But it also adds to the knee joint load.

Forward Lunge Exercises

After mastering the split squat and reverse lunge, you are ready to progress to the forward lunge.  This requires greater balance and control of your trunk.  And if performed poorly, will increase the stress on your knee.  Remember; focus on your technique before getting fancy with weights, bands, balls, or balance devices.

There are an endless number of variations that can be incorporated into the forward lunge.  Some include the use of external loads (dumbbells, kettlebells, and other weights).  Other variations utilize technique modifications to unload or load certain parts of the body.  We will focus on a few of these types of lunge exercises.

Allowing the front of your knee to move past your toes will increases stress to your patellar tendon.  In the early phases of rehabilitation or when pain is severe, this should be avoided.  Instead, in these instances perform the lunge with your knee staying behind your toes.  In most cases, this is your best approach.  However, if you are bothered by chronic patellar tendinitis, (AKA “jumper’s knee”) controlled stress or load to the tendon may be a good idea.  Your physical therapist will help you decide if this is the right approach for you.

Additional Ways to Modify Forward Lunge Exercises

  • Hold a light medicine ball out in front of you to act as a counterbalance. This will make it easier for you to maintain proper trunk position.
  • Add an external load or weight to increase the demands on your hip muscles and ankle. However, adding weight will have less of an impact on your knee joint.
  • Hold a dumbbell in the hand opposite to the side you are lunging with to increase glute activation.
  • Slightly lean your trunk forward to further increase glute muscle activation (instead of keeping a perfectly straight trunk).

Final Thoughts on Lunge Variations

This article outlines some key points about progressing lunge exercises for people with knee pain or injury.  You can achieve great benefits from sticking with the split squat and never progressing to a traditional lunge.  Other people will be able to modify and progress through these exercises.  After mastering the forward lunge, you may want to experiment with lateral or transverse lunges.  These exercises are more challenging and require impeccable form.  The doctors of physical therapy at BSR are experts who can help you move without pain.  If you want a little extra help to get over the hump, contact us and schedule your initial evaluation.




Returning to Sports after Knee Replacement

It is estimated that the number of knee replacement surgeries in the United States will increase 673% from 2005 to 2030.  People under 60 years old are responsible for most of this spike in surgeries.  Also, people are living longer than before.  Most expect to stay as active as possible up to and after retiring.

Many people desire to return to high-level activities and sports like golf, hiking, jogging, or tennis.  A common and worthy goal after surgery is to return to playing sports.  This article highlights realistic expectations and timeframes for returning to your favorite sport.

Health Benefits of Physical Activity and Sports after Knee Replacement

knee arthritis

Knee replacement surgery has an unquestionable positive impact on your health and fitness.  This is because decreased pain and improved function following surgery allow you to resume previously restricted activities.

In fact, research proves the risk for serious cardiovascular events is reduced by 12.4 % after hip or knee replacement surgery.  So undergoing a knee replacement not only reduces your knee pain, it also decreases your risk of a heart attack or stroke.

Can I Play Sports after My Knee Replacement?

Research shows you are extremely likely to return to low-impact activities after your knee replacement.  The majority of people (94%) will safely return to walking, biking, swimming, dancing, and playing golf.

People hoping to return to moderate impact activities do so with a success rate of 64%.  This includes sports like bowling, skiing, hiking, and doubles tennis.

Those who desire to return to higher impact sports do so at a lower rate (43%).  This includes activities such as softball, basketball, jogging, and singles tennis.

aerobic exercise back pain

Several factors will increase or decrease your chances of returning to sports.  People who are overweight or obese are less likely to return to any sport.  Younger people (< 70 years old) are more likely to return to their favorite sport.  Also, research shows men are slightly more likely to return to sports after their surgery.  Women, don’t let this discourage you!

When Can I Get Back to Playing Sports?

Many people we rehabilitate hope to return to golf after their knee replacement.  As long as there are no post-surgical complications, expect to return to playing golf within one year of your surgery.  Some people (13%) may return as soon as 12 weeks after surgery.  Most people (44%) resume playing a full round of golf between 4 to 6 months after surgery.

Golf exercises

The average time to return to other low-impact sports (biking, swimming, and dancing) is similar to golf.  Expect to resume moderate impact activities (doubles tennis, bowling, and hiking) between 3 to 4 months after your surgery.  In most cases, people looking to resume high-impact activities (singles tennis, softball, and jogging) do so no sooner than 6 months after surgery.

During jogging, loads 5 to 10x your body weight is imparted through your artificial knee.  Not all joint replacements are designed to withstand these forces.  Studies show higher wear of the artificial joint surface in people who run after their knee replacement.  However, there is no evidence that running increases your risk of undergoing another operation.

Final Thoughts on Sports after Your Knee Replacement

Discouragement from your surgeon, mainly to high-impact sports, may be a barrier for you.  Surgeons usually approach these recommendations on a case-by-case basis.  We recommend you discuss your situation with your surgeon. It is always a good idea to weigh the pros and cons of returning to your sport.

Pain, weakness, and a loss of confidence are other reasons why you may not return to your favorite sport.  Your physical therapist can help in these cases.  It is important to keep open communication with your therapist.  This includes shared decision-making about your goals and reasonable expectations. If you would like help returning to your sport after your knee replacement surgery, give us a call.

Knee replacement
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