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Femoral chondral defect 4: prehab

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The backstory…

In October 2022, I was playing a routine tennis match when my knee went *crunch*.  This is part 4 of the story.  You can read about the injury here, about the diagnosis and plan here, and about planning how to manage after the operation here.

Why does prehab matter?

I mentioned in my last post that I was going to book in with an old Army physio colleague to discuss my physical preparation for surgery.  I know both from written research and from lived experience with my patients and from my own previous surgeries, that prehab (practising neuromuscular, strength-based and balance exercises prior to surgery) has a great chance of improving your post-operative outcomes, and speeding up your recovery.  It’s one of the reasons I’m so keen to see patients not just after an operation, but beforehand where possible.

Deciding what prehab to do

However, whatever your injury is, you have to balance your prehab with your damage and your level of function.  You don’t want to make your injury worse before your surgery, because you don’t want your surgeon to have to change their plans and do a bigger operation than they’d originally intended – and especially you don’t want them having to make that decision while you’re actually on the table!

In my case, I have a chondral defect – a hole in the cartilage – on the weight bearing surface of my femur or thigh bone, at the knee.  Annoyingly, the hole, which exposes a patch of bare, bruised bone, is exactly where I weight bear at 30-45 degrees of knee flexion – a position I normally adopt multiple times a day as I play tennis or go up and down stairs.  So – quite apart from being painful – that’s a potentially damaging position for me to “prehab” in, and I have to work around it.  No squats, lunges or step-ups for me!  Even walking for more than half an hour tends to aggravate my knee, so I do have to be relatively careful.

My prehab routine

As I mentioned in my last post, the equipment I have at my disposal is a Reviber, a Swiss ball and a Compex muscle stimulator, and I’ve ordered an Occlusion Cuff for later on.  I don’t need the Compex yet though, as my muscles haven’t been inhibited by surgery, and that’s when it’s at its most useful.

So, I am trying to prevent my muscles from wasting away, while not overloading the knee.  That means I am:

  • Standing on my Reviber in a mini squat (less than 30 degree bend), and also doing mini lunges with one foot on it.  I do this for around 30 minutes, 3 times a week.
  • Doing some bridges with my knees fairly straight.  This works really well on a Swiss ball, and I can switch it up by doing the bridges with my shoulders or my feet on the ball.
  • Walking for around 30 minutes, 3 times a week (this is in addition to walking my dog Feta, because given that she’s 16, that’s more of a protracted sniffing session than an actual walk).  While walking, I’m focusing on technique – especially rolling through my feet to push off the big toes, and making sure my glutes are firing, because I’ve noticed that if I don’t focus, my left leg tends to roll in, and that’s irritating my hip.
  • Joining an online Pilates session once a week – my knee isn’t fond of all the exercises so I do a certain amount of modifying what the instructor is teaching, but it gets me doing movements that I wouldn’t otherwise do. 

Anything else?

I went and discussed all of this with my old physio colleague Dave, who thought I had the exercise side taped; but who also poked my thigh and calf and thought they were a lot tighter than was ideal, so I booked to see his colleague George for a session of soft tissue work.  An hour later, I limped home with my quad and calf more painful than my knee, but after a couple of days I really did feel better.

I’ve also been practising with the crutches (walking, stairs, getting up out of a chair and off the bed) and practising getting off the floor on one leg, which I’ve found a lot more difficult than it sounds – there’s a definite technique to it! 

All of this will help me to feel stronger and more confident when it comes to the point where I have actually lost the use of my left leg for six weeks; and it will also mean that when I am allowed to exercise my left leg again, I’ve not let the muscles waste away too much, so I’ll be ahead of the game for recovery.

And of course, in addition to the exercise side, I’ve been working on optimising my tissue health, which will be tomorrow’s post!

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Many people assume that a stiff or sore neck is an inevitable part of aging. 

I’m here to show you that doesn’t have to be the case!