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The Key Principles for Success
Following Knee Surgery

Jason Kidd Retrospective

By MATT GIBBLE PT, Excel Orthopedic Rehabilitation

*All Access Note: this article is based on Jason Kidd's rehabilitation from knee surgery in 2004.

My initial impression of Jason Kidd was not unlike that of the average Nets fan. I regarded him as a world class athlete, a man of astonishing determination and skill and a single-minded intensity, imbued not only with greatness but with a charisma that inspired everyone around him.

But I never fully appreciated these traits until the day I made him throw up.

Theres a story there, and dont worry, it wont be too graphic.

For 12 weeks in the autumn of 2004, I was responsible for helping Jason rehabilitate his knee after his microfracture surgery. Our routine covered the spectrum of physical challenges, and in that time I concluded that he is the only professional athlete I have ever encountered who could win an Ironman Triathlon, which is a pretty neat trick for a guy who didnt know how to swim until we began our endeavor at the Jewish Community Center on the Palisades in Tenafly.

The JCC is a charming, teeming, wonderful monolith on Clinton Ave., but the epicenter of Jasons existence was the dark, gloomy ground-level pool. He still complains about tiles on the pool bottom that cut his feet to pieces; still complains about the water temperature nowadays, youll hear him tell Nenad Krstic, with whom I am working now, Curly, you dont know how good you have it for the comparatively tropical conditions that his teammate enjoys at the Nets practice facility.

But it all began in that pool and Jason will be the first to admit it. And my realization that this is a man of extraordinary will also began in that pool.

As everyone knows, Jason was coming off microfracture surgery on his left knee, and dealing with a great deal of anxiety about how it would affect his career, given the less-than-perfect case history of others such as Penny Hardaway, Allan Houston and Chris Webber.

His fortitude became clear to me, however, one afternoon in that icy pool during Senior Swim Hour, in fact -- when I had him doing short-burst cardio intervals. During these sessions, he runs in chest-deep water with Styrofoam dumbbells in each hand, and he is wearing a heart rate monitor. The goal is to get his heart rate up to 140 beats for at least 45 seconds, and if at first he doesnt succeed, he starts again after a 45-second rest.

I was especially tough on Jason that day, which is what he had come to expect, but it wasnt doing much good: He gave it five tries, and after each he was hanging on the ropes of the pool, gasping for air. I wouldnt let up, calling for him to try it again. I saw a cloud slide across his face in that dark room, but he didnt quit.

Then he jumped out of the pool without a word, made a visit to the bathroom, and then jumped back in to give it another shot.

I only found out later that he was violently sick that day, and he wouldnt tell me. Thats the kind of resolve this guy has. And every step of the way, he showed the same resolve especially in those early days, even when he had to climb 20 steps to get to the locker room, literally pushing on his legs with his hands to get up the stairs. And the fact that I kept pushing the envelope didnt matter. He did everything EVERYTHING that I asked him to do.

Yes, he even learned to swim. For a guy who originally couldnt go 50 meters without stopping, he became as good as a champion, and especially enjoyed racing the old folks who came in for their daily laps.

This is just one illustration of why a Physical Therapist never had a better subject. But that anecdote was only a brief example of the work he put into his rehab. The entire process step by arduous step is annotated below. As you read these key principles for success following knee surgery, keep in mind that one cannot compare Jasons injury, his surgeon and his rehabilitation to that of another athlete, even though certain elements for success with therapy following knee surgery are rudimentary and universal. Naturally, the extent of the injury, the patients ability to heal and respond to the surgery, and the surgeons expertise are variables to be considered, but the following paradigm and its adaptation for Jason is representative of Excel Orthopedic Rehabilitations philosophy for maximizing outcome.

1. Building on a sound foundation. Following surgery, the foundation for success starts with a strict adherence to the surgeons guidelines. These guidelines may involve using crutches, restricting activity level, the use of ice, the implementation of stretches/exercises, and in some cases using a continuous passive motion machine or CPM at home. Also, physical therapy is indicated early after surgery to reduce swelling, decrease pain, restore range of motion and prevent muscle atrophy. The physician will indicate when it is appropriate to begin physical therapy. Typically physical therapy may begin several days or weeks after surgery depending on the type of procedure. Most patients following knee surgery require ice or cold compression to reduce or control swelling and pain. Also, stretching is usually indicated to restore range of motion in addition to a progressive exercise program to improve strength in not only the surrounding knee muscles but also hip and lower leg muscles. In Jasons case, following micro-fracture repair surgery he was advised to stay on crutches non-weight bearing for six weeks to allow for the repair site to completely heal. At 8 weeks, Jason started physical therapy and fortunately his knee revealed minimal swelling and great range of motion. His primary goal was to restore strength in the atrophied muscles without imposing unnecessary stress on the knee joint.

We started with easy exercises immediately following surgery consisting of isometric quadriceps sets and straight leg raises in various directions. We then progressed to close chain exercises using the leg press machine with very light weights or we may recommend easy standing exercises or wall squats while squeezing a ball in between your knees. It is important to gradually progress the strengthening exercises over time. It is just as important that the exercises should not cause pain in the joint or around the knee cap or patella. Some muscle soreness or pain following exercise is appropriate pain. Pain in the joint is usually a message that the joint is not ready to assume the stress of that specific exercise. Always communicate with your physical therapist and let him/her know when and where you are feeling pain. Moreover, always progress to functional exercises which are closely related to your activity level or sport. We incorporate balance and proprioception exercises using a dynadisc, Bosu, mini-tramp and physioball when progressing exercises to improve strength in the core, hip and leg muscles. Each treatment is also customized for the patient based on their specific needs and goals. Jason for example performed basketball related functional exercises and drills while in physical therapy for several weeks before getting on the court.

2. Implement aquatic or pool therapy to compliment Physical Therapy. Jason began working in the pool during his first week of physical therapy which included swimming, deep water non-impact running, and kicking drills. The deep water running proved to be an excellent cardiovascular workout without imposing unnecessary stress on his knee. Jason then progressed to partial body weight closed chain and functional exercises in chest deep water performing forward, backward running and lateral movement drills. Most patients will begin pool therapy following surgery at or around two to three weeks after the surgical incisions and arthroscopic portals have healed. At the later phases of Jasons pool workouts he performed all basketball movements including jumping, bounding, lateral slides and cutting in the pool. After eight weeks of physical therapy and pool therapy Jason began his on the court rehab. We were certain Jasons knee would respond appropriately to the basketball court progression because every drill, movement and type of stress on the knee was performed in the swimming pool for eight weeks prior to doing it on the court.

3. The home exercise and stretching program is essential. Every patient at Excel, including Jason, receives a home exercise and stretching program while they are in physical therapy. Each home exercise program should be designed by the physical therapist and meet the specific goals of the patient. Most patients attend physical therapy two or three days per week after surgery. The patient now has four or five days at home, which is a great opportunity for working on the same goals that have been established in physical therapy. As you progress in physical therapy your home stretching and exercise program should also be progressed. After discharge every patient receives a home/gym rehab maintenance exercise and stretching program. Jason performs his program twice a week during the NBA season and then three times a week during the NBA off-season. Jason understands that the long term success of his micro-fracture repair surgery is directly related to his ability to maintain a strong and healthy knee.

4. Always communicate with your Physical Therapist. Communication is essential in order to optimize recovery and success following knee surgery. The patient must inform the physical therapist of any soreness, pain or swelling during or after the physical therapy treatments. This information helps to guide the physical therapist in progressing the treatment with the appropriate exercises and stretches. The physical therapist must constantly reevaluate the patients knee on an on going basis and adjust the treatment as indicated. At Excel we reevaluate every patient on a daily basis by spending one-on-one time with the patient. 5. Have Patience. Every patient must have patience during the initial healing phase to allow the repaired or damaged tissues to heal. Moreover, patience is necessary in the later phases when progressing exercises or activities. It is a common mistake to start exercises or activities too soon after surgery as well as in the later phases of rehab. Being too aggressive or not paying attention to signs such as pain and swelling can significantly delay your recovery and even cause chronic problems. In order to ensure long term success following surgery you must have patience and take small steps during progressions. This is where the guidance of a well-trained Physical Therapist is essential.

By adhering to these key principles following knee surgery you will maximize your outcome and join Jason and over 20,000 patients who have been successfully treated at Excel Orthopedic Rehabilitation.

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