Pilates specifics for knee injury rehab
Let’s start with a bit of anatomy revision. In simple terms, we have 2 bones making up our lower leg (our fibula and our tibia), one bone in our thigh (our femur) and our patella (knee cap).
That’s only 4 bones, yet this joint has the potential to cause us real pain if it becomes damaged. Holding these 4 bones together are 4 ligaments. The ACL (anterior cruciate ligament) and the PCL (posterior cruciate ligament) form a cross through the centre of the knee joint providing stability in the sagittal plane. The MCL (medial collateral ligament) and the LCL (lateral collateral ligament) join the femur to the tibia and fibula respectively around the outside of the knee joint to steady the knee joint so the bones do not slide from side to side.
Common knee injuries and what Pilates can do to help.
These are injuries to the ligaments that hold the knee joint together. The ligaments may have become stretched and painful or they could be torn and the knee is unstable. ACL is the most common knee sprain as it can happen when the foot is fixed (say in stud football boots or in skis) and the torso twists. The ACL ligament is unable to hang on and becomes stretched and weakened, tears a little or completely, requiring reconstructive surgery. If the person has surgery they will be given a rehab plan involving physio sessions and they will not be able to return to exercise immediately. Once cleared to exercise, Pilates moves that will most benefit this client are:
- Heel slides – usually given in weeks 1-2 of rehab. This is a modified version of Single Leg Stretch and has a different starting position. The client would begin lying supine with their injured leg straight and their uninjured leg bent with their foot on the floor. This will seem like they are at the end of the movement, but for them the discomfort will initially be when the leg is bent, so it would be uncomfortable to start there. They will need to perform the move in reverse, sliding the heel in towards the buttocks until they feel slight discomfort inside the joint, then hold that position for 10 seconds and return to a straightened leg
- Single leg kick – usually given in weeks 2-4 of rehab. Lie prone in neutral spine, lifting the heel of the affected leg towards the buttocks within the range of comfort. It would be advisable to hold at the top for a few seconds and lower slowly. If they need their unaffected leg to support, they may hook it underneath and support some of the weight during the movement
- Mobility squats – usually given in weeks 2-6 of rehab. As we would in our mobility section, set the body up in good posture and place a small squashy ball between the knees to aid stability and add additional inner thigh strengthening. Hold at the lower point for 5-10 seconds and return to standing
- Hamstring stretches and calf stretches – usually given after 4 weeks of rehab
- Maintenance stretches rather than developmental at this stage to keep the muscles around the knee from becoming tight
We have fluid filled sacs in our joints called bursas. These act as shock absorbers to minimise the stress caused to the knee joint in our activities. They can become infected, irritated or inflamed and swell up. This can be painless or can cause noticeable discomfort. Your client will most likely have seen a physio to begin treatment on their condition which can include draining the bursa. Once cleared to exercise, Pilates moves that will most benefit this client are:
- Heel slides, mobility squats with a small ball and hamstring and calf stretches, as already seen in ACL recovery
- Side kick with static quad contraction
- Side lying, lifting the top leg as we would in our usual layers for side kick, but add a static quad squeeze throughout and perform with control
As can be seen from the diagram, the meniscus are shock absorbing pieces of cartilage. These can be damaged as a result of aging, overuse or an injury. In the early stages of rehab, range of movement exercises would be appropriate such as the heel slides, mobility squats with a ball and single leg kick as with ACL recovery. If the client is pain free and has been advised by their physio to begin strengthening exercises, then this can be done in the form of static contractions (such as the side kick with static quad contraction). In addition to these, the client could also perform Shoulder Bridge. This would be performed to strengthen the glutes and hamstrings around the knee joint. Emphasis should be placed on knee alignment and stability throughout
These are the most common knee injuries you will encounter as a Pilates instructor and what you can do to help. Other knee conditions include knee joint dislocation, knee fractures and patellofemoral pain (runner’s knee) and chrondromalacia patella (degeneration of the cartilage under the kneecap). These vary in treatment plans and should be advised by a physio.
Written by Heather Oakes