Physiotherapy &
Gait pattern after knee surgery.
Operations to the knee are common, and the extent to which they are carried out is only increasing. In recent years, there has been growing attention to anterior cruciate ligament operations and rehabilitations. This is because we are seeing more and more (young) patients within the walls of orthopedics as well as physical therapy where such knee injuries present. Annually, more than 9000 cruciate ligament surgeries are now performed in the Netherlands alone. Depending on the level of sport, we see that about 3% of amateur athletes sustain a cruciate ligament injury, and this rises to as much as 15% in elite sports. Fortunately, today we have a lot of scientific research that tells us how to best manage this type of injury handle. We see in the main target group: the young dynamic athlete, that almost everyone undergoes surgery. This is because it achieves the best long-term results when it comes to knee function and retention.
Nevertheless, it frequently occurs that pain persist for an extended period of time after knee surgery. Scientific literature shows us that this could be due to changes in gait pattern after surgery. Of course, there are always multiple factors that can play a role in pain symptoms, but in this blog we'd like to tell you more about the influence of the running on knee function and pain.Â
Are you due for knee surgery soon, or have you already undergone it? Then you probably recognize that walking doesn't go smoothly at first. After surgery the knee is swollen, stiff and you notice that it is often difficult to move. The latter is partly due to the swelling and stiffness, but also largely due to muscle inhibition. The activity of the muscles in the upper leg (and mainly the quadriceps) decreases after surgery. The body does this out of a kind of protective mechanism, because it does not understand that we have operated to perform a cruciate ligament reconstruction. Therefore, all this makes walking not smooth. Fortunately, we see that all these symptoms do diminish over time and thus walking will get better and better. Still, we see in the literature that the running in some cases does not return to normal all by itself. If we walk abnormally, it sounds pretty logical that this can cause symptoms, right? Especially when we know that in 60% of us running there is support on only 1 leg.
To be able to say something about the normal or abnormal nature of a running, it is of course important to know what a walking pattern should look like. We can therefore divide walking into different phases, all with their own characteristics.Â
To chart how you walk, we can use video analysis. This method is the easiest to apply in daily practice. However, it is important to look closely at what we see.Â
The main abnormalities in gait seen in people after knee surgery are:
- Lack of full extension of the knee (0 degrees) at the heelstrike.Â
- Lack of full extension of the knee (0 degrees) at midstance.Â
- Overactivity of the hamstrings and adductor longus at the the end of swing phase/beginning of stance phase.Â
If we look critically at all the exercises that recur in the first phase of rehabilitation, we see that almost all have a link to learning to walk properly again.
Indeed, you are at this stage:
1; agility
2; control of muscle tightening (specifically the quadriceps)
3; good quality stretching
4; maintain mobility and strength in the lower leg/ankle
5; maintain mobility and strength in the hip muscles
6; getting rest in the knee
It is important that we have a quality running know, recognize abnormalities of it and beyond that we look beyond the knee. In fact, know that an abnormal running may as well arise from changes around the hip or only. Have you achieved good quality gait with a quiet knee? Only then is it responsible to move forward without a walking aid. Of course it is possible to move around in a less efficient way, but in many cases this will cause long-term complaints.
Do you have knee problems after surgery or questions about your gait? Feel free to ask your physical therapist at Fysio Fitaal. We'd love to check with you!
Richie Brewer
Physical therapist, sports rehabilitation
Evidence-based and measurable physical therapy. That's how we make care as efficient and targeted as possible. By collecting data during your rehabilitation, we know what you do, and therefore how you improve over time. In this way, together we ensure that you will soon be able to sport and move again without any complaints!
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