Mind Your Knees Please

Since I injured my knee rolling, I have been researching what I can do now to heal my knee, and what I can do later to protect my knee when I finally get back on the mat. Although some of you may have experience with this type of injury, others may not-I didn’t. Sure I had heard of it, but I didn’t know very much about it. So, I thought I would share some of what I have learned over the past few weeks. I want all of you to know what you can do to help prevent / lower the risk of the same thing happening to you.

The two key things that you can do to protect your knees are stretch and strengthen the muscles surrounding your knees. The knee muscles help to protect the ligaments in your knee.


Facts:

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue-the anterior (ACL) and posterior cruciate ligaments (PCL) and the medial (MCL) and lateral collateral ligaments(LCL)-connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

Tears are measured in grades from 1-3, with a grade 3 being a complete tear or rupture. The MCL and LCL have the ability to heal themselves, the ACL and PCL do not and thus require surgery to be fixed.

The surfaces where the femur, tibia, and patella touch are covered with articular cartilage. Articular cartilage is a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous cartilage tissue, called the lateral and medial menisci, act as shock absorbers and stabilizers. These can also be torn or damaged.

What?

For those of you who have not heard, I completely tore my MCL, and ACL, had a two grade tear in my LCL, tore part of my PCL, and damaged a meniscus (because I always go all out in everything I do! LOL). The weird thing is that I wasn’t doing anything crazy. I wasn’t caught in a leg lock or knee bar, I wasn’t rolling rough....it was just bad luck. I am very flexible so I am thinking that maybe more weight lifting ( I do some weightlifting) could have helped to prevent this injury or at least minimize the amount of damage-if my knee muscles had been stronger....maybe, maybe not.

Through my research over the past month, I have learned that this is a very common sports injury, and I have met many people who have torn their ACL, some more than once. Knee injuries are very common in basketball, football, soccer, I even met a student who tore his ACL during cheerleading (yes, his : ) My uncle tore his ACL just losing his footing and tripping at work. So, these injuries could happen at anytime during any activity. Considering all of the years that I played soccer, I guess I’m lucky that this didn’t happen to me sooner. The good news for you guys is that women tend to suffer knee injuries 4x more than men, most likely due to the fact that the muscles surrounding their knees are weaker. So strengthen those knees girlfriends! (and guy friends).

When it comes down to repairing (or actually replacing) the ACL you have three choices:
1. A patellar graft. They cut a piece of your patellar tendon (in your shin) and use that to replace your ACL.
2. A hamstring graft. They cut a piece of your hamstring and use that to replace your ACL.
3. A cadaver graft. They use donated tissue to replace your ACL.

The graft is then attached to your bone using screws and anchors (Ouch!) with the hope that scar tissue will build up and attach the graft to your bone.

Pro’s and Con’s:

There are pro’s and con’s to all three of the above choices. I’ve been told that the patellar graft is the most painful of the three, and the hamstring is the second most painful. Recovery time for these two options is also longer because you have two parts of your body to rehab.

The cadaver graft is the least painful but there is also a higher risk of infection, rejection, and contraction of disease. Although the risks of contracting something is extremely small, like 1 in 300 million.

I was torn between the hamstring graft and the cadaver graft at first. I wasn’t keen on them cutting up a perfectly good part of my body, but I was also wary of contracting something from donated tissue. When I found out that my PCL was torn and they could only use a cadaver graft to repair the PCL I chose to go with the cadaver graft for my ACL also.

My little brother is a Podiatric surgeon (extreme type A personality) and he said with today’s screening, it was fine to use a cadaver graft-so I feel good about my choice.

The following information was taken from: www.grapplearts.com/ACL-Injury-FAQ.htm and written by, The Stewed Owl

“Numerous athletes in MMA and BJJ have torn an ACL, including Tito Ortiz, Vitor Belfort, Ricco Rodriguez, Nino Schembri, Ken Shamrock, Javier Vasquez, Michael (Bolo) Jen, Dan Henderson (who tore his doing a victory jump off the ropes after a PRIDE win!)....more than I can list.
Knee injuries in general, and torn ACLs in particular, are common in Judo. As the saying goes, young judoka are tachi-waza (throwing) specialists, old judoka are ne-waza (matwork) specialists.
If you want to see specifically how I (The Stewed Owl) tore my ACL, look in Royce and Charles Gracie's book "Brazilian Jiu-Jitsu: Self Defense Techniques" on page 55, lower left hand corner. I was practicing a throw from a Rear Bear hug on a (much larger) partner, and tried to take it easy on him when throwing him across my hips. I held my legs like Royce says NOT to do in the book, and had the guy's full weight collapse across the side of my knee, buckling it inwards. Ouch.
Certain other BJJ moves, such as bicept crushes from spider guard, gogoplata, some rubber guard movements, trying to stay standing when a larger opponent jumps to your guard, etc., have been noted as having an increased risk of ACL damage.




“What is the recovery time before I can start training BJJ / MMA / Judo again?”
A: Many doctors and physical therapists will be unfamiliar with the demands of our sport (it helps if you equate it to wrestling). Here are some experiences from forum members:

"Korhal", a physical therapist who posted on the forum, suggested:

- Rehab exercises only and walking x 6 months
-Light training drills with no full contact x3 months after that
- Hard training at the 10 month mark, but go easy on the free rolling and free sparring.
-1 year, you're good to go.

The above schedule is basically what I did and seems a good, conservative (but not too conservative) timeline.

Korhal went on to say:"If you do it this way, you'll have a good knee for life. If you rush it, you'll be missing training sessions and icing your knee for life.
'

The Bottom Line:

Stretching and Exercising Can Prevent Injury!

Strengthening the muscles that support the knee with knee exercises is most important in protecting your knees from injury and knee pain.
Weak or fatigued muscles cannot adequately support the knee joint or absorb shock before it gets to the knee and the extra stress placed upon the knee can cause injury to the structures of the knee. Strengthening exercises can make the muscles tight, so follow strength exercises with stretching exercises.

Here is a link with knee exercises:
www.bigkneepain.com/knee-exercises.html

Me:

My surgeon, Dr. Fleischli, in Charlotte was AWESOME. My anesthesiologist, Dr. Oesterle, was even more AWESOME. I was very worried (I didn’t sleep for a week) thinking about the drilling through my bone, and the screws and anchors bit...plus, I heard numerous horror stories about the three days of HELL following the surgery. When I mentioned my concern to Dr. Oesterle, he offered me the “On-Call Ball” which is a nerve block that lasts for three days...I wanted to tell him that I LOVED HIM. It was great. Don’t get me wrong, I was still in pain and probably will be for at least a week or so, but nothing like what I had feared. Thank God for modern medicine!!!

Well, hopefully I won’t be out for too long...I’ll try to pop in periodically and return (even if it’s just to sit on the mat and stretch at first) as soon as my doctor gives me the AOK. Until then, I will miss you guys!!! xoxo

Great post Debbie.

Good luck, God bless.

Thank you, Bryan.

Here's a link to a post-op xray of my "screwed-up knee"-literally.

I was just wondering.....does this make me the toughest person at FTW by any chance??? Next to Steve of course! ; )


http://www.facebook.com/album.php?aid=36656&id=1365141383&l=3ffef7576e

Nice post Debbie, thanks for sharing you experience.

Hopefully it will help others avoid the same injuries in the future. Unfortunately most of us learn by doing, not by seeing or hearing.

I have been lucky enough that I have not had any major damage to my tendons, aside from some sprains and strains (although my meniscus in both knees is pretty close to gone). This type of injury is a very real possibility, and that is why I do as many squats as I do. So next time you guys moan about doing 150 squats, and complain about you legs hurting the next 4 days, remember I am helping you.

Debbie....my knee is swollen....I hope it goes Down by. Sats open mat, I never miss those..my god it looks like twice its size...
What do I do?

Girlfriend...you need to REST! Better for you to miss one Saturday than to be out for a week-or longer. If you stay off of it, hopefully it will be better by Monday. Have you heard of the RICE method? Rest, Ice, Compression, Elevate. Here is an article about it:

http://sportsmedicine.about.com/cs/rehab/a/rice.htm

Hope you feel better soon! See you on MONDAY : )

I would hate to miss it I always have tons of fun when I'm there plus I get to watch the advanced guys do awesome moves.....and of course u deb...

What a coincidence, I just got back from the doc to have my left knee checked out. Been nursing it for a couple of weeks and something happened last night to aggravate it a little. Turns out it's nothing major (like Debbie went thru) but they put me on anti-inflammatory meds and told me to take it easy.

about a year and a half ago, I waited a little too long to tap to a heel hook. Initially I looked my opponent in the face and literally laughed out loud at the ridiculousness of the situation when, in the beginner division, some dude busted out a freaking heel hook, I then started to climb up (incorrect escape), then "Oh yeah, I need to twist with the lock" by then it was def a little to too late, no full on pain, but I knew.

The next week walking to work, in BJJ class, going for a jog, it was apparent my knee was not the same, hasn't been ever since, may never be, eventually I guess I'll have it looked at, not life or death.

Be careful with leg locks, defending or applying ESPECIALLY heel hooks.