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Feldman Physical Therapy and Performance
United States
Registrace 13. 04. 2014
Feldman Physical Therapy and Performance is the Hudson Valley's premier destination for physical therapy and wellness. We offer one on one service for an entire hour at each visit. No care is ever provided by aids or office staff.
Why Does My Knee Still Hurt After ACL Repair?
Up to 25% of all ACL reconstructions (ACLR) will continue to experience knee pain. That means one in four people will have knee pain once they return to higher-level activities. With the current prevalence of ACL injuries we're willing to bet you don't have to look very far to find someone who would benefit from knowing why they continue to have knee pain months after their ACLR.
One of the most common sites for ACL graft is the middle third of the patellar tendon. The quadriceps tendon and hamstring tendons are also used in certain cases but the patellar tendon had historically been the most common. This means the tendon at the front of the knee is severely weakened and must not only regenerate but it must increase its capacity dramatically to handle the demands of sport. In my experience managing ACL injuries for the past fifteen years I've identified three prevalent issues plaguing individuals with ACLR:
“Return to Run” too soon
Insufficient strength
Inadequate deceleration training
Typical post op protocols for ACLR breakdown the 9-12 months after surgery and provide “phases” of rehab with specific “do's” and “don'ts.” What a lot of them suggest is that the individual will resume jogging/running at 3-4 months. Unfortunately this proves to be a bit early for many ACLR individuals. Regardless of what the paper or the surgeon says it is crucial to take the individual into account and create a plan of care around their needs and their timeline. The issue with following a blanket timeline is that it becomes difficult to convince the patient otherwise and they will force the issue and often times run with a pronounced limp or a very weak tendon in the knee. Both of these scenarios can and do lead to complications down the road. If you want my opinion I would tell most clients on the fence with their rehab that the whole process is going to take a while and waiting and extra few weeks will barely be an issue in the grand scheme of things.
Lack of quad strength is also a big issue I've noticed over the years. Following the timelines far too much emphasis is places on running and plyometric drills and often to the detriment of the patient. There will certainly be a time for the higher intensity drills however the first 5-7 months of treatment needs to prioritize strength, strength, and more strength in the days. Knee extensions, step ups, front squats, calf raises, split squats, etc are some of the bread and butter you will find at the heart of a solid post-op protocol. And these exercises need to be continued into the later months of rehab even through return to sport. A common pitfall is dropping the strength focus when in reality you have to continue to strengthen throughout “return to play.”
Lastly I'd like to point out that not enough emphasis is placed on proper deceleration drills. This ultimately leads to a sharp rise in stress to the ACLR. When it comes to multidirectional power sports the knee's energy is split between producing force and slowing the body down. Slowing down is the deceleration component of sport-movements that places a high stress on the anterior knee structures. Once sufficient strength is achieved then it's time to practice slowing down or “deceleration.” These higher intensity drills should be incorporated as soon as the client has enough strength to handle the repeated load of slowing down. The more training the better adapted the client will feel and we all want someone to feel confidence in the knee free of danger.
It's not the end of the world if you're one of those patients who is experiencing some knee pain after your ACLR. It can be a normal and expected symptom pattern but it doesn't mean will we stop the training. Some times it becomes important to review the post-op protocol and get everyone to the same page even if it means tweaking it a bit. So keep your head up, don't get discouraged because the timeline is shifting a bit, and make sure you have a good plan of attack for any of these symptoms.
Take a look at the video for some of the exercises. And lastly, be sure to stay honest with yourself and don't be afraid to reach out with any questions.
Feldman Physical Therapy & Performance is the premier provider of physical therapy services in the Hudson Valley. With locations in Poughkeepsie, Fishkill, and Pawling New York.
Each patient receives a full hour of personalized one-on-one treatment with a Doctor of Physical Therapy. This means you will save time and money with fewer visits over a shorter period of time, resulting in faster healing and recovery.
www.feldmanphysicaltherapy.com
Join Our Facebook Group - groups/386308185242697/
#injury #aclrehabilitation #aclrecovery #aclrehab #acl #physiotherapy #physicaltherapy
One of the most common sites for ACL graft is the middle third of the patellar tendon. The quadriceps tendon and hamstring tendons are also used in certain cases but the patellar tendon had historically been the most common. This means the tendon at the front of the knee is severely weakened and must not only regenerate but it must increase its capacity dramatically to handle the demands of sport. In my experience managing ACL injuries for the past fifteen years I've identified three prevalent issues plaguing individuals with ACLR:
“Return to Run” too soon
Insufficient strength
Inadequate deceleration training
Typical post op protocols for ACLR breakdown the 9-12 months after surgery and provide “phases” of rehab with specific “do's” and “don'ts.” What a lot of them suggest is that the individual will resume jogging/running at 3-4 months. Unfortunately this proves to be a bit early for many ACLR individuals. Regardless of what the paper or the surgeon says it is crucial to take the individual into account and create a plan of care around their needs and their timeline. The issue with following a blanket timeline is that it becomes difficult to convince the patient otherwise and they will force the issue and often times run with a pronounced limp or a very weak tendon in the knee. Both of these scenarios can and do lead to complications down the road. If you want my opinion I would tell most clients on the fence with their rehab that the whole process is going to take a while and waiting and extra few weeks will barely be an issue in the grand scheme of things.
Lack of quad strength is also a big issue I've noticed over the years. Following the timelines far too much emphasis is places on running and plyometric drills and often to the detriment of the patient. There will certainly be a time for the higher intensity drills however the first 5-7 months of treatment needs to prioritize strength, strength, and more strength in the days. Knee extensions, step ups, front squats, calf raises, split squats, etc are some of the bread and butter you will find at the heart of a solid post-op protocol. And these exercises need to be continued into the later months of rehab even through return to sport. A common pitfall is dropping the strength focus when in reality you have to continue to strengthen throughout “return to play.”
Lastly I'd like to point out that not enough emphasis is placed on proper deceleration drills. This ultimately leads to a sharp rise in stress to the ACLR. When it comes to multidirectional power sports the knee's energy is split between producing force and slowing the body down. Slowing down is the deceleration component of sport-movements that places a high stress on the anterior knee structures. Once sufficient strength is achieved then it's time to practice slowing down or “deceleration.” These higher intensity drills should be incorporated as soon as the client has enough strength to handle the repeated load of slowing down. The more training the better adapted the client will feel and we all want someone to feel confidence in the knee free of danger.
It's not the end of the world if you're one of those patients who is experiencing some knee pain after your ACLR. It can be a normal and expected symptom pattern but it doesn't mean will we stop the training. Some times it becomes important to review the post-op protocol and get everyone to the same page even if it means tweaking it a bit. So keep your head up, don't get discouraged because the timeline is shifting a bit, and make sure you have a good plan of attack for any of these symptoms.
Take a look at the video for some of the exercises. And lastly, be sure to stay honest with yourself and don't be afraid to reach out with any questions.
Feldman Physical Therapy & Performance is the premier provider of physical therapy services in the Hudson Valley. With locations in Poughkeepsie, Fishkill, and Pawling New York.
Each patient receives a full hour of personalized one-on-one treatment with a Doctor of Physical Therapy. This means you will save time and money with fewer visits over a shorter period of time, resulting in faster healing and recovery.
www.feldmanphysicaltherapy.com
Join Our Facebook Group - groups/386308185242697/
#injury #aclrehabilitation #aclrecovery #aclrehab #acl #physiotherapy #physicaltherapy
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I have had lower back pain on the right side for 2 years now, not due to the disc or spine. Every time you run fast or endurance, you will feel a lot of back pain. What is the problem? I have been exercising my glutes for 1 month and feel better? So what should I do to completely stop that?
I can only use sodium citrate? Is it different from table salt?
Got hit with a soft ball on my shin feels fractured hurts bad .
I am a bit confused I just got back from work (which is like a 4h workout lol) but I felt pretty fit and wanted to take a short walk since it's pretty nice outside, but my battery shows me "5" 🥲 even tho I feel pretty great 😅
I’ve been waiting to get back to running for the last 9 months 😭
Thank you for the video. I am struggling with insertional tendinopathy. I have 2 questions, I appreciate your help. 1. Should I do these exercise one a day or 3 times a day? 2. Do you recommend doing alternating ice/hot bath?
road trip neck pain here and these stretches helped :)
Started doing "creep walks" before I even saw this video. I didn't even realize this is what they were called. I just started walking on my balls of my feet because it relieved the tension and some pain. It's good to know that it's an actual exercise.
is the video of the single heel raise incorrect?
I was wondering the same thing.
yet another self proclaimed youtube doctor.
I fell down on the tibia and so I presume it is a kind of fracture --- but I feel it less when I am bike riding.
So I run up the stairs 20 min 3 times a week. The right side always is soar. I beat I step up with the right foot.
An MRI doesn't treat your discomfort. It tells you why you have that discomfort. My back pain was from a compression fracture. Without the MRI my doctor wouldn't have known what treatment to send me for.
Thank you! I am going to do these daily to see if they help alleviate my hip/thigh pain.
So, work through the pain or wait a few days for the pain to subside before doing these stretches?
I’ve got a strange problem. Perhaps someone can help. I’ve run 40 years, but the last decade I have been plagued by soleus problems. I’ve spent more on physical therapy, podiatrists and others than I care to recall. I tried my first pair of carbon fibre shoes a year ago, Brooks fuel cell, which cured the problem! But I was rewarded with two hamstring pulls - the first time in my life. So I need to try something new, again. I’m 56, run 22:00 for 5k and weigh 165. Any running shoe wizards out there want to recommend something that reduces strain on the soleus and hamstring. Clearly my gastrocs and quads will need to step up, but given my situation, a new shoe seems my only hope.
I can relate. Low drop shoes kill my calves, high drop shoes make my knees sore. I’m going to try an in between drop and see what happens. I’ve been to a couple of running shoe stores and they look at me like I’m crazy. So I guess we’re on our own. lol.
Allright, so I have double stress fractures. How fun...😢
what about pandiculation ?
Kinvara is terrific. But you can’t go wrong with durability on the Cohesion model.
I’ve been told it takes 24 hours for shoes to decompress. Thoughts?
After body warm pain can be gone but after cool down pain increases
Injurd in girls basketball during b game yes get injured in sports leaft injury msmojo on CZcams video
Great information. Thank you. I'm stressed by almost everything including work... and my injuries aren't healing. That might be key.
Definitely a huge factor
I don’t believe this has anything to do with life span, because I got a few kids to do it and none lasted longer than 5 seconds with eyes closed lol. I’m sure that doesn’t mean they will be gone in the next decade. Also, I was rubbish with it until I kept practicing, and within 24 hours I am able to consistently hold longer than 60 seconds.
You keep saying 30 seconds. You meant 10 seconds, right?
At what point would you introduce cupping or dry needling? And can you needle directly into the proximal hamstring tendon?
I work on dirt eqpt . But recently more so. I climb up into machine through loose dirt
Ive developed ankle pain running because i pushed too much starting early, any fix ?
Thanks!
I hurt my ankle. And I need physical therapy. What do I do? If when I go it hurt.4 moths go
Try doing exercises that will strengthen your ankle which will promote the healing of the ankle.
The quality of getting eight hours of deep sleep is also important.
Yes it is
Helpful mannnnnnn luv it
Thanks
Excellent video, wish I had seen this sooner!
Would you recommend Brooks Adrenaline GTS 23 for someone with IT band issues ?
Interesting …I am 44 super athletic in the gym 5 days a week. Don’t drink or smoke , eat clean no fast food no history of health issues. I use the Apple Watch Ultra 2 which is the best if not one if the best trackers and it shows my HRV score between 25-28. What’s odd is my GF doesn’t work out eats like crap and her HRV shows 75 😮😮😮 I am like ummm somethings not right here.
Admin, saya mohon 😢🙏tambahan subtitle Indonesia supaya saya lebih mudah untuk memahaminya, Terima kasih
So why do I only see this on one foot and not on both feet? My left foot feels this every time I run longer than a mile, but my right foot is completely fine?
Recovering from GBS and the use a TENS unit 2x day on a moderate setting has been a tremendous help to my recovery. It helps alleviate muscle tightness/chronic pain in my left foot and ankle which have allowed increased mobility, strength building, and healing the neuropathy instead of “learning to live with it” as I’d been advised by medical professionals.
Great
Yes up to a point but peaks that are too high make me think my afib is trying to return.
Wow! So much great information! Thank you so much! I'm glad I found your channel, I will now be going though one by one. What about caffeine?
Read more here - www.feldmanphysicaltherapy.com/the-power-of-sport-specific-rehab/
should i where it for just in case something happens. It’s been a year and a half and my dad is forcing me to where 2 knee braces is that a waste?
obrigado terapeuta
How can I export the HRV data?
I don’t believe you can
What U do if what U wearing changes drop and u use to low drop and Ur injury prone. Think it's wrong that they dnt keep them at same drop so people have option
I think I have insertional Achilles tendinitis and multiple channels have recommended the intervals with heel raises and it only makes it hurt worse. I wonder why?
Any advice for mid portion achilles?
Super helpful :) thank you!!
Thanks for watching
I think this video is helpful. Now I can go to sleep.