Something didn’t feel quite right in Irma Nieves-Torres’ left knee after weightlifting. She’d had surgery on that knee before, but this was different.

“When I was in the eighth grade, we discovered that my patella (kneecap) floats congenitally, meaning the back doesn’t land within the femur and tibia,” Nieves-Torres said. “I had patellofemoral syndrome reconstruction at that time where they took the ligaments and muscles from my tibia and used them like a Band-Aid to keep my kneecap from moving around.”

Nieves-Torres didn’t experience any issues with her knee after the surgery in her teens. The Puerto Rico native went through high school and committed to strength training. She played college soccer for four years at Universidad Metropolitana de Puerto Rico and earned a bachelor’s degree in exercise science before moving to the Midwest to attend Kansas State.

“I stayed active, worked at a gym, practiced and competed in Olympic weightlifting and did some CrossFit for fun,” she said.

As a certified personal trainer with a master’s degree in kinesiology, Nieves-Torres knew that she needed help to deal with the pain and swelling she developed. She turned to a physical therapist in Manhattan, but after using therapy and dry needling without success she sought out an orthopedic surgeon to help alleviate the pain.

Scans showed that Nieves-Torres didn’t have a meniscus tear as the team originally thought. It was worse. She had grade three degeneration in the knee, meaning that her knee was literally bone on bone.

“With that diagnosis, it was time for more aggressive treatment,” she said. “My surgeon recommended a cartilage restoration procedure called MACI, so we did an initial scope to clean out the knee and harvest cartilage before scheduling a second procedure after Christmas.”

MACI stands for membrane autologous chondrocyte implantation. It’s a procedure that uses a patient’s own cells to regrow cartilage for use in knee repairs. It’s most commonly used for young adults and athletes with an acute injury to the cartilage, but it’s also used for patients whose cartilage develops improperly.

Long rehabilitation process

After knee surgery, life doesn’t generally go back to normal right off the bat. Nieves-Torres was in for a long road of rehabilitation — one predicted to take up to 18 months — but she couldn’t just hit the ground running.

Patients with injuries where weight-bearing activities are limited, such as stress fractures, or those with post-operative weight limitations, as in Nieves-Torres’ case, may be good candidates for hydrotherapy.

For that, she turned to Dan Lorenz, sports medicine director at LMH Health Therapy Services.

“The extent of Irma’s injury didn’t allow for her to do any weight-bearing activities because of the post-operative instructions,” Lorenz said. But in a pool, “the water is far less compressive on the joint,” making rehabilitation activities easier.

“Having that environment meant we could still be mindful of the healing process and help improve her function through earlier weight-bearing activities,” Lorenz said.

LMH Health’s West Campus has a special pool called the Hydroworx 2000 that’s designed to allow patients with weight-bearing limitations to perform exercises in the water that they can’t do on land. The pool is equipped with warm water, adjustable depth, jets and a treadmill.

Nieves-Torres said she began working in the pool as soon as her incision closed.

“I jumped in and we started with walking,” she said. “Having my patella realigned during the surgery really changed my gait. I also discovered that I had pronation, as well as tight and underactive muscles I didn’t know about.

“Using the pool helped me gain confidence,” she added. “I became comfortable walking and got back to that heel-toe movement.”

Soon, Nieves-Torres began strength training with exercises such as lunges and squats in the pool. She progressed to running, kicking and swimming. And when the time was right, the team turned on the jets, which provided more resistance. After about 12 weeks in the water, Nieves-Torres was ready to get back to work on land.

“Dan and his team made the call when it was time for me to get back on land and into the gym setting,” she said. “I continued to work in a pool on my own with the knowledge that they provided. It built confidence and was reassuring for me to be able to jump in on my own and continue my rehab.”

The Hydroworx pool is just one of the many high-tech tools available to therapists working at the West Campus. The campus also has an isokinetic testing machine that can objectively measure joint function following injury or surgery, as well as force plates that can use sensors to detect differences in forces that a patient’s body exerts on the ground that therapists might not be able to see with the naked eye.

Looking to the future

Nieves-Torres is near the end of her rehab journey, and she said she’s mostly back to normal. She experiences occasional swelling due to the long hours she spends on her feet as a personal trainer, but taking Tylenol or Advil, elevating her legs and using ice takes care of that.

“There’s still some stuff that occasionally feels funky, but I don’t have any pain. I may have some discomfort after I’ve done a little too much or stepped wrong, and I’m very aware of my walking because it’s been a change from the way I’ve done it for 25 years,” she said.

Nieves-Torres said that when looking for a physical therapy provider, it’s important to do your research and make sure they fit your needs. That makes the rehab process easier to get through.

“There are a lot of dark times in your rehab,” she said. “Your therapist is your person, so it’s important to build a rapport with them. Dan understood where I came from and that I wanted to get back to the best level I could again — 1% better every day.”

— Autumn Bishop is the marketing manager at LMH Health, which is a major sponsor of the Journal-World’s Health section.