Final rehabilitation process is a gruelling journey
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THE HEALTH | MAY , 2023
| Column |
BONE TO PICK
THERE ’ S so much a person goes through after an injury . From the athlete ’ s perspective , it could be a life-changing and career-defining experience . One moment you are at the top of your game ; the next , you are at the lowest of low .
From the critical moment of the injury to the initial recovery process and through to the final rehabilitation process , it ’ s a gruelling journey . It ’ s a fight to get back to the top , a struggle not many are willing to take on , let alone overcome .
I know this because I went through it before as a young athlete , and now I see on an almost daily basis the battle my patients face . Allow me to draw upon my own experience here again as an example .
After I fractured my tibia ( shin bone ) for the second time , I put myself through much physiotherapy work to get back to my best . Through the combined efforts of myself and a dedicated team of coaches , I reached previous levels of performance in sports .
Well , that ’ s one example . The other isn ’ t a happy outcome . I had undergone reconstruction surgery for my Anterior Cruciate Ligament ( ACL ), and this time , I didn ’ t put the same amount of effort into physiotherapy . Although I do participate in sports socially now , I have never been able to return to my previous levels of sports , not even close .
These experiences are not unique to me . Let ’ s zoom in our focus here a little towards rehabilitation after an ACL surgery . There ’ s been a lot of attention given to returning to sports after an ACL reconstruction surgery .
Researches have divided these patients who return to sports into three categories : return to any sport , return to pre-injury level and return to competitive level .
While about 80 per cent of patients were reported to have returned to some degree of sport , only about half of those returned to their pre-injury or competitive levels . So , as mentioned above , my case is not unique .
In fact , I am the rule and not the exception .
A FEW STEPS BACK So how long does the recovery process
The injured and recovering athlete
Final rehabilitation process is a gruelling journey
take ? Or how does one know when they ’ re ready to start participating in sports again ? Before that , let us take a few steps back and examine how ACL reconstruction surgery is done .
Essentially , the gist of the surgery is to recreate the ACL , which is torn . The surgeon will first create tunnels within the knee ’ s tibia and femur ( thigh bone ). Subsequently , tendons ( various existing forms ) will be passed through these tunnels and secured to the bone .
The biological healing time for this repair takes approximately nine to 12 months . There are three distinct phases in this healing process , namely the early healing , proliferation and maturation phases .
So now we understand that biological healing plays a vital role in recovery . It is important because it will be a rate-limiting factor in the type or intensity of physiotherapy the patient
or athlete undergoes .
There are many other factors that could affect the recovery programme . For instance , if a meniscus or cartilage repair is done , the recovery will be slightly slower .
In any case , after an ACL reconstruction surgery , the surgeon
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ). will prescribe a brace to be worn and crutches to be used to assist with ambulation .
The rehabilitation process can also be divided into a few phases .
There is an existing rehabilitation protocol . However , most agree that jogging can commence by the third month after surgery , followed by training at around six months and returning to playing sports at about nine months .
In the early stages after surgery , the goal will be to control inflammation and swelling around the knee . Gradually range of motion exercises will begin till the entire movement is acquired . By the second month , strength and proprioception training should be started .
This training will be more advanced by the third month , including resistance weight training and more sophisticated proprioception training . ( Proprioception is an important sensing ability that tells the mind the body ’ s position within a specific space ).
MORE DIVERSE DIRECTION
The fourth month should signal the beginning of running and jumping exercises and exercises specific to the athletes ’ sporting demands . It progresses until around the sixth-month mark when training for a return to sport can begin .
These include speed , agility , and specific functional exercises . The complete preparation is made by switching from the previous simple direction to a more diverse direction with movements of running or jumping in a more power-driven manner .
Before returning to sport can be recommended after the rehabilitation , the affected athletes ’ knee should reach a performance level of at least 85-90 per cent compared to the uninvolved side in tests , such as strength , balance and functional tests . There are also questionnaires that can guide in judging one ’ s readiness to return to sports .
The above plays a significant role in rehabilitation , but it will not count for much if the athlete is not psychologically ready . From personal experience , I can vouch that this is probably the biggest stumbling block .
Where before , there was no fear , and you would go sliding into a tackle in a football game or kick your opponents in a taekwondo sparring match , there is now doubt . It is always in the back of your mind .
To overcome that fear is a huge challenge . Should I go all in ? Will I injure my leg again ? Luckily for me , after some time , those initial fears eventually disappeared , although never completely .
This part of the recovery is often overlooked , but when you sit down and speak to patients , you see this is a real problem that needs more attention .
It ’ s never a delightful experience getting hurt . Recovery is a long road ahead . For athletes , there is a little extra on the line . Their aim is not merely recovery but to reach a certain level of performance again .
Many factors come into play to achieve this , all of which have to work in harmony to reach that eventual goal . – The Health