Rehab: 4 months’ progress

Hey everyone,

I thought I’d talk a bit about what life was like immediately post-surgery, what rehab looked like and how it has developed into what I’m doing now. I’ve even included an example training diary. Enjoy!

Post-surgery (meniscus repair) I was stuck in a hip-knee brace for 4 weeks, though I was partial weight bearing using two crutches. This was a right pain in the arse because it never seemed to fit right. Tight enough to feel support and  walk and it hurt like hell, too loose and it would just fall down all the time.

The first week or so was pretty painful. The main focus was on getting my leg mobile again, reducing swelling and increasing range of motion. The exercises I was doing were very basic, but nonetheless very important. The exercises included leg raises, heel slides and some calf strengthening and stretches with an exercise band. It took me around 3 weeks to be able to flex my knee to 90 degrees. Around this point I was doing exercises supported by an exercise ball.

Once I was off the brace, I spent two weeks using one crutch. My knee was still very swollen, especially after exercises. Around this time I began to work on strengthening. One of the problems I was suffering from, as well as the pain and swelling to the rear of the knee, was pain around my kneecap on leg pressing. Now by this point I had become very anxious and worried about any kind of pain in my knee, however I was assured that it was weak quads leading to my kneecap not tracking properly.

My rehab routine continued like this for a few weeks, gradually adding other things such as single-leg balancing and squats. At first, the progression for these we’re incredibly simple but also incredibly difficult. I started squatting by simply standing up out of a chair, moving onto arm supported and eventually free-standing squats. The same was true of the balance work, at first I would just stand on one leg, then perform a calf raise, then toe touches etc.

That brings us to around week 12(ish), or early December. There was a bit of a shift in December with my decision to have an ACL reconstruction, it was time to get my leg as strong as possible before surgery.  At this point my strength was OK, but my glutes were lagging. My physio recommended romanian deadlifts (RDL), which I’d heard about before whilst looking into strength training in general. By this point, I was desperate to do what barbell training I could. My bench press and overhead press were improving, but I was desperate to squat or deadlift however I could. With a month over Christmas without seeing the physio, I was left to my own devices and threw myself into training and rehab.

At the time I was running the strong lifts program for strength training. It’s basically a full-body, linear progression program 3 days a week and upping the weight with each workout. Every time I was in the gym I would squat and RDL, as well as my upper-body workout for the day. I found I had to really play it by ear when it came to my rehab work. Some days I would push a bit too hard and have to ease off the next day (often after agility ladder work), other days I’d feel stronger and do a little more.

It’s worth mentioning at this point just how much effort it took to keep training. My knee would swell after every session, so I’d ice it every evening. Too many sessions in a row and the ibuprofen came out. Sometimes it felt like I was taking one step forward and two steps back, each time I did more me knee would swell more. Work. Exercise. Ice. Repeat. Thankfully, I kept a detailed diary of my training and it really helped to be able to look back and see my progress written down.

January came and it was back in with the physio. To my delight, she was impressed with the progress I’d made. In my glutes especially the difference was night and day. All the RDLs had paid off. Whereas in December I’d managed ~8 single leg squats, in January made it to 20 before we both lost count. Whereas in December I’d managed about 3 lunges and nearly fallen over, in December I made it to 10 on each leg and could have kept going. Whereas in December I’d fallen off the exercise ball doing glute bridges, in January I got to 30 seconds and was still going strong. This was real progress and I was over the moon, but there was one problem. My squat. It lacked control. My knees wobbled on the way down, my leg jerked around trying to do clams and fatigued quickly holding my leg in the air whilst on my side. Everything else was strong, but my gluteus medius needed some work.Because of the lack of control, I couldn’t put the weight up on my squat or RDL. The verdict was simple, strengthen the gluteus medius and increase the number of reps on other exercises rather than add weight.

Which brings us nicely to today. I’ve recently changed to a 5 day a week strength program which I’ve combined with rehab. Rather than be dogmatic about how I train, instead I use some general principles whilst remaining flexible to account for fluctuations in soreness and swelling. An example week might look like this:

Monday
Warm up: 10 min row, theraband upper body
Bodyline exercises: Plank, hollow hold (reverse and side planks not included due to stress on knee)
Bodyweight leg rehab: Monster walk, side-lying abduction, lunges, single leg squat, balance board squat
Upper body volume: Bench, overhead press, pull up, face-pull

Tuesday
Warm up: 10 min row, theraband upper body
Bodyline exercises: Plank, hollow hold
Posterior focus leg strength: Monster walk, clam, low bar squat, RDL, prone leg curl

Wednesday
Warm up: 10 min row, theraband upper body
Bodyline exercises: Plank hollow hold
Bodyweight leg rehab: Monster walk, side-lying abduction, lunges, single leg squat, balance board squat
Heavy overhead press
Incline bench
dips

Thursday
Warm up: 10 min row, theraband upper body
Bodyline exercises: Plank, hollow hold
Quad focus leg strength: Monster walk, clam, front squat, leg extension, hack squat

Friday
Warm up: 10 min row, theraband upper body
Bodyline exercises: Plank, hollow hold
Bodyweight leg rehab: Monster walk, side-lying abduction, single leg squat, lunge, balance board squat
Heavy Bench
Close grip bench volume

Saturday/Sunday
Whatever I feel like. Usually climbing.

A few points:

  • I didn’t just invent this myself. The upper body section is from the excellent 5/3/1-based routine created by reddit user nsuns found  Here. I simply changed the lower body section to suit my needs.
  • This is far from set in stone, but I do make sure I do something for my legs every day
  • Overall, this usually takes around 2 hours
  • Rowing is my preferred warm up, I just don’t like exercise bikes
  • My current weak point is my gluteus medius so clams and monster walk etc feature every day, some days for lots of reps/sets others for just a couple as a warm up
  • Leg exercises are for higher reps ie 15-20 for theraband work, 8-12 for strength work
  • I’ve eased off on the RDL, though my aim is to increase reps until I can do 10 x 10

In future, I’m just aiming to increase sets/reps and weight where possible. I’ve noticed a significant imbalance in my legs, oddly my unoperated right leg is much less stable. When I was running more two years ago I was having problems with some ITB pain in this leg, maybe that was week glutes? Anyway, this imbalance means I’ll be doing more unilateral exercises to try and even things out, as well as a lot more balance work.

As usual, thanks for reading guys. I’d really appreciate some feedback and would love to see some questions from everyone.

Liam

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