mykneeandme

[mykneeandme]

Introduction

When assigned with a special population and injury focus I immediately thought of my older sister Emily. Emily Pietruszka, now Culbreath is a professional dancer. Starting ballet at age 3 and staying in the practice until her 20’s. She then moved on to the styles of West African, Hip-Hop and House dancing. During the pandemic she earned her corrective exercise certification and became a personal trainer, all while keeping up with her dance practices. She most recently- alongside her husband Joshua Culbreath started a dance collective called “Snack Break” and earned her masters degree in fine arts (MFA) in dance with an emphasis in choreography. She’s had a very successful and movement-driven career, which unfortunately has not remained unscathed. She suffered a meniscal tear in her early 20s and now remains very mindful when working with her body. This topic is obviously very personal to me, connecting me not only to my mission for becoming a Pilates instructor which is being able to help people feel good in their bodies both mentally and physically, but it helps me feel as though I’m supporting my sister’s career in a deeper way. 

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Video context to my sister's career

The first video is footage of my sister and her husband preforming for their dance collective “Snack Break” the second and third videos are my sister preforming in dance battles, all videos have examples of the dance styles I mentioned before. Keep an eye on those knees!

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Snack Break promo video

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Emily in a battle "An amalgamation of some styles."

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Emily in a "House battle"

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Q&A with my sister Emily

M: How old were you when you were injured?

E: “I tore my meniscus when I was 22 or 23. I think it was 22 but it was a result of a buildup of smaller injuries, but that’s when I tore it.”

M: What caused your injury?

E: “So I grew up as a ballet dancer, and when you’re taught ballet you’re taught to use your internal and external rotators to always be turning your legs outward and so I was doing that in a way that wasn’t safe for my body, especially my growing body for a really long time. Then towards the end of my college career I started taking West African classes and Hip-Hop classes and a vernacular style called ‘House’ and it’s a lot of bending the knees in a parallel position, a lot of stomping the feet in a parallel position, so since my legs were so used to being turned out, when I started doing that movement more frequently, the muscle groups started opposing each other. My physical therapist told me that my kneecaps were starting to travel up my legs, and I really didn’t have the knowledge of how to train my lower body back to healthy alignment, and that resulted in a torn meniscus.”

M: How did it feel?

E: “Physically I didn’t feel it when it happened because I was in the middle of a performance so it wasn’t anything crazy that I was doing but after the performance was over my knee started to swell up really bad, and the next morning it was so swollen I could hardly walk on it. Then we had a photo shoot that day and I tried to dance for the photo shoot and it was so strange it was like if I hopped on it or jumped from one foot to the next, which is a lot of the movement we were doing, it was so painful and my knee would buckle backwards so I couldn’t because it was too painful to try to stabilize it enough to bear weight on it. Emotionally it was the first tour I was ever on as a professional dancer and I ended up doing this on the first night of tour. It was the first professional performance I had ever done on tour and I dislocated my shoulder and tore my meniscus and I just convinced myself that I wasn’t injured, I was like ‘nope I’m good’ and did the rest of the tour on a torn meniscus and then went home and found out that I tore my meniscus and then I was just bummed.”

M: What surgery did you undergo and what was recovery like?

E: “Its funny because it was technically a voluntary surgery, if I hadn’t had health insurance I would’ve had to just let it heal on its own somehow… but they gave me an option given that it was torn about 25% of the way through to go in there and sew it up, but they told me that recovery time will take way longer, and it will have a higher risk of being torn again quicker. Then they said we can go in there and just take out part of your meniscus which because you’re young it’ll heel quicker, but there’s a chance that when you get older, given the fact that you would be missing a large part of your meniscus, the pain will come back to say hello, and potential for re injury may come back, we ended up going with that route and so far so good (knock on wood!) The surgery was called scoping, and recovery was tough especially because I was in my early 20s and not concerned with taking care of myself in general, just partying a lot. Being injured and not being able to dance or be a part of the dance company that I worked so hard for took an emotional strain. Since my left leg had the injury, my right leg then started to compensate for the stuff my left leg couldn’t do. I feel like that’s the reason my right leg now feels more injured than my left leg, after years of overcompensation… my left quad is still not as strong as my right quad I still feel the differences in my left quad, my left glute and my left hamstring.”

M: How does it feel now?

E: “Now it feels fine, again knock on wood… you can see the two little scars where I got it scoped, like I said I still feel the effects of my right leg overcompensating for losing strength in my left, and my left quad is really tight all the time. I think that has something to do with my injury. So I think during recovery I developed habits that never went away that I will likely be figuring out and reversing for a long time.”

M: When I took you through a Pilates class flow for your first time, did you feel as though it helped you? Could you see a consistent Pilates practice helping you in the long run?

E: Oh my gosh, yes I do. I feel like because of my background in dance my knees are the crux of a lot of the issues in my body like hip misalignment, which leads to my back and neck pain, and I’ve had plantar fasciitis because of the misalignment in my knees. I wake up everyday and look at my knees and say “I love you lets make it through the day please!” but you know as I get older and having a history of being a personal trainer and having a corrective exercise certification, I still tend to lose sight that everything is connected. The glute activation exercises, glute medias and external rotator exercises that we did really felt like it took pressure off of my knees, That activation through my glutes was such a nice reminder that if you keep the other things healthy it will alleviate the pain and pressure in my knees so they’re not always taking the brunt force of things in this career that I have. Which the name of the game of said career is stomping my feet on the floor, spinning on my knees and falling onto my knees. But yes, the holistic activation that Pilates provides feels like critical work for rehabilitation and its so important that its this full body experience vs. when I was going through Physical therapy, which I feel is such a westernized concept that only hones in on the problem area, not giving you any real everlasting tools to set you up for success to undo the problems that brought you there in the first place. Pilates is such a great way to address the body as a whole holistically, and heal you from the problematic movement patterns that we put ourselves in, but oh my god short answer: Hell yeah.”

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The Meniscus

So, what is a Meniscal Tear? Well first lets find the Meniscus in our own bodies. The Meniscus or Lateral Meniscus (outside) and Medial Meniscus (inside) are two C-shaped pieces of Cartilage that run between your thighbone and shinbone, acting as shock absorbers and providing a smooth surface to help the knee with any forward motion, like running, walking etc. Think of the meniscus as a car’s tire… just as a tire absorbs the bumps in the road, making for a smoother drive, the meniscus absorbs the impact of activities on the knee joint.

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A Meniscal Tear

A meniscal tear is any damage to that small protective area, according to MayoClinic.org, it is one of the most common knee injuries and to quote them:

“A torn meniscus can result from any activity that causes you to forcefully twist or rotate your knee, such as pivoting or sudden stops and turns. Even kneeling, deep squatting or lifting something heavy can sometimes lead to a torn meniscus. In older adults, degenerative changes in the knee can contribute to a torn meniscus with little or no trauma.”

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How does it feel?

This injury can feel like a number of different things, and it may take up to 24 hours to feel any symptoms. You may experience:

A popping sensation

Swelling or stiffness

Difficulty with full extension and flexion

The feeling of your knee giving way

The feeling of your knee locking in place

The feeling of pain when twisting or rotating your knee

If not properly treated, a meniscal tear can lead to other complications such as, osteoarthritis in the injured knee, ACL injuries, and instability.

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Surgery and Recovery

The possibility of surgery, though dependent on the severity and location of the tear, as well as age and activity level of the patient, is common. There are a couple different options when treating a torn meniscus; HSS.edu states those options as the following: 

Meniscal Repair: Sutures are placed in the meniscus to fix the tear, recovery time for this surgery 6-9 months, including 2-4 weeks on crutches with a knee brace for the first 6 weeks

Partial Meniscectomy: A “trimming” or “removal” of the tear, recovery time for this surgery is quicker than the rest. Patients can typically put weight on the injured leg the same day, although using crutches for at least a week is common/recommended. Full recovery in 4-8 weeks

Meniscus transplantation: A surgeon will first preform a full meniscectomy, then replace the removed area with a cadaver meniscus, the recovery time for this surgery is 6-9 months

Luckily if the tear is on the milder end of the spectrum, you are able to go a more conservative route by use of ice, rest and over the counter pain meds, followed by physical therapy.

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Is Pilates beneficial for this injury?

Fundamentally, Pilates provides work for strengthening all supporting muscles, improving range of motion, stability and amongst other things, enhancing joint health overall. So when healing from or trying to prevent an injury such as a meniscal tear, Pilates would be an extremely beneficial tool to aid in the process, as long as you get permission from your doctor or physical therapist after injury.

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Pilates Modifications and Contraindications

When creating a Pilates class flow that caters to a client with this type of injury, there are certain modifications and contraindications that need to be considered. As I mentioned before, this injury is the result of activity that causes you to forcefully twist or rotate your knee, such as pivoting or sudden stops and turns, kneeling, deep squatting or lifting something heavy and degenerative changes in the knee over time. So with that in mind it’s important we avoid:

Certain ranges of motion

Kneeling on the affected side

Increased load, twisting/pivoting motions

Deep squats

We should also be well aware of the timeline of the injury/surgery to gage what we can and cant do with this client. Modifications that can be utilized in these cases include:

Limited knee flexion

Unilateral and bilateral work

Using props to assist in progressing an exercise

Modifying the load for each exercise making sure we aren’t causing pain or creating compensation in other parts of the body.

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How to spot a torn meniscus on your client

From what I’ve gathered by speaking to instructors here at the studio, its very common that clients don’t realize they are injured, and if they are feeling something in their knees they likely wont tell you, so it’s important that we know how to spot a torn meniscus, be sure to look for:

Uneven movement patterns (compensating in other areas of the body)

Trouble with ROM

Unable to kneel, lunges squats etc.

Hyperflexion

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Pilates exercises available to this client:

Footwork

Able to do footwork with light springs though I suggest gearing out the reformer or lowering the footbar, so their knees don’t bend too deeply. Parallel footwork to begin with, then eventually progressing them to internal rotation- extremely helpful in aiding knee injuries by strengthening the internal rotators of the hips.

Bridge

Able to do bridging, though I would suggest taking client down to the mat then progressing to reformer with springs at heavier setting. Keeping feet in parallel, heels on then progressing to arches, then toes. Using the ring on the outside of thighs is beneficial in pulling pressure away from knees, and working the supporting muscles in the outer thighs and glutes.

Abs

Most Pilates Ab exercises can be done with a torn meniscus, you really only need to avoid excessively bending the knee and twisting or rotating the body with feet planted, it is crucial to maintain a strong core to help stabilize the body and bring less stress to the knees.

Upper Body

Most upper body exercises are available to clients with a torn meniscus, the one thing to pay attention to is body position choices, avoid having them do any kneeling exercises as that can agitate the injury.

Lower body

Most lower body exercises are available to clients with torn meniscus, however you must pay special attention to range of motion, and spring load. You want to work with a smaller ROM and lighter springs and progress forward. Keep an eye out for hyperflexion during feet in straps. Modify for frog/leg press and anything that would have their knees come to a 90-degree angle. Progression to single leg work, long foam roller can be used in standing single leg balance work.

Full Body/Plank

Wall planks are a great modification, however you are able to do regular planks on hands or forearms as long as you move slowly in and out of exercise, we want to avoid quadruped position as much as possible. If doing planks on reformer, use lighter spring setting. Planks are safe as long as there are no twisting/rotating movements or hyperflexion happening in the knee. Extra kneepads can be used to land safely on to get in and out of this exercise.

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Sources:

https://www.mayoclinic.org/diseases-conditions/torn-meniscus/symptoms-causes/syc-20354818

Phone interview with Emily Culbreath. Videos sourced by her from her YouTube channel “Emily Culbreath.”

https://www.hss.edu/health-library/conditions-and-treatments/meniscus-surgery-meniscectomy#surgery