So you just had knee surgery or just thinking about having knee surgery. And wondering if your running days are over. Having knee surgery, even a total knee replacement, does not mean the end of running for you. However, there are some things to keep in mind when coming back to running after surgery.
The knee is the largest joint in the human body and many consider it the most complicated one. The knee is actually not just a simple hinge joint. It also provides for rotating movements as the connection between the upper and lower leg. The axis of rotation actually changes as the knee moves through its range, making it a rather unique joint.
There are two menisci located between the upper and lower leg bones in each knee. They provide the shock absorption in the knee.
The knee cap or patella is located on the front side of the knee. It is embedded in the tendon of the thigh muscles. The knee cap is needed for the transmission of force while extending the knee and protects the internal regions of the joint.
The knee joint is surrounded by a joint capsule. The capsule is lined internally by a mucous membrane which produces synovial fluid. It must be present in sufficient quantity in the required consistency.
Like most articulating joints, the opposing bone areas are covered by a layer of cartilage. This smooth, firm and elastic layer ensures that the knee moves easily and without friction. The major component of the cartilage is water and only a fifth is composed of collagen fibers.
Healthy cartilage is like a sponge: during compression, metabolic products are squeezed outward and, during relaxation, nutrients move inward. The cartilage is nourished in this way since it is not supplied by blood vessels.
Two intersecting ligaments are located in the center of the knee joint: the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Both of these ligaments are important for the stability of the joint. The medial and lateral ligaments of the knee are also important. They allow the knee to be precisely guided through the full range of motion of the knee.
Strong muscles around the knee are essential for good knee joint function. They ensure support and stability. Weak muscles are setting you up for injury and ultimately surgery. And in the event that you’ve had surgery, it’s setting you up for another injury and/or surgery.
Types of Knee Surgery
There are a lot of different types of surgeries for the knee. However, the most common knee surgeries include
- Meniscus Repair
- Meniscus Transplant
- Plica Removal
- Lateral Release
- ACL Reconstruction
- Tendon Repair
- Knee Replacements
These surgeries are done secondary to a traumatic event (ACL tear, tendon rupture) or just from wear and tear (knee osteoarthritis).
What to Expect After Knee Surgery
After knee surgery, you’re going to have pain, swelling and weakness in and around the knee. For proper knee function and return to running, these issues need to be resolved or nearly resolved. If they’re not, you risk further injury to the knee and/or injury to other joints. I see a lot of people that don’t properly rehab the knee and end up with injuries to other joints.
If you’re still experiencing pain and swelling, you’ll also notice that the knee feels weak or occasionally buckle. You may also notice that your balance feels off due to decreased proprioception (brain’s awareness of where the knee is located in space). Pain and swelling are going to affect quad activation as well as proprioception.
How to Proceed After Surgery
Like I mentioned before, you need to address the pain and swelling to help with the other issues, like the strength and balance. That means you’re icing, elevating and not overdoing your activity level. This doesn’t mean you don’t exercise though. You’ll want to exercise in a way that minimizes an increase in pain and swelling, especially early on.
I have my patients doing strengthening and cardiovascular very quickly after surgery. Depending on surgical precautions, right after surgery, I have most doing the following
- Riding stationary bike
- Aquatic exercises
- Open chain strengthening
- Quad sets
- Leg lifts
- Bending knee
- Straightening knee
I progress to more weight bearing activities as soon as indicated. This means moving to activities like
- Closed chain strengthening
- Balance exercises
Keep in mind that some surgeries, like ACL reconstruction or meniscus repair, have protocols or precautions that need to be followed to avoid injuring the new tissues.
Another consideration after knee surgery, and this is essential for return to running, is restoring a normal gait pattern. I commonly see people after surgery or even months after surgery walking like they have a peg leg. That definitely doesn’t work for running. Make sure that you spend the time on improving your gait after surgery. This means restoring proper gait mechanics. In addition to making sure that your quad is strong to absorb impact, you need to work on the glutes as well. You need them for stability upon impact and for proper push-off. If you need some glute exercises, check out this post.
One important component to restoring gait is achieving full extension. Full extension is needed for proper gait. This isn’t the case for flexion; you don’t need full flexion for proper gait. Therefore, it’s very important that you can restore your extension as soon after surgery as possible. Otherwise, your gait will be affected.
In the event that you have had a total or partial knee replacement, keep in mind that running will shorten the life of the parts. However, maintaining a proper body weight and keeping the muscles strong will help with prolonging the parts. So if you do plan to return to running after one of those surgeries, make sure you do well with the rehab process.
If you’re not sure how to address the pain, swelling, strength and balance on your own, then you need to see a physical therapist. They can guide you through the process and help you get back to running as soon as possible. Don’t try to take short-cuts and don’t be afraid to get help. You will probably pay for it later if you do.
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