 Knee Surgery and Post-operative Running
Eric Browning, MPT - - February 2006
Many of us as young athletes don’t worry much about father
time’s effect on the joints. But either through natural wear and tear, or
traumatic events, we are ultimately and eventually humbled by our own bodies.
Though exercise is proven to improve overall health, all the training in the
world can’t prevent the freak accidents. And thank your parents and their
parents for both your good and bad genetics.
As a physical therapist in outpatient rehabilitation, I see
the result of time and trauma on the knees. Many of the painful complaints are
resolved with training modifications, simple exercises to balance strength and
flexibility, and/or in–house orthotic fabrication to resolve biomechanical
abnormalities. For most, this is all they need. However, more serious knee
pathology exists in the form of meniscal tears, cartilage thinning (chondral
defects), ligament tears (i.e. ACL, PCL), or patellar tracking disorders,
sometimes warranting surgical intervention.
For runners, after surgery questions all point back to
running. In some instances a “yes” “no” answer in regards to whether someone
can run again on a regular basis depends on a few things. Let’s focus our
attention on a couple more common knee problems requiring surgical intervention
 Repairable
meniscal tear-
The meniscus is the C-shaped cartilage in your knee that
provides for shock absorption, stability, and protection from the bones during
movement. It typically does not have a good blood supply, except the outer
third portion, and therefore when injured, doesn’t often repair itself.
Symptoms include pain or swelling, with an occasional locking of the knee.
Surgery involves removing a portion of the meniscus.
When the meniscus can be repaired, it is usually determined
during surgery, and is up to the discretion of the physician. If it is
repaired, immobilization for several weeks after surgery is common, and a
running progression should not begin until 12-14 weeks after the operation.
Knee range of motion should be full and strength at least 80% of normal. Your
physical therapist can measure this with a goniometer and a digital muscle
strength tester.
Running Progression:
-
Start on the treadmill with a walk/jog progression up to 2 miles
beginning at one half a mile and progressing by ~10% per week.
-
After treadmill jogging, move to a track, running the straight always,
and walking the curves. Work up to 2 miles, then run the curves as well.
-
Running distance should for the first few months be limited to no more
than 3 miles per session, with a day of rest in between. On this day of rest,
if you’d like to continue exercising, low impact activity is encouraged such as
swimming, biking, or use of an elliptical machine..
Though physical therapy sometimes gets the bad rap for
inflicting “pain” on their patients, the general rule of no pain, no gain
doesn’t apply in your rehabilitation process.
Rules for progression based on soreness:
-
If no soreness is present from running during the week, progress by one
half a mile. If your exercise regime includes more than one type of exercise,
changing just one variable at a time such as running distance, is advised.
-
If soreness is present from the previous day’s exercise, but then
dissipates after a warm up such as stretching or walking, stay at your same
intensity level.
-
If soreness is persistent from a previous day’s exercise and doesn’t
recede after warm up, reduce the intensity of the exercise by 25-50%. If it is
still sore
after lessening the intensity, take the day off. When starting again, begin at
the lower intensity level.
Non-repairable Meniscus
With
removal of this portion of your cartilage, the knee loses some of its shock
absorptive ability. Repetitive stress to this area during higher impact
exercise such as running, since the compressive forces can equal 4 times the
body weight, can lead to progressive degeneration and arthritis over time. The
end result may be a total knee arthroplasty. Don’t fret, this doesn’t have to
be so.
When your foot hits the ground, force is generated up
through the ankle, knee and hip. The amount of force is dictated by the
intensity of the movement over land. The direction of the force is dependent on
your body’s natural alignment. Normally, force is generated from the middle of
your ankle to the middle of your hip bone, passing centrally through the knee.
It should be measured using a standing x-ray of your legs. If the meniscus on
the inside of your knee joint has been surgically removed, and because of
natural malalignment, the force passes through that same area, you are at risk
for developing arthritis and chronic pain. This step should not be
overlooked.
A quick way to change this direction of force is by using
heel wedges to alter ankle biomechanics. This is particularly helpful if the
malalignment is as a result of a foot abnormality. If this resolves the
direction of force, a permanent orthotic may be fabricated for use during
everyday walking, and even running.
Typically, 8-12 weeks is required for healing before any
higher impact exercise like running is allowable. Knee range of motion should
be full and strength should be at least 80% of normal. Orthotics, if needed,
should be in place before running is attempted. The advised running progression
above should be followed.
Total Knee Arthoplasty-
I am often asked if a person can run after having a total
knee replacement. It is generally accepted that after having a knee replaced
running is not an acceptable form of exercise. The impact created when running
on the prosthetic joint is likely to cause the life of the replacement to
diminish significantly. Water jogging, biking, or swimming are appropriate
alternatives and should be explored.
Knee surgery doesn’t necessarily mean you can’t enjoy
running. With mother nature’s blessing, and a rehabilitation plan, in the end
you might find yourself telling father time just who’s daddy.
Eric Browning MPT is a physical therapist at Keith Physical
Therapy specializing in orthopedic, sports, and manual therapy. The clinic is
located at 4323 NW 63rd St in Oklahoma City. He can be reached at
843-5710. Same day orthotic fabrication is available.
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