Right knee prehab for a 19yr old vegetarian

May 6, 2009 10:43 AM

Advice following recent knee injury (inc. ACL tear)?

Hi,

I am 19yrs old and I have just returned home from a ski season in Whistler, BC. On my 105th day on the slopes, my right ski juddered violently whilst stopping. It turns out I badly injured my right knee, and will have to have surgery if I am ever to return to skiing...here is the break down from the MRI I had in Canada;

1) Complete tear of the mid ACL
2) Large kissing bone bruises / osteochrondral injuries bilateral tibial femoral compartment
3) Subchondral infraction lateral femoral condyle
4) Other ligaments intact
5) Lateral meniscal tear
6) Large join effusion with complex partial rupture of a Baker's cyst.
7) Partial tear of the popliteus

As I am back in the UK I have to now wait a few weeks to see a consultant about my knee.

In the mean time, I was wondering if you could give me some advice as to what I should do to get my knee in the best condition possible before surgery.

Also, I am a vegetarian, so any dietary advice to aid my recovery would be very welcome.

Thanks,

BritishGas.

posted by BritishGas to sports, hobbies, & recreation (11 comments total)

I'm very sorry to hear about your injury. However, you seem to have a healthy attitude about things, and you've got your mind right about nutrition being important.

If I had just seriously hurt my knee, I'd be sure to get enough vitamin E. Plenty of fresh raw almonds should take care of that dietary need. In addition, getting enough omega3s would be high up on my list of things to do. I STRONGLY suggest purchasing a vegan omega 3 supplement with DHA from an algal source. DHA has done wonders for me, but of course your mileage may vary. Lastly, I'd be sure to get enough B vitamins as well.

Some people swear by Glucosamine, or gelatin(not vegetarian obviously), but I've had pretty good results with just the O3s and Vitamin E.

I wish you the best in your recovery.
posted by satori_movement at 11:14 AM on May 6

Interestingly, I tore my ACL on Whistler Mountain too, back in 1994. Surgery didn't take place until 2002 because it took a few years for the loose knee joint to make life especially difficult for me. Also that a local hospital lost my MRI scan results for 3 years, but that's another story.

When the injury wasn't so bad that it was obvious to doctors that it needed surgery, I was told to strengthen my thigh muscles to compensate for the lack of ligament tension holding the knee stable. Given that my leg muscles atrophied a great deal in the days following the surgery, I wonder if it might be a good idea to build muscle beforehand for that reason, too. Impact sports and anything involving nonvertical strain on the joint would cause pain, but walking and cycling were good, cycling especially.

Good luck with that. And better to get the surgery sooner rather than later.
posted by sinderile at 11:26 AM on May 6

This is for after surgery, but from a recovery perspective - do whatever you can to get or rent one of these. Accept no substitutes. When Mrs. True had her ACL reconstructed they put the cuff on under her immobilizer. We just filled the box with icewater and it would automatically circulate temperature-controlled water and apply pressure. Total lifesaver.
posted by true at 11:51 AM on May 6

I had ACL reconstruction in about '92, also after a bad stop while skiing.
The surgeon advised me to build up the muscles surrounding my knee (both quads & hamstrings) before surgery. I had the surgery in July or August, and was back skiing competitively the next winter. I'm sure the surgery has improved since then, so you should be good to go fairly soon.
Get a good knee brace, for confidence if nothing else.
posted by nprigoda at 12:17 PM on May 6

There's a reason why Whistler has the highest per capita count of physiotherapists and orthopaedic surgeons in the world ;-)

Anyway, you can't do anything right now except RICE (Rest - Ice - Compression - Elevation). Maybe some NSAIDs (Aspirin or Ibuprofen) to reduce inflammation. Avoid all activity that could strain the knee. Be very careful when getting up from seated position, climbing stairs, etc. Don't pivot on the knee (i.e. don't rotate upper and lower leg in different directions).

Eat well but forget vitamins, herbs, supplements and all that other naturopathic mumbo jumbo. You are dealing with major trauma and you need surgery. You then need to diligently follow a regime of physiotherapy for the year following surgery. If you are overweight, losing weight will greatly reduce the stress on your knee (especially now that you have cartilage damage).

I am in Canada (in Whistler, actually) and I know how frustrating it is to deal with a public healthcare system. The "free" part is great, but the glacial pace of non-emergency care can you make you want to take shortcuts or explore alternative treatment. Don't. Just be patient and be diligent. If you fuck up your knee any further, life with reduced mobility really sucks.
posted by randomstriker at 12:19 PM on May 6

nthing the building up muscle before surgery, it speeds up recovery mightily they say. You might even get some pre-surgery physio 6-8 weeks ahead of time.

Make sure you get a surgeon who specializes in sports injuries... I had my ACL repaired in Bradford and the scar is tiny. The surgeon I had skis, climbs, plays squash and did his level best to ensure I had the knee to do whatever I wanted.
posted by itsjustanalias at 2:48 PM on May 6

I also had my ACL repaired (well, replaced) by a sports ortho surgeon. It does make a big difference.

The only advice I have is practical stuff. Crutches are a pain - they render you handless. You can make a cup of tea, you just can't carry it anywhere. Bathing is difficult; get bin liners and tie at the top with an elasticated bandage. Accept help from absolutely everyone. Demand help from everyone else - make them stop the escalator, load you onto the plane in the cargo lift, and arrange wheelchair assistance everywhere possible.

(If you are in the US, the American Red Cross will loan you a chair if you need it. I went back to the US for my sister's graduation, and I swear to God walking (hopping) across that huge field would have killed me. Thank you, Red Cross.)

Do all of your physio. Add swimming even if it is not part of the plan - gentle swimming was the single biggest contributor to my recovery.

And the number one thing I can think of: DO NOT GAIN WEIGHT. I spent three months on the couch, unable to walk, waiting for the swelling to go down enough for surgery. I gained weight and it made my recovery more difficult.

This is a long process. It sucks a lot. Be patient.
posted by DarlingBri at 3:14 PM on May 6

In my experience, keeping your knee elevated above your heart for most of the day is the most effective way to reduce inflammation. You probably want to avoid NSAIDs. In the past few years research has popped up strongly indicating they slow long term healing rates. This is particularly true of bone, ligament and tendon repair.
http://www.jbjs.org.uk/cgi/content/abstract/91-B/2/259
http://www.sportsmed.org/tabs/education/downloads/SDAbstracts.pdf

Acetaminophen is effective at reducing inflammation and I am unaware of any ways in which it inhibits healing. The pineapple enzyme bromelain is a potent anti-inflammatory that I used with considerable success after my ACL repair.

Ayruvedic medicine has several preparations to reduce inflammation, including boswellia serrata, tumeric, ashwagandha, ginger and guggul. More info. Cissus quadrangularis is a herb indiginous to Asia and Africa known for it's ability to speed fracture healing times, probably through glucocorticoid inhibition.

As for nutrition, depending on the research you read, the average vegetarians diet is low or deficient in vitamins (A, B2, B12, D), zinc, magnesium, iodine, protein, saturated fat and omega-3 fatty acids. Regardless, the best way to figure out what you need more of is expensive testing, or keeping a food journal on a site like nutritiondata.com for a few weeks and then adjusting your diet.

You also want to preserve as much muscle mass in your injured leg as possible before you have surgery. The less mass and strength you loose the less rehab you will have to perform. Calf raises and walking backwards up the stairs (just a way of doing peterson step ups) are safe and effective ways to exercise the majority of the muscles in the low leg.

Occlusion training is growing in popularity (called kaatsu in Japan), where bloodflow is restricted to a limb by use of a blood pressure cuff for a few minutes, and then light to moderate intensity exercise is performed. Here is an interesting paper, Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction.
posted by zentrification at 3:38 PM on May 6

I strongly recommend a sports orthopedic surgeon and a sports medicine physical therapist for your rehab. RICE and a cryocuff too. I also agree with trying to keep your muscles as toned as possible (without overdoing it and making the injury worse) before the surgery. I took arnica — the homeopathic sugar pills — for a week prior to the operation and my surgeon said I bled a lot less than normal during the procedure. (I actually agree with randomstriker — this is serious and requires serious medical attention— but hey, vitamins etc. can't hurt)
posted by I could but I won't at 5:36 PM on May 6

zentrification, the documents you linked to seem to indicate that Ibuprofen also doesn't have any adverse effect on healing. Too bad Ibuprofen aggravates my asthma.
posted by randomstriker at 6:07 PM on May 6

A few things I'd add, for pre and post surgery:
Gameready is for the rich... there are other cryocuff alternatives that will do the job great, i got one for $80 that was great, and it kept me actively raising and lowering the cooler. Gameready looks like the high-tech lazy mans version of this.
My ACL complete tear and double meniscus rip healed well with what i could afford. (I had an allograft FWIW, and had the meniscus repaired instead of bits removed)
The biggest thing was to try to do as much, even the most miniscule exercises to flex and build your muscle. Try all things, to the piont of not stressing the injury, in order to retain as much muslce and flexibility as you can. It can be tedious and totally repetitive, but it will be worth it.
Also, I had one of the best surgeons there is for this thing, and he/they recommended you don't need to do it sooner than later, its okay to wait 3 months because then the major swelling is gone and they've seen better surgical results.
Oh yea, and with moving around, definitely try to keep your heal up when you turn around or turn down stairs etc...pivoting like in basketball on the ball of your foot (good way to avoid twisting in the knee joint, I learned the hard way, a few times :P)
Find a can or some other type of rolling pin that you can put under your foot and roll it back and forth. Actually taking your fingers and "raking" them lightly from the knee up your thigh, will promote blood flow of the toxic crap out of the wounded area(to be technical)...and you can use a straight edge like a book cover or blunt back of a butter knife and kind of rake that along the skin from the knee up the thigh... I know it sounds weird, but I believe it helps get the circulation going.

Best of luck...and be patient! You'll get there without a doubt, just do your exercises and take care of your nutrition. :)
posted by talljamal at 3:18 AM on May 7