8 Things Your knee Surgeon Won't Tell You
If you had meniscus surgery but now feel like you haven’t recovered and are not where you want to be, it’s likely because your surgeon didn’t tell you about these 8 things that could be causing you problems.
Why Shouldn’t You Use a Pillow Under Your Knee After Knee Surgery?
One of the most common things patients do after knee surgery is they put a pillow under their knee.
They do it because it’s more comfortable… but what they don’t know is that it will make your knee hurt worse later and make your rehab longer.
See when you put a pillow under your knee that’s putting your knee in it’s most comfortable position… but what it’s also doing is making the back of your knee really tight.
Keeping your knee in a bent position can make it get stuck there.
And in order to walk normally you need a straight knee.
So if you put a pillow behind your knee it will make it harder to straighten your knee.
If it’s harder to straighten your knee it will make it painful to walk.
The more painful it is to walk the more likely you’re going to change the way you walk to compensate.
And so then not only will you be rehabbing your knee from surgery, you’ll be trying to force your knee to straighten out and you’ll be rehabbing hip or back pain that is caused by walking weird.
So don’t put a pillow under your knee for definitely the first 2 weeks and maybe even the first whole month.
But, aren’t I supposed to elevate my leg after surgery… so I have to put a pillow behind my knee?
Yes you should elevate your leg after surgery. This helps circulation and swelling. However, don’t put the pillow under your knee, put it under your ankle. This will not only improve your body’s ability to get rid of the swelling in your knee compared to having it under your knee it will also give your knee a passive stretch to straighten out your knee.
Stack the pillows high and under your calf/ankle, let your knee relax and let gravity stretch it out.
Do this any time you are resting… so if you’re on the couch, in bed sleeping, sitting at a table for awhile you can even put your leg up on a chair.
Your recovery isn’t done when you don’t have pain
After meniscus surgery one of the first things to recover is pain levels.
And that’s because most of your pain comes from the fact that you had surgery. The surgeon had to cut your skin to be able to see inside so they can take out or repair whatever was damaged.
With surgical intervention being what it is now surgeons know how to make the smallest cuts possible so you’re left with 3 keyholes in your knee.
So pain comes on from the fact that the surgeon cut into your skin and when the inflammation related to that is gone the pain is gone.
Luckily inflammation and pain can be managed by medication and at home remedies like ice and estim units.
I’ve seen patients have their pain levels so low that they don’t talk about pain anymore as soon as 3 days after surgery, or maybe a month after surgery.
One time a patient saw me in the clinic 3 days after surgery and said she didn’t know why she was there because her pain was gone.
And I’ve had other patients after the first month say they were done with PT because their pain was gone.
The problem is physical therapists aren’t there to get rid of your pain. I mean, don’t get me wrong yes that’s one thing they do. But it’s also it train your muscles to be stronger, be more flexible and guide you in the proper timeline of getting back to running.
So it’s great when your pain is gone. That means the healing is going well.
But there are many other aspects to rehabbing after meniscus surgery that when you cut out too soon you’re putting yourself at risk for injury or pain.
Ice pack - https://amzn.to/3jJy2LQ
E-stim unit https://amzn.to/3TcN5ef
It takes 3 months to gain strength
One of the things that physical therapists help with after meniscus surgery is getting your strength back.
Many patients will think their full strength is back when they can walk without crutches or a limp.
And yes, that means some strength is back. But full strength isn’t back.
In general it takes 3 months to gain strength if you’re starting from scratch. And it takes about 1 week for muscles to start losing strength from not exercising that muscle. And depending on how long it’s been going on it can take 1-2x that timeline to get it back.
So let’s say you stopped strength training certain muscles because it bugged your knee so much and at some point you saw your physician and decided surgery was the right option for you but their schedule meant you booked out 3 months for the surgery.
So now you’re not strength training for at least 3 months leading up to surgery. Even if you were allowed to start strength training those muscles the day after surgery (which you’re usually not because of healing time) it would still take 3-6 months to get that strength back.
And what if you can’t do the exercises that you know to strengthen those muscles because it still hurts after surgery, or your knee is swollen, or your knee just doesn’t move that way yet… now what are you supposed to do? Just wait 6 months until you can squat (for example) again?
Nope.
That’s what a physical therapist guides you through… teaching and guiding you in the exercises that strengthen those same muscles in a different position. This way when your knee can bend that way you have some more strength than you would have had you just waited for 6 months. This makes those squats (or other movement) even easier.
It takes 1 year to get more flexible
Flexibility is one of those other things that physical therapists guide you through during your rehab process and that doesn’t come back just because the pain is gone.
Our muscles don’t like change.
So they resist it every step of the way and you have to keep pushing through (to a point).
So when you’re rehabbing your knee after meniscus surgery you may notice that some days the back of your leg is super flexible maybe you can even touch your toes… and then the next day you can’t even reach your knees. What gives?
See when you stretch out if you stretch too far too fast your muscles will rebound and actually tighten up again because they sense danger and think you’ll go too far and tear them (even tho that’s unlikely… they don’t know that).
So it takes progressive stretching in a variety of ways to stretch out the muscles for good so they are as flexible or even more flexible than before surgery.
Insurance doesn’t pay for everything you need
I hate to break it to you but insurance doesn’t cover everything you need. Said another way just because insurance doesn’t pay for it doesn’t mean you don’t need it.
Your surgeon may recommend you need something and then you find out your insurance doesn’t pay for it. These could be things during your rehab visits.
In the rehab space insurance companies have very specific guidelines of what they will and will not cover and physical therapists need to get paid so they do what the insurance will pay them to do. Typically no more, no less.
Many companies now will talk about add-on services that they can provide that insurance doesn’t pay for.
I had patients automatically assume that if it was a cash add-on service that it wasn’t necessary and it was just another way for the company to make money.
That’s not necessarily the case… for example: in my business I am also a certified personal trainer and certified nutrition coach.
Most insurance doesn’t pay for those things. I got certified in them because I felt my knowledge in these areas was lacking and they were things that my clients needed to be able to succeed.
So I offer them in addition to being a physical therapist in the state of Nevada. My clients benefit from continued progressive strength and mobility training, but insurance caps out if the patient is capable of doing the exercise program themselves. My clients also benefit from nutrition information about what kinds of foods and ingredients flare or stop inflammation, but insurance doesn’t pay for that.
All of those things sound pretty important when getting back to running after meniscus surgery right?
Rehab timeline changes depending on age of the problem
You’re googling and asking how long it’ll take until your knee feels better or until you’re running again after meniscus surgery.
You’re going to get some frustrating answers… it depends.
It depends on how long the problem has been going on (age of the problem), other health problems and if there were any complications during surgery. But the latter 2 are obvious so I’ll just talk about the former.
If you’ve been dealing with a meniscus problem for years or decades before taking care of it it’s going to take a lot longer than it would had you only been dealing with it for weeks or months.
Now, not everyone has the ability to get things taken care of super quick… but I’m not talking about waiting for years or decades to have surgery but not doing anything else… no the other things count as trying to take care of it.
But, still the longer it’s been an issue the longer the issue is there.
Because see here’s the thing… there’s this threshold for the inflammatory stage in your body. Inflammation is good when you’re healing because that’s what ignites the healing process… but once the inflammation reaches a certain point, a threshold, it’s out of control and your body needs more time and resources to heal.
So if you’ve been dealing with this problem for years the inflammation has been low-key (or not so low-key) there for years so your inflammatory gauge isn’t starting at 0 or even close to it by the time you have surgery. It’s already higher up on that chart so it doesn’t take very much else to make it hit or go above that threshold.
But if you’ve only had the problem for a few weeks or months the likelihood that the inflammatory gauge is lower on that chart than if you had waited years or decades.
So for one person rehabbing from surgery may take 6 months, but for you it may take a year. The longer the problem has been going on the longer it takes to make it go away.
Your knee may hurt off and on for a year
This is a frustrating one… your knee is going to bug you on and off for another year (at least) after surgery.
See, pain is your body’s warning sign that something is (or could be) wrong… it tells you to stop what you’re doing so you don’t get hurt.
Unfortunately sometimes your body doesn’t get this right.
It gets it right when you get near an open flame or put your hand too close to the stove top burner. You start to feel the heat or maybe you even touch it a little and feel the pain of the burn. This forces you to back up and pull your hand away. This keeps you from danger.
Unfortunately when you’ve had pain and inflammation in your knee your body sometimes gets the signal mixed up and your brain wants to tell you to stop doing something so it sends you the pain signal. But, really it sent the signal a little too soon… it sent it because before your surgery this type of movement, exercise, amount of running caused the meniscus to flip and make your knee lock… but you haven’t done this [insert whatever you’re doing here] since before surgery so the signal is pre-emptive.
Another reason you’ll get pain on and off for another year is because inflammation in your knee (and your body) will come and go… and when there’s inflammation in your knee there’s pain. I’ll explain more about the inflammation (swelling) in the next section so read on.
Every time you do something new your knee will swell after meniscus surgery
This is another frustrating one… your knee will swell every time you do something you haven’t done ever or since your meniscus surgery.
Remember when I said that inflammation is part of the healing process? Well every time you do something new or something you haven’t done since before surgery your body is on guard and ready to start the healing process from any kind of injury or danger. And right now anything new or new since surgery your body thinks is dangerous so it gets mildly swollen.
Some examples include:
You go up stairs for the first time
You walk a mile for the first time (and every new additional mile after that)
You go to the grocery store
You go to an amusement park
You walk on uneven ground
You walk on the beach
You run for the first time
You do a new exercise for the first time
You add more time to your exercise routine for the first time
You ride a bike for the first time
You hold a stretch for longer for the first time
You do anything in the heat for the first time
You get stressed out from work/home/relationships
Those are just a few examples. And when I say the first time, it’s really the first few times.
So any time you do something new or it’s still like-new ice the heck out of your knee for 20 minutes.
So to combat the pain and inflammation you'll get: ice your knee with any new thing you’re doing.
Bonus thing that your surgeon isn’t telling you
Ice soon and ice often after meniscus surgery
Ice is one of the best anti-inflammatory and pain relieving techniques you can do right at home. Most of my clients stop icing too soon. Ice is your best friend after surgery.
Within 2 weeks since surgery
Ice every hour you’re awake for 20 minutes at a time
2-4 weeks after surgery
Ice 5x/day for 20 minutes at a time
4-8 weeks after surgery
Ice 2-3x/day for 20 minutes at a time
8-12 weeks after surgery
Ice 1-2x/day for 20 minutes at a time
12 weeks and beyond
Ice after every run
Ice after every strength workout
Ice after every stretching workout
Ice at the end of the day any time you do something new or feel swelling
There you have it: 8 things your surgeon doesn’t tell you about your knee after meniscus surgery. And it’s not their fault they didn’t tell you, they don’t have time and if it’s not explicitly asked they probably aren’t thinking about it.
I spent so many hours with my patients and clients after they’ve had meniscus surgery that these are some of the top questions they ask me because their surgeon didn’t tell them.
Ice pack - https://amzn.to/3jJy2LQ
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