Rehabilitation of Fractured Knee Cap, Bruised Bursa and Lateral Meniscus Tear Injury, and Dislodged Osteophytes

Janine NoopetchFebruary 2017

Brisbane, Australia 2015

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Abstract

This paper follows the research and rehabilitation of myself Janine Noopetch 42yrs old ,

using Pilates after suffering an impact injury to the knee, resulting in a Simple fracture of

the Patella, a Lateral Tear to my Meniscus, Bruised Bursa of the knee and dislodged Os-

teophytes.

A fracture of the Patella is break to the small bone that is located at the front of your knee.

A Lateral Meniscus Lateral Tear is an injury to the semi circular cartilage on the outside of

the knee joint. Symptoms include tenderness and pain around the outside surface of the

knee. Each knee joint has two crescent shaped cartilage menisci which cushion and sup-

port the knee. They can be injured by twisting or traumatic injury as well as degenerating

over time which is highly likely in my case due to my life as a Dancer and Circus Per-

former.

Knee bursitis swelling is within the bursa, not the knee joint

Symptoms of knee bursitis are usually aggravated by kneeling, crouching, repetitive bend-

ing or squatting and symptoms can be relieved when sitting still.

Any of the bursa in your knee can become inflamed, but knee bursitis most commonly oc-

curs over the kneecap or on the inner side of your knee below the joint.

Knee bursitis causes pain and can limit your mobility.

Osteophytes are bony lumps (bone spurs) that grow on the bones of the spine or around

the joints. (3)

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By Participating in Bi-Weekly Pilates Equipment Sessions, I was able to rehabilitate myself

sufficiently to be able to physically teach dance classes again. Pilates is truly amazing!

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Table of Contents

Anatomical Description of the Knee Joint 5

Introduction / Case Study 7

Pilates Conditioning Programme 9

Conclusion 11

Bibliography 12

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Anatomy of the Knee

The knee consists of four main things: bones,

cartilage, ligaments, and tendons.

There are 3 bones that meet at the knee joint

(the largest joint in your body)

Femur Bone, Tibia Bone and the Patella

The knee is the most commonly injured joint in

the body.

There are 2 Meniscus:

Medial Meniscus and Lateral Meniscus

The meniscus is a piece of cartilage that provides a

cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in

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each knee joint. They can be damaged or torn during activities that put pressure on or ro-

tate the knee joint. (4)

Cartilage within the knee joint helps protect the joint from the stresses placed on it from

walking, running, climbing, and bending.

The Patella (Knee Cap)

The patella, also known as the kneecap, (and is shown clearly in the image below) is a

thick, circular-triangular bone which articulates with the femur (thigh bone) and covers and

protects the anterior articular surface of the knee joint.

This paper is focused on the Pre-patellar

Bursa located in the foot of the knee behind Patella as

pictured to the left.

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Introduction

This case study is on myself a 42yrs old Female Dance Teacher from Cairns, Queens-

land, Australia.

10 days prior to commencing my Basi Comprehensive Global Format training, I had an

impact injury to my left knee. I was unable to walk, bear weight on or straighten my leg for

9 days but fortunately I was able to straighten my leg enough to get on a plane to travel to

Brisbane from Cairns to attend the training. I wasn’t go to miss that.

As a Jazz, Tap Dance Teacher and bootybarre Instructor teaching actively for 20 classes

per week, I needed to get myself back on my feet as soon as possible.

Due to the impact to my left knee, I suffered a Fracture to the Left Patella, a Tear to the

Left Lateral Meniscus Osteophytes broken off, and damaged Bursa. I saw multiple practi-

tioners and Physio’s with conflicting treatments suggested including surgery.

Initial Recovery took 3-4 months and commenced immediately with my Basi Pilates Train-

ing under the guidance of Shayne and Jordanna Smith in Brisbane Australia. Over the

course of the Basi Training weekend, I had a real improvement in my knee. I arrived using

crutches, and was able to weight bear and walk slowly on the last day of training.

When returning back home, I participated in bi-weekly Pilates Equipment sessions. I fo-

cused on maintaining a parallel position during footwork and omitted anything involving

external rotation in the Pilates Repertoire due to the tear in my Lateral Meniscus. I was

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working purely to strengthen the Hamstrings, Quadriceps and Knee Extensors as well as

maintaining a full body session using the Basi Block System. I was unable to do any flex-

ion type exercises of the knee or in a Quadruped position and I was unable to bear weight

on my knee due to the fracture in my Patella. Over my experience I found the Cadillac to

be the most beneficial for strengthening the knee extensors. I also did regular footwork on

the reformer and focused on the alignment of my feet. My aim was to get back on my feet

and able to actively teach as it is not my style to sit down to teach.

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Basi Pilates Block System Conditioning Programme

Cadillac Sessions 1-20Post Injury

EXERCISE Notes on Exercises Muscle Focus Objective

Warm Up Leg LiftsSpine Twist SupineChest LiftChest Lift with Rotation

Pelvic Curls were omitted as was too painful on knee in the bent position

Abdominals/ Obliques

Pelvic Lumbar StabilityImprove Flexibility To Strengthen Abdominals

Footwork Parallel Heels, Toes, Calf RaisesPrancesSingle Parallel Heels & ToesOn Cadillac and Reformer

Small V, Open V Heels and Toes were omitted as anything externally rotated was extremely painful.This footwork was amazing for strengthening the knee extensors and working the hamstrings

Hamstring/Quadriceps

To Strengthen Hip & Knee Extensors

Abdominals Roll Up with RU BarRoll Up Top LoadedRoll Up Bottom Loaded

Other ab work on the Cadillac was too painful in the bent knee position.

Abdominals Abdominal ControlTrunk Stabilisation

Hip Work Single Leg Series This series was great for hamstring/hip flexor stretch. It felt really good

Hamstrings Adductors

Adductor ControlHip Extensor ControlPelvic Lumbar Stabilisation

Spinal Articulation Tower Due to leg being in the straight position it was the only spinal articulation exercise possible to reduce the pain in my knee.

Abdominals & Hamstrings

To develop spinal articulation & improve flexibility or the Hamstrings & lower back muscles

Fullbody Side ReachSawSitting Forward

These were great as I was in a sitting position with no pressure on my knee

Abdominals & Back Extensors

To develop Abdominal, Back Extensor muscle & Shoulder extensor control

Arms Cadillac Standing Arm Series

Latiissumus DorsiPectorals MajorShoulder ExtensorsTricepsBiceps

To develop Shoulder stabilisation and strengthen

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Stretch Lying Hamstring with Theraband

Pole Series

It was too painful to do standing Lunge due to the pressure on my knees so had to modify.Pole Series was fantastic for mobilising my tight shoulder joints.

Hamstrings Improve Flexibility of HamstringsImprove mobility in the shoulders

Full Body I/M Elephant from session 11

Abdominal Muscles & Back Extensors

To develop trunk & Scapular stabilisationImprove Hamstring & Shoulder flexibility & core strength

Legs Magic Circle Fantastic for strengthening the adductors

Lateral Flexion and Rotation

Side Lifts (Mat)Spine Twist (Mat)

I found these extremely hard to keep my legs together on side lifts

Oblique Abdominals

To strengthen the lateral flexorsPelvic Lumbar StabilityTo develop Hip Adductor Control

Back Extension Basic Back Extension (Mat)SwimmingSingle Leg Kick ReformerBreaststroke Prep

Single Leg Kick was hard but kept trying as the stretch for my knee was good over time

Back Extensors To Strengthen Back ExtensorsTo develop abdominal & Scapular Control

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Conclusion

Participating in the above initial bi-Weekly Basi Pilates Conditioning programme I believe

kept me off the surgeons table. I was able to strengthen the hamstring, Quadriceps & knee

extensors to be able to return to my work of teaching my Jazz, Tap Dance and bootybarre

classes as well as completing head to toe sessions using the Basi Block System rather

than a physio injured area focused programme). Over time I was able to add more exer-

cises containing knee flexion to give a more balanced workout for conditioning my legs

and I was able to externally rotate my legs finally and weight bear on my knee and fully

resume all my normal teaching duties of demonstrating and teaching exercises in Jazz,

Tap and bootybarre. Thank you Joseph Pilates & Basi Pilates for your wonderful

programme.

Participating in Pilates definitely helped to strengthen and rehabilitate my knee, I really

would hate to think how my recovery would have been without Pilates.

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Bibliography

1. http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/lateral-cartilage-tear

2. http://physioworks.com.au/injuries-conditions-1/pre-patella-bursitis

3. https://www.nhs.uk/conditions/osteophyte/

4. https://www.medicinenet.com/torn_meniscus/article.htm

5. Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, 2013

6. Isacowitz, Rael. Pilates. Illoinois: Human Kinetics, 2006

7. Isacowitz, Rael Pilates: Second Edition. Human Kinetics 2014

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