 Poster: A snowHead
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Hello, I hope you don't mind if I include a fairly lengthy preamble to my question in case any of you have a similar history.
The Skiing accident happened exactly 11 weeks ago.
Austrian hospital were grand. X-ray, crutches, brace and back in England next day.
GP 5 days later and quick referral to local orthopaedic consultant for 1 week later.
MRI a week after that.
The next appointment with the consultant was for exactly 4 weeks later (12th March) at which he told me that the MRI had revealed some tearing to the MCL, more severe tearing of the ACL and a white zone tear in the meniscus. By now flexion was only about 45 degrees although extension was fine. However he had expected that flexion would have improved once the elephant-like swelling had gone down and extensive bruising disappeared.
I was lucky to be offered a very rapid surgery slot for 15th March during which he did an arthroscopy and trimmed the meniscus back to a stable rim. During the operation he also achieved 140 degrees of flexion and after the operation told me that I should find that knee bends would become easier and deeper.
(As an aside this arthroscopy was an interim procedure after which he would be better able to assess ACL stability and determine whether that will need reconstruction).
Unfortunately improvement in flexion didn't happen although I did the various exercises which had been shown to me by the efficient physiotherapy department.
The most recent appointment (on 9th April) was probably as disappointing for him as for me. Anyway, it seems that the difficulties with flexion are due to quadriceps adhesions and that I must do the exercises more rigorously because there is no articular obstruction so any pain will be due to adhesions separating. This sounds like good sense to me and I will do any amount of exercises if pain means gain (of flexion) but what I am hoping you can tell me is whether there is any grounds for optimism that I can really recover almost full flexion.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Hopalong, Sorry cant help but I hope it does improve soon.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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NickyJ,
That's kind. Thank you.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Hopalong, you said that your physio gave you exercises? Did he/she not suggest ultrasound? I found this a great help to break down adhesions.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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A good physio can separate the quads through deep massage. Take it from me though, it isn't too much fun.
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You'll need to Register first of course.
You'll need to Register first of course.
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Hopalong,
You have sustained a common ski injury.
You'll see from my other posts that I despair at how long it is taking snowHeads to get a clear diagnosis and more importantly treatment plan.
If you were allowed to commence physio within days your should be further down the line, if you didn't have any physio for four weeks( whilst diagnosis being made) that may be your problem.
What grade is the MCL?
Where you braced?
If so were you allowed to move the knee whilst braced?
Quads adhesions do not, in my experience occur with the injury you describe,unless you have torn the quad muscle aswell.
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Hopalong, it sounds very sore. Regardless of what else is going on, your muscles won't be in great shape, both because of the fall/injury and the subsequent immobility. Alongside the more focussed work on your knee it might be worth finding a good sports massage therapist - someone who does deep tissue work and understands where to look for trigger points in the muscles. As maggi says, this work can be painful - a gentle soothing massage it's not!
Quite often the source of the problem is some way from the actual pain you are feeling - when I get lower back pain the problem is invariably in my glutes, for example. A good deep tissue therapist will help get you moving generally (though of course you need more specific medical attention to that knee).
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pam w, +1
Be Warner the sports massages can be very painful but they do really help. I needed a couple during my rehab after ACL reconstruction, and I was literally sweating with pain from it at the time but my movement and leg felt so much easier and better afterwards.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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maggi,
Thank you for this possibility. Ultrasound hsn't been mentioned yet.
The exercises were the standard quad sets, heel slides, leg raises off a raised support and step ups.
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Mosha Marc,
pam w,
NickyJ,
Thanks to all of you for telling me this. I've yet to commence a regular programme with the NHS physio (hopefully next week and the orthopaedic surgeon has provided me with the arthroscopy operation notes and a memo for the physio asking that we concentrate on deep flexion) but I'm going to visit a private sports physio on Tuesday who has been recommended by a couple of active friends. They tell me that their experiences involved a certain amount of agony but the results were spectacular. Not sure that I'm hoping for 'spectacular' but I do want to work hard to get back to normal eventually.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Jonathan Bell,
I thought that (for the NHS) I was dealt with fairly quickly - within the context of patients waiting months for hip / knee replacements ... but you are spot on in surmising that I did no serious, structured, focussed exercising between 25th January and 16th March. I just tried to walk further every day. Pretty pointless in retrospect.
I think the MCL is a 2.
I only wore the brace which the Austrian hospital gave me for 3 or 4 days and dispensed with the crutch(es) after about a week.
I don't recollect any specific mention of injury to the quadriceps muscle itself when the surgeon explained the MRI to me.
Jonathan - I note that it is unusual in your practice for people to develop these adhesions but if there are any cases you know of do you know whether they have been able to break and dispel the adhesions?
Thank you for taking the trouble to reply. Very much appreciated.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Hopalong,
If a grade II and you are severely restricted you need physio twice a week as a minimum.
Hydro wold be good.
Carry out daily exercises, a little often. Your surgeon should be pressing you to do this, and organising it for you.
Ask your private physio to communicate with your surgeon to find out how hard they can push the knee.
You will developer adhesions within the knee not outside of it, if you don't move the knee.
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For muscular pains/adhesions, I'd also recommend acupuncture. I had physio, sports massage and acupuncture for persistent shoulder pain and, though they all helped, the needling was vastly less painful than the other therapies!
I'd recommend avoiding the High St acupuncture joints like the plague, and only consider trained physios or doctors (www.bmas.org.uk has a list of trained docs).
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You know it makes sense.
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Jonathan Bell,
Thank you for this advice which I'll certainly follow.
I don't think we've any hydrotherapy facilities up here in the north pennines but swimming is certainly possible and can only be beneficial generally if not specifically I guess.
The surgeon's memo to the physio says "See my op note whereby ~140 degrees was achieved on 15/3/13 (under anaesthetic). We will try to reobtain this and hold a re-MVA and CPM in reserve. No intra-articular block to movement is present." This sounds to me as though he is advising the physio to be as tough as necessary to get the 140 flexion back.
So ... teeth gritted in advance but still determined.
mr brain cheat,
Thanks for sharing your experience and advice. We don't have many high streets, let alone high street acupuncturists, up here so I'm grateful for the bma link.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Hopalong - I'm no expert but I recently had my ACL reconstructed and thought my experience might provide a bit of anecdotal hope. My timeframes are similar to yours, I hurt myself on the 28 Dec (ACL & MCL) and had surgery on the 18th March.
I was sent away two weeks post-op with orders to toughen up with my flexion exercises as I was struggling to bend my knee beyond 70-ish (and that HURT). The exercises are excruciating/eye-watering, but my perseverance did pay off pretty quickly. After about five days I gained about 40 deg of flexion and the pain lessened to normal, bearable levels.
Be careful with the swimming until you have seen a physio as I have asked a few times when I can get back into the water, but it is apparently it's ages away due to the kicking action. I wasn't allowed to swim pre-op either.
(My surgeon was in fact Jonathon Bell. I'm not an expert, but he is, so treat this as anecdotal only!).
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Poster: A snowHead
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apparently it's ages away due to the kicking action.
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breaststroke being really bad - avoid! It's also very bad for your neck if you swim with the ubiquitous "must keep my new hair-do dry" style.
But once you know the exercises to do, you can presumably do them in the local pool? No need for a dedicated hydrotherapy facility.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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aussie82,
That's really encouraging. I'm persevering. It was about 110 last Tuesday and now it's maybe 85-90 so I can see how you did so well so fast.
Thanks for the advice about swimming. I was thinking of doggy paddle and the sort of pre-crawl leg movements you do holding onto the side when you're learning to swim.
(My surgeon was in fact Jonathon Bell. I'm not an expert, but he is, so treat this as anecdotal only!).
Lucky you! He's at the other end of the country to me. What a generous guy! He's posted some great advice.
But I've been impressed by the surgeon I've been seeing up here. He's authoritative and decisive but takes plenty of time to answer questions and explain exactly why he thinks a course of action will work. In many ways I think his skills are wasted in the sense that he has to release patients, both pre and post-op, into a system which doesn't readily move to the same beat or appreciate the time-frames in which the various components of treatment should - in an ideal world - happen. Oh well, there's plenty one can do to help oneself.
Hope you're skiing again soon.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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pam w,
Hee, hee!
No breast stroke then. Not that my hair style is worth protection.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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| Jonathan Bell wrote: |
Hopalong,
Quads adhesions do not, in my experience occur with the injury you describe,unless you have torn the quad muscle aswell. |
Hooray ... you were right. Not adhesions at all just lots of knotty points in the rectus femoris and vastus lateralis which were 'ironed out' by the sports physiotherapist who did indeed turn out to be superlative. Pain involved on a subjective scale of 1-10 probably about 4 at worst and of very short duration.
Already increased flexion to about 120-130 degrees. Three cheers for good sports therapists!
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Hopalong,
Extension is the movement that most overlook , but a small loss of 5 degrees will have a large impact so make sure you get full bend and straightening.
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You'll need to Register first of course.
You'll need to Register first of course.
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| Hopalong wrote: |
| Jonathan Bell wrote: |
Hopalong,
Quads adhesions do not, in my experience occur with the injury you describe,unless you have torn the quad muscle aswell. |
Hooray ... you were right. Not adhesions at all just lots of knotty points in the rectus femoris and vastus lateralis which were 'ironed out' by the sports physiotherapist who did indeed turn out to be superlative. Pain involved on a subjective scale of 1-10 probably about 4 at worst and of very short duration.
Already increased flexion to about 120-130 degrees. Three cheers for good sports therapists! |
great news!
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| Quote: |
Not adhesions at all just lots of knotty points in the rectus femoris and vastus lateralis which were 'ironed out' by the sports physiotherapist who did indeed turn out to be superlative.
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Great! Those trigger points can cause a huge amount of trouble. they might not be fully dealt with after one session - might need another.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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pam w,
Many thanks for this, Pam W.
I've booked another session for Tuesday week so that the old knee-bend is as good as possible for next visit to the orthopaedic surgeon in 10 days. I'm hoping to give him a big surprise.
Isnt it great when skiing again stops looking like an unachievable ambition.
I wonder whether there would be any mileage in planning a snowheads week for people with previous-year injuries who would like a bit of reassurance in the company of similarly tentative skiers.
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Jonathan Bell,
I'm lucky in that respect. Extension is the same as the good leg which thanks to lots of gymnastics and ballet years ago is almost hype-extended.
Thanks for yours posts. Your professional experience and advice is so reassuring.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| Hopalong wrote: |
pam w,
Many thanks for this, Pam W.
I've booked another session for Tuesday week so that the old knee-bend is as good as possible for next visit to the orthopaedic surgeon in 10 days. I'm hoping to give him a big surprise.
Isnt it great when skiing again stops looking like an unachievable ambition.
I wonder whether there would be any mileage in planning a snowheads week for people with previous-year injuries who would like a bit of reassurance in the company of similarly tentative skiers. |
I have run a Return from Injury Ski Camp with Wimbledon Clinics ( my clinic ) and Warren Smith Academy, in Verbier. i did it for about five years. I took my own patients back skiing after surgery , like ACL reconstruction. It was fantastic fun! 'm thinking of changing the format to run it for a day or two, at the weekend, in the UK in Autumn. What do you think? Would there be takers? I'm thinking it would be less commitment than a week in Verbier, not to mention cheaper.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Hopalong wrote: |
Hooray ... you were right. Not adhesions at all just lots of knotty points in the rectus femoris and vastus lateralis which were 'ironed out' by the sports physiotherapist who did indeed turn out to be superlative. Pain involved on a subjective scale of 1-10 probably about 4 at worst and of very short duration.
Already increased flexion to about 120-130 degrees. Three cheers for good sports therapists! |
Glad to hear you found a good therapist,
contrary to popular belief, sports/remedial massage should not be painful.
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Jonathan Bell, I would be interested in that, I was already thinking of having some time with Inside Out skiing at Hemel, which is run by 2 snowhead instructors. Perhaps between you, you could work something up ?
Edit: In fact if you really want to guage interest I would suggest a new thread, and put it in the Piste which has most traffic, with maybe a link from the Fitness forum. Happy to help, PM me if you like
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You know it makes sense.
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I'd most definitely be interested in a Return from Injury week/weekend if I was fit to give it a try by next season. And with the proviso that I was a bit of a nervous blue run wonder, even before the injury.
I've had good indoor lessons with both Warren Smith and Inside out.
I've also heard good things about easiski, and was planning to attend her Cautious to Confident course when I was able to.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Jonathan Bell, will it be in the beautiful saaf?
If not, I'd give it a crack.
Neville, won't the pain depend on how quickly you want to be mended?
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Poster: A snowHead
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Jonathan Bell,
I'd definitely be interested. It's a great idea.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| holidayloverxx wrote: |
Jonathan Bell, I would be interested in that, I was already thinking of having some time with Inside Out skiing at Hemel, which is run by 2 snowhead instructors. Perhaps between you, you could work something up ?
Edit: In fact if you really want to guage interest I would suggest a new thread, and put it in the Piste which has most traffic, with maybe a link from the Fitness forum. Happy to help, PM me if you like |
I'll do that thanks. I'll pm you
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| Mosha Marc wrote: |
Neville, won't the pain depend on how quickly you want to be mended? |
No, not really.
If they are doing deep tissue massage, pressure can be gradually increased but all the time to a bearable (and not through gritted teeth) pressure.
if there is too much pressure and it causes pain, the muscle will just tense up.
Also there is far more to "sports" massage than just deep tissue work
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