WWPD (What Would Physios Do?): A Physio's Journey In Self Rehabilitation
How I fixed my meniscus injury (the knee).
Hi, my name is Danielle van Andel.
I'm one of the virtual physiotherapists with Ontario Physiotherapy Online, and this is my physical rehab story.
This past summer, while sailing with my family, I hurt my knee. I was moving from one side of the boat to the other, keeping low to avoid the “boom”, when my knee locked. It didn’t hurt, it just wouldn’t straighten completely. After kicking in the water, it clunked, and I could straighten it again! Unfortunately, this happened a couple more times that day and it began to get sore. Any sort of twisting movement would hurt. If I bent it too far it would clunk, and I couldn’t straighten it anymore. As it began to get stiff and swollen, that's when I suspected a potential meniscus injury... Here's the 6 phases of how I rehabbed my knee.
Phase 1: Catastrophizing about my injury
While this is technically not really the first step in rehab, it's important to remember that this is a very normal part of an injury. Some do it more than others. Have you thought about how horrible your injury is and how it will affect your life? I wondered if it would prevent me from cycling 10 km to my clinic job, if I could use my new punching bag, play with the kids, do yoga - and most importantly, would I be able to ski this winter?
I had a deadline to determine this as ski pass prices would go up in 6 weeks (oh, budgeting for fun)! Of course, this was before we all went into a provincial pandemic lockdown for the winter.
Phase 2: Diagnosing my injury
I was fairly convinced this was a meniscus injury. Some typical signs include the following:
The clunking and locking
The way I injured it: Deep squat with twisting movements
Phase 3: Analyzing what to do next
Would I need surgery?
How effective is physiotherapy, if I want to get back to my active lifestyle?
I knew from professional experience and research that physiotherapy can be as effective as surgery, but that’s on the “average patient”.
What about me? What does it mean by average? If I’m a healthy, active person, would I have a better chance at recovery?
After talking myself down from the catastrophization phase and accepting the fact that it could be a meniscus injury, I decided to take precautions for acute pain management and did a full self-physio assessment.
Fun fact: This also wasn’t my first meniscal injury. I had torn the meniscus in my other knee as a teenager, so knowing what THAT felt like, I had a feeling I had injured the same structure.
Phase 4: Acute Pain Management
The first step in rehabilitation of an injury is to get swelling and pain under control. You also want to get that body part moving better again.
When did I start this? The day after the injury.
At an orthopaedic clinic, we would either stick you on a stationary bike or move your leg for you. My knee was fairly swollen and I couldn’t bend it as far as my non-injured knee. I didn’t have a stationary bike or another physio at home so I got on my bicycle to see how it felt. Initially, it felt super STIFF, but it wasn’t getting worse. The more I cycled, the looser it got. I added 20 minutes of cycling, at least 3 times/day. I also applied some ice on my knee if it felt really swollen. Overall, cycling actually helped to decrease the swelling, stiffness and pain.
It can be hard to tell what exercises and how much of an exercise are okay to do after an injury. Pain with exercise is not necessarily a problem. How the pain responds to the exercise is more important. In my case, it hurt a bit to bike initially, but as I continued it got better. If the pain had gotten worse the more I biked, or if it was noticeably worse afterwards, I would have stopped.
Rule of thumb: If it hurts with the first repetition but gets better the more you do it, AND you don’t “pay for it” after, it’s okay to continue!
If it gets worse the more you do the exercise , OR you pay for it after, you need to:
Stop doing it
Decrease the intensity (how hard you are doing it), OR
Decrease the duration (how long you are doing it) of the exercise.
Phase 5: Strengthening
One of my favourite recent courses, “The Female Athlete” encouraged me to try loaded exercises (adding weight to movements). I was pleasantly surprised with being able to do some squats a few days after my injury - so I added a 20 lb weight - and they felt even better. I stuck to the range I felt comfortable with and slowly increased it as I gained confidence. This excitement encouraged me to add other weighted exercises for my legs! I even went to test out my knee on the Bruce trail but the uneven ground made my knee feel ‘twingy’, and that’s when I began to question my ability to ski this winter...
One of the ways we often fall short in rehab, is that we get back our range of motion, our strength, but then we stop. We don’t address quick movements (such as jumping), or weird movements (such as twisting). This is a problem because we end up compensating for our weaknesses. Addressing higher level activities is essential to being confident in the body part that was injured and getting back to the activities that bring meaning to our lives.
Phase 6: Higher level activities
These are the types of movements and activities I would need to perform in order to return to everything I want to do - which for me was skiing.
For example, I started off with some single leg squats, using my rings for balance. It turns out that my left (injured) leg was not as strong, or as stable as my right when doing squats. I couldn’t go as low on that leg, and needed to use the rings for more support compared to the right side. Once that got easier, I challenged my knee to kicking the punching bag (picture below). This helped me develop balance with movement and quick bursts of strength. Then I added in some jumping movements to develop balance with quick changes of direction and bursts of strength.
At 5 weeks post-injury, I am still on step 6, but I’ve seen big improvements. I no longer feel pain with most twisting motions. Hiking the Bruce trail feels better. I still don’t have full knee flexion (my child’s pose and deep squat aren’t quite what they used to be), but I’m close. Single leg jumping, especially side to side or forward and back, isn’t as good on my left (injured) leg as my right, but it’s improving. I’m confident enough that I bought my ski pass last night, with a full week to go before the deadline!
Progress isn’t always uphill - sometimes you experience set-backs
7 weeks into rehab, I flared up my knee. I wanted to demonstrate child’s pose to a patient and as I was doing it, I immediately sensed it was a bad idea. I knew that bending my knee too far would likely cause it to lock again. It felt like I was back at step 1, having to unlock my knee with the clunking motion and it got stiff and swollen. This is the not-so-fun part of recovering from an injury. We all want to think improvement is in a progressive, linear way, but we all hit bumps along the road. Unfortunately this is incredibly rare. More often, recovery is interspersed with “flare ups”.
So our first instinct during a flare is once again, to catastrophize. “This is horrible, terrible! I am right back to where I started! This will never go away.” Once again, this is normal. Not super helpful, but normal. What would I tell my patients? “It’s just a flare.” “Don’t freak out over flare ups” “Flares are normal.” “It will improve. And you will likely flare again. And it will improve again.” Now, like most physios, I am better at helping my patients than myself. So it took me a day or so to come around to this type of thinking.
What did I do? I took a step (or two) back in my rehab plan. I was back to icing and range of motion (mostly cycling) for a couple days. But just like I tell my patients will happen, I was able to progress much more quickly this time. Within a week I was back up to step 4, and now back to kicking the bag! Hopefully, the ski resorts can safely open soon but at the very least, I've had some time to continue to rehabilitate my knee for whatever season's sport comes up next.
Written By: Danielle van Andel, PT
Danielle van Andel obtained her Master’s of Science in Physiotherapy from McMaster University in 2008 following a Bachelor’s of Science in Human Kinetics from the University of Guelph in 2006. She has worked in outpatient physiotherapy clinics in orthopedics, chronic pain and pelvic health. Her passion is getting you back doing whatever you want to do!
Is your knee keeping you from doing meaningful activities? Do you have a knee injury and don’t know where to start? Book with Danielle or contact OPO so we can help you develop your own tailored rehab plan.