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Knee
sprain rehabilitation for athletes
Rehabilitation
exercises
Alternative
exercises
Rehabilitation
after surgery
When
can I return to my sport or activity?
Read
more about knee sprains
Knee sprain rehabilitation for athletes
Often caused by a sudden twisting motion, knee sprains are one of the
most common football injuries. For a mild sprain (Grade 1), your doctor
may recommend an exercise program to strengthen muscles surrounding the
knee. The doctor may also prescribe a protective knee brace for you to
wear during activity, and in some cases, may prescribe you to wear a leg
cast for two to three weeks.
For torn ligaments
(Grade 2 or Grade 3 knee sprain), such as a torn ACL,
torn PCL,
or meniscal
tears, your doctor is likely to recommend surgery, in which the torn
ends of the ligament are reattached or reconstructed.
As an athlete, you
may already know that one of the most common and best ways to begin rehabilitating
a sprain is R.I.C.E.:
- Rest
Avoid putting any pressure on your ankle by not walking on it.
- Ice
Apply ice or a cold pack to the ankle for 15-20 minutes, 4 times a day
for at least 2 to 3 days. This helps reduce pain and swelling. Wrap
the ice or cold pack in a towel. Do not apply the ice directly to your
skin.
- Compression
Wrap your ankle in an elastic compression bandage (e.g., Ace bandage).
This will limit swelling of your ankle.
- Elevation
Keep your ankle raised above the level of your heart as often as possible
for the first 48 hours. This will help drain fluid and reduce swelling.
Rehabiliation exercises
You can begin exercise rehabilitation when the swelling subsides, which
is usually a few days after the injury. Because warmed tissue is more
flexible and less prone to injury, you may want to warm the knee before
doing rehabilitation exercises. Use ice when finished to minimize any
irritation to the tissue caused by the exercise.
To get you back in
the game as quickly as possible, there are three main goals in rehabilitating
the knee: restoring motion and flexibility, restoring
strength, and restoring
balance.
- Front thigh muscle
sets
Sit with legs extended and fully contract the muscles of the front thighs.
Hold contractions for 10 seconds. Repeat 10 times.
- Straight-leg raises
Lie with one leg extended and the other bent at the knee. Lift the entire
leg from the hip so that the heel is about 5 inches above the floor
or ground. Hold this position for 5 to 10 seconds, then slowly lower
the leg. Repeat 10 times for each leg.
- Backward leg raises
Lie on stomach with legs straight. Lift one leg as high as possible
and hold for 5 to 10 seconds. Repeat 10 to 20 times for each leg.
- Half-knee bends
Stand with feet shoulder width apart or as the injury improves, try
to stand with feet together. Slowly lower the body weight by bending
the knees. Do not perform a full squat but rather stop at about half
of the full-squat position and then fully extend the knees. If there
is pain before achieving the half-squat position, stop downward travel
at that point. Repeat 10 to 20 times.
Once knee pain has
been minimized, you may swim, cycle, walk, stair climb, weight train,
or jog, as pain allows. These activities will help you to gradually return
to full training. Also remember to continue these stretching, strengthening,
and range-of-motion exercises in order to reduce the risk of injury recurrence.
Alternative exercises
During the period when normal training should be avoided, alternative
exercises may be used. These activities should not require any actions
that create or intensify pain at the site of injury. They include:
Rehabilitation
after surgery
An athlete who wishes to return to sports that involve jumping, cutting,
and pivoting may need surgery to reconstruct the ligament if it's torn
completely. This stabilizes the knee, preserves the cartilage, and enables
a return to sports at the same level as prior to the surgery. After surgery,
exercise and rehabilitative therapy are required to strengthen the muscles
and restore mobility. With this procedure, most athletes can return to
their chosen sport at the same level.
Keep in mind that
if your knee injury requires surgery, the soft tissue needs time to heal
before exercise can begin. While in the hospital, patients start partial
weight bearing with exercises to re-establish knee joint mobility and
normal gait. In these cases, you would be required to wear a brace and
use crutches for the first six weeks.
A physical therapy
program usually begins with range-of-motion and resistive exercises, then
incorporates power, aerobic and muscular endurance, flexibility, and coordination
drills.
Finally, patients
develop speed and agility through sport-specific exercise routines. A
typical patient may begin to ride a bike at three months, start running
at five to seven months, and return to competitive sports after eight
to 12 months. Full recovery may take up to two years.
The ultimate goal
of reconstructive knee surgery is to provide dynamic stability while maintaining
full range of motion, so that athletes can return to competitive or recreational
sports. Progress is assessed by the patient's perception of how stable
the knee feels and by comparing the strength and stability of the injured
and uninjured knees.
When can I return
to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity
as soon as is safely possible. If you return too soon you may worsen your
injury, which could lead to permanent damage. Everyone recovers from injury
at a different rate. Return to your activity is determined by how soon
your knee sprain recovers, not by how many days or weeks it has been since
your injury occurred. It also depends on how serious the injury is. Instances
where reconstructive surgery is required will obviously create a longer
recovery period than patients with a mild sprain.
A good rule is to
allow pain to dictate when you're ready to return to activity. You should
return in moderation, and back off if you feel any pain.
The ultimate goal
of reconstructive surgery is to provide dynamic stability while maintaining
full range of motion, so that athletes can return to competitive or recreational
sports. Progress is assessed by the patient's perception of how stable
the knee feels and by comparing the strength and stability of the injured
and uninjured knees.
You may safely return
to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:
- You have full range
of motion in the injured knee compared to the uninjured knee.
- You have full strength
of the injured knee compared to the uninjured knee.
- You can jog straight
ahead without pain or limping.
- You can sprint
straight ahead without pain or limping.
- You can do 45-degree
cuts, first at half-speed, then at full-speed.
- You can do 20-yard
figures-of-eight, first at half-speed, then at full-speed.
- You can do 90-degree
cuts, first at half-speed, then at full-speed.
- You can do 10-yard
figures-of-eight, first at half-speed, then at full-speed.
- You can jump on
both legs without pain and you can jump on the injured leg without pain.
How long will the
effects of the injury last?
With proper rehabilitation, a first occurrence of pain that is diagnosed
and treated in its early stages with rest, ice, elevation, and compression
usually lasts two weeks. If the injury has recurred several times, full
recovery may take as long as six weeks.
Frequent episodes
of knee sprains may result in a ligament tear. Such a complication may
require surgical treatment, and full recovery under such circumstances
can take up to two years, depending on the severity.
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