Knee: Meniscus Menisci (cartilage) Symptoms Pain when twisting, turning or full lock of knee Pain on screw homes or hyper extension Pain whilst running on hard surfaces (i.e 3G, road running) Pain going up or down stairs Locking Swelling with in first 72 hours Expected recovery time Grade 1: 1-3 weeks Grade 2: 3-16 weeks Grade 3: 16 weeks + Acute stage If swollen, ice injured site for 20 minutes, then remove ice for 40 minutes before re applying. Keep ice in plastic bag to prevent ice burn. Keep ice compressed around site of injury. Keep leg elevated when icing.
Ergonomic aids to help increase healing rate Ultrasound by qualified professional Game ready or cryocuff during if any swelling or after intense session Contrast therapy after no swelling 2 minutes of hot water bottle, 2 minutes of ice pack alternated for 20 minutes. Allow 40 minute break before re applying. From day 3 lengthening stage Transcutaneous Electrical Neuromuscular Stimulation (TENS) or Muscle Stimulation for Vastus Mediallis Oblique (VMO) Non weight baring exercises to maintain cardio swim, cycle Plan of progression Only progress to following stage when form is correct and pain free Especially to medial menisci damage, aim to develop strength to VMO Allow minimum one day recovery in between strengthening exercises Maximum of 3 strengthening exercises to be progressed per day Avoid road or treadmill running Aim to lengthen for 40% of rehab time and strengthen 60% of rehab time. I.e grade 2 strain: 4 weeks lengthen, 6 weeks strengthen.
Range of motion 1) Heel slides Lying down on back, keeping knee a wrist width apart, bend knees and slowly bring injured leg heel towards glute. Aim to have heel as close towards glute as possible. Even range on both left and right legs. 3 sets x 30 secs
2) Leg flexion Lying down on stomach, bringing heel towards glute. Aim to have heel as close towards glute as possible. Even range on both left and right legs. 3 sets x 30 secs Progression a) Have a therapist passively take your leg to the further range, pain free as possible to help increase range. Only progress when full range is achieved, pain free and no swelling
Lengthening 1) Foam roll: Weight to the side from top of the knee to the bony prominence of hip 3 sets x 30 secs
2) Foam roll: Weight assisted from top of the knee to the bony prominence of hip 3 sets x 30 secs
Strengthening Non weight assisted 1) Double leg 20 degree squat Legs shoulder width apart, toes pointing at 11 and 1 o clock. Knees not passing toes and dropping hips and knees down towards floor. Working on first 20 degrees of squat. Squat will be shallow and not encompass full range. 3 sets x 20 reps
2) Single leg squat Flexing injured knee. Keep knee neutral as squatting down, make sure knee does not buckle in or out to the side, keeping in line with toes. Squat will be shallow and not encompass full range. 3 sets x 20 reps
3) Step up Driving leg up on to step and placing weight through knee to step up, hold for 2 seconds the come step back down. 3 sets x 20 reps
4) Lunges Driving knee down towards bosu/floor at right angle. Keeping head, chest up right and hips in neutral (no tilt). 3 sets x 20 reps
5) Figure of 4 single leg squat Place yourself in the middle of four cones laid out in a cross fashion + Single leg squat on injured ankle in the middle of four cones, aiming to extend opposite leg to touch top cone, come back up from squat, then single leg squat to touch the outside cone, continue to single leg squat and work way round figure of four cones. Progressions: a) Balance mat on standing leg b) Eyes closed c) Throwing and catching ball simultaneously d) Weighted vest / holding medicine ball / holding kettle bells or weights e) Volley with leg touching cone
6) Resisted medial adduction With knee locked, bring leg in towards body, eeping neutral hips and head up right 3 sets of 12 reps
5) Resisted lateral abduction With knee on full extension, locked out, take leg away from body. Keeping back nice and flat with hips in neutral position so no compensatory movement occurs. 3 sets of 12 reps
6) Resisted strengthening Hold band or tie around fixed surface. To begin, hold heel towards glute. Push foot away from glute towards the floor, keeping bodied in fixed position. Maintain neutral lower back and stomach on the floor. 3 sets x 6 reps.
Weighted exercises 1) Double leg squat 3 second lowering phase, 1 second raising phase 3 sets x 6 reps. 2 sets x 1 rep max Before returning 1 rep max must be 1.5x body weight Progressions a) first 20 degree shallow squat b) full range deep squat
2) Single leg squat 3 second lowering phase, 1 second raising phase 3 sets x 6 reps. 2 sets x 1 rep max Before returning 1 rep max must be 0.75x body weight Progressions a) first 20 degree shallow squat b) full range deep squat
3) Lunge 3 second lowering phase, 1 second raising phase 3 sets x 6 reps. 2 sets x 1 rep max Before returning 1 rep max must be 0.75x body weight