As the offseason program begins, knee concerns have been the focal point for three potential offensive contributors this year: newly drafted Chris Hendron IV, apparent fan favorite Jordan Leggett, and possible QB2 Teddy Bridgewater. While there are varying degrees of differences between each diagnosis, there are common goals for success rehabilitation.
To recap, Hendron IV had season ending surgery at the end of November to repair a torn medial collateral ligament (MCL). In general, MCL tears are typically treated non-surgically because of the blood supply available to the ligament so it truly speaks to the severity of the tear that surgery was required. Last year’s draft pick, Leggett underwent knee surgery around the same time however details about the procedure and what was repaired are undisclosed. Lastly, Bridgewater’s horrific knee injury has been well documented over the past 2 years. Based on the information available (ACL tear with knee dislocation), I wouldn’t be surprised if the posterior cruciate ligament (PCL), MCL, or even one of the menisci (there are two in each knee) were also possibly involved thereby lengthening the rehabilitation process. Luckily, the nerves and arteries were intact or else Bridgewater’s injury would have taken a more woeful turn.The goal of any rehab program is two fold – successful return to pre-injured state and prevent injury to the same body part (either re-injury or new injury) or possible new injury at a nearby body part. As a result, a good rehab program should not only focus on the injured joint but also the joint above and below the injury (in this case, the hip and the ankle).
In the weeks following surgery, the primary goals include limit swelling, restore range of motion and joint mobility as soon as possible, and strengthen the body parts around the injury to make sure they don’t become weak/stiff from inactivity. A common complication from knee surgery is loss of range of motion resulting in decreased overall strength of the muscles around the knee (the quads and hamstrings) and stability of the whole leg in general. As patients leave the acute stage, the rehab protocol initiates basic knee strengthening exercises and gradually progresses to include weight bearing exercises and whole body movements.
Strengthening of the hip and ankle really comes pivotal when the knee becomes strong enough to begin running, plyometric/agility work, and ultimately sports-specific drills. Decreased strength, mobility, and flexibility at the hip and ankle puts the knee in a precarious position for injury. Weak gluteals play a big role in knee injuries as the knee has a tendency to cave inwards as a result; this mal-alignment during agility or explosive motions often contributes to non-contact ACL tears and other knee injuries. Similarly, if there is a loss of mobility in the ankle, the calf muscles are at a disadvantage to either push off from the ground and/or land on the ground correctly while running or jumping which would then also result in an awkward position for the knee. To make this rehab process even more complex, it is not about solely strengthening the hip and ankle; the athlete has to make regain coordination and motor control of the hip, knee, and ankle to assure these joints work together during day-to-day tasks and sports specific tasks. These are two examples of how the hip and ankle play a crucial role in daily knee function.
Above all else, the biggest factor for successful rehabilitation is perhaps the most simple yet complex – the athlete’s mindset. While every athlete has a strong yearning to get back on the field, it is a long and lengthy process with many inevitable bumps along the way regardless of their injury history. The rehab staff spends the most amount of time with the athlete than any other healthcare provider and it is certainly a challenge to help the athlete stay even keel throughout the whole recovery. Even after successful return the sport, there is always some sense of fear that the same injury will occur (ask Gronk – he ended up missing one week but he clearly thought he re-tore his ACL). From days where the pain is excruciating to achieving rehab milestones to (hopefully!) returning to the field, keeping the athlete in the right mindset is without a doubt the biggest challenge for any rehab specialist.–
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