SPOTLIGHT ON - Davey Kaleopa Pt.2
Davey suffered a patella dislocation on Saturday 28 July 2018 and he’s now 3 weeks after the injury.
He has had an MRI which is best form of imaging.
The MRI gives us an idea of the extent of the damage in the knee without having to actually go inside and having a look via surgery.
So what did the MRI find?
Some bony fragments, patella tendon tear and a retinaculum tear. Sounds pretty serious but in all honesty it's a very good report all things considered and let me tell you why!
Firstly, when Davey's patella (kneecap) dislocated the bottom part of the kneecap scraped part of the thigh bone (femur). That results in the small bony fragments (loose bodies).
Secondly, as the knee dislocated outward the quadriceps muscle that anchors at the front of the knee (patella tendon) was trying to keep the knee cap in position. The result of that heavy force of pulling caused the patella tendon to tear. Luckily it was only a small tear.
Finally, there was a retinaculum tear. What's that? Think of the retinaculum as the 'gladwrap' that wraps around the knee and helps keep it 'bound together'. When Davey’s kneecap was forced outward that pulling force from the kneecap 'stretched the ‘gladwrap' which caused it to tear.
Imagine when you are wrapping sandwiches with gladwrap in the kitchen. It can only take so much stretch before it tears. It's the same situation here with the retinaculum.
That's the summary of what the MRI found - sounds pretty serious doesn't it?
Fortunately for Davey it's not serious.
How do we know?
I use MRI imaging to support my decision making on how we should manage Davey's recovery.
For example if Davey came to physio in a brace with crutches, unable to put any weight through his leg, very swollen around the knee and needed medications just to help him cope then I would be very concerned.
But the opposite was the case.
Davey injured his knee playing Rugby League on Sat 28 July and he came to physio 5 days later on the 2 Aug.
When I looked at him... No knee brace. No crutches. Very minimal swelling. Full knee movement available. Plus he was in good spirits as he could sleep and move around comfortably. Davey had already seen the specialist for advice which gave him and his family a lot of confidence.
So as I outlined in Part 1 of this Spotlight I screened Davey's knee and decided he was good enough to start some gentle rehabilitation to start his road back to recovery.
Here’s the general guidelines on how to rehabilitate soft tissue injuries (ligament, muscles and tendons):
Injury to week 2: Reducing the pain and swelling
Week 2-6: Improve movement
Week 6-12: Improve strength/return to sport training
Week 12+: Return to sport
Davey is now in the week 2-6 recovery block and we have already found that he’s got full movement available in the knee plus we also screened his lower back, hip and ankle to ensure the whole leg has good movement available.
Even though we are in week 3 post injury we can now focus on strengthening as his recovery is 3 weeks ahead of schedule which is awesome! (Typically physio would consider strengthening only when movement has returned to normal).
The main focus of the rehabilitation is to strengthen the leg. We don’t want to focus on some of them. We want to rehab and strengthen ALL of them.
Gluteals (bum muscles), quadriceps (front thigh muscles), hamstrings (back thigh muscles) and place particular focus on the inner quadriceps muscles (VMO) or the ‘teardrop’ muscle
So if we are looking to strengthening the leg with a focus on the inner quad/VMO here are my key exercises that I gave Davey:
1. Double bridge from day 5 to week 3. Stopped this exercise and progressed to the single bridge.
2. Single bridge from week 3 to week 6
3. Straight leg raise from day 5 to week 3. Stopped this exercise and progressed to the single leg squat.
4. Single leg squat week 3 to week 6
5. Resisted crab walking from week 3 to week 6
I hope you’ve found this post helpful.
The main point I would like to share is that if you play sport there’s a chance you’ll get injured. There’s nothing scary about it if you get the right information and you persist with your exercise homework so you can return to sport asap!
Look out for Part 3 when Davey returns at week 6 post injury and we will be aiming to begin him on a measured running program with the approval from the specialist.