New West Network

A Step-By-Step Guide

How to Blow a Knee Properly

By Lucia Stewart, 12-26-06

Crack. Snap. Pop. Ripppp…

The dreaded sounds are hateful to hear when it comes to the human body, especially the knee.

Knee injuries are not uncommon, especially in the winter. With the knee being a complex structure, webbed with bones, ligaments and muscles, each is vital in the functionality and stability. But some more easy to tear, rip or sever than others.

When the idea to blow the knee comes to mind, there are a few steps that should be taken to do it properly.

1. The Decision- Ah-ha!
The idea to blow a knee may not enter the mind, but the activities prior to the incident are important. Go out drinking. Smoke cigarettes. Do not drink any water. Do not stretch. The tighter the muscles, the less freedom of mobility and play the knee has.

Knees are predisposed to ligaments tearing, said Dr. Timothy O’Brien, an orthopedic surgeon in Bozeman, Mont. They are the centerpiece of activity and mobility within the leg, easy to contort or stretch just a little bit too far.

The leg is simple. Structurally, the femur, the strongest and longest bone of the human body, is aided by the tibia and fibula in the calf. Then joined by the patella, or kneecap. The hamstrings and quadriceps are the strength while the ligaments create the stabilizing structure.

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) crisscross within the knee joint, preventing shifting forward and backward. The medial collateral (MCL) and the lateral collateral ligament (LCL) are on each side of the knee joint, preventing the calf from folding to either side of the femur.

The ACL is the most common of knee injuries and the number one injury currently in most physical therapy offices in ski towns. In the winter season, skiers are prime candidates for blowing a knee. Being fixed onto a pair of 5-foot planks only adds to the contortion within the knee. Severe jolting may result in torn cartilage and ligaments.

2. The Insurance- Chi-ching
Without insurance, the cost could equal a typical college graduate debt.

The price includes: the hospital, anesthesiologist, orthopedic surgeon and an assistant. The total, a chilling $15,000 to $20,000. Don’t forget the $300 post-surgery brace, the $1,000 athletic brace and the $2,000 physical therapy. And if the accident happens at the ski resort, an ambulance ride will run between $550 to $750 dollars. Sorry, student loans are not available.

Advice from an ACL surgery veteran, “Do it at work.”

3.The Blow- POP!
It was a beautiful day in Frazier Basin near Bozeman last Thursday. A crew of backcountry skiers peered down the ridgeline as a light breeze blew. The conditions were fast with consolidated, creamy snow, but stable. It looked to be a perfect line down. One skier at a time dropped in. Brad Herzog was half way down, starting to feel his rhythm. Suddenly, he hit a wind-loaded spot, throwing him off balance, back into his seat, almost sitting on the tails of his skis. Keeping control, he pulled himself back, POP!, into a standing position and finished the line to the basin floor. “I knew something was wrong right away, but I was in denial,” Herzog said. “It was subtle, but I felt it.”

Scott Wilson dropped in minutes behind Herzog. Taking deep telemark turns, dropping the knee so it almost touched his skis, snow billowed into his face. Whish, whishh, whishhh. Faster and faster. Cruising. Then in a split second, he was cartwheeling, tumbling, keeping momentum, telemark skis fixed. CRANK, AHHHH! “I was going to fast,” said Wilson. “I don’t know what I was thinking.”

Ski Patrollers at Bridger Bowl Ski Area speak of snow conditions being a factor in knee injuries. Most knee injuries seen are on hard snow because people go faster and deep snow because people go crazy, said Pat Heines. “The two extremes.”

Not being afraid to fall and falling properly is key, Dene Brandt said, another ski patrol personnel. He remembered when learning to ski in 1970’s, he was taught how to fall properly. “I don’t think they teach that anymore,” he said. It can often be more damaging to the knee to try recovering than simply falling.

After recovering from a fall or a pull up from the backseat, pain is not usually a factor. Within 3 hours, the knee starts to swell.

4. The Surgery- Owwwwch!
After a ride to the hospital, home or 4 mile skin-out of the backcountry, the stiffness and swelling sets in. This is the moment of epiphany; something is definitely wrong.

Often, injured skiers go directly to the emergency room where a doctor will administer a knee immobilizer, said Dr. O’Brien. That only helps stiffen the knee, building up inflammation. He recommends going to see an orthopedic specialist immediately. If not significantly swollen to the typical size of a melon, they can give a proper exam by carefully pulling and twisting the knee to diagnose the injury.

There are three types of graphs to replace the ACL: the hamstring graph, the less painful; the patella graph, the faster recovery; and the cadaver graph, the least painful and fastest recovery, but with possibility of rejection from the body.

The ACL surgery typically takes three hours, with actual slicing, drilling and screwing time only an hour. After awaking from anesthesia, the leg will typically be immobilized with a post-operative brace from hip to ankle. Don’t stand up. Sit tight, for the brace is a new best friend for the next 6 weeks, according to Dr. O’Brien. A prescription and a ride home to put the feet up, pack on the ice and relax, for it has only just begun.

5. The Recovery- Argggg
Life will consist solely of physical therapy, or also coined “physical torture” for a recommended nine months. “Rehab is almost as important as the surgery,” said Kimberly Myers, a physical therapist at the University of Montana.

Dr. O’Brien recommends the day after surgery seeing a physical therapist to begin a structured rehabilitation program. The recovery process begins with regaining complete range of motion, typically seeing a few degrees a day increase. After two weeks, the strengthening begins, for the muscle atrophy is shockingly apparent. “Physical therapy is crucial because the knee can stiffen up without knowing what to do and how to do it right,” said Myers. Proper instruction and pushing to go further, while protecting the graph, is the key role in physical therapy.

Healing time can take up to a year, usually forcing an athlete to skip the next season.

“It takes a lot longer than you think,” said Kelly Rinck, who just returned to skiing a few weeks ago. “I had to chill. That’s what I had to do.” Rinck celebrated her one-year anniversary of ACL surgery with Herzog and Wilson laid-up with their knees on ice.

Herzog has insurance. He saw the specialist on Friday. He has a severed ACL. He will have surgery the typical two weeks to reduce the swelling and obtain range of motion back before going under the knife.

Wilson does not have insurance. He sits at home, self-medicating. He knows something is wrong, for his range of motion is 20 percent of normal. Wilson is visiting the Bozeman Hot Springs, working on his range of motion while puzzling over what to do.

Most will be like Wilson, sitting on the couch, wondering what to do. Re-read the article, swallow the price and go see a doctor.

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By Lucia Stewart, 12-26-06 | comments (4) | email story | print story

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