Home Posts tagged "Knee Surgery"

Stuff You Should Read: 4/27/10

Here are some reading recommendations for the week: Q&A: Partial Knee Meniscectomy - Here is a great blog from Mike Robertson about training modifications for those who have had a portion of the meniscus removed.  Mike's a brilliant knee guy (definitely check out Bulletproof Knees if you haven't already).  Stick around Mike's site and read a bit; he's been kicking out some great content lately. bpkAre You Inflamed? - This is a good one on the nutrition side of things from Mike Roussell. What Makes Roy Run? - This was an awesome article about Roy Halladay from a few weeks ago in Sports Illustrated.  To be blunt, a ton of professional baseball pitchers are lazy, one-trick ponies who rely on natural talent and don't work hard to fulfill their potential.  Halladay is an exception to that rule: a guy who has worked incredibly hard to become arguably the best pitcher in the game.  This is a tremendously well-written and entertaining piece about the path he took and how he deserves every bit of success that comes his way.  Phillies fans are lucky to have him.
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Why Wait to Repair an ACL?

Q: I was just curious: why would surgeons have waited so long to repair Brady's ACL? It seems that it would be ideal to do the surgery as soon as possible after the injury to give him more time to rehab and come back. A: It actually has less to do with the anterior cruciate ligament (ACL), and more to do with the associated injuries he (presumably) had. It's widely speculated that he ruptured both the ACL and medial collateral ligament (MCL). A MCL will heal on its own, in most cases, so they'll give it 4-6 weeks to do so before going in to do the ACL reconstruction. Had he experienced a lateral meniscus tear, though (as is common in traumatic ACL injuries), they'd have gone in pretty quickly. ACL injuries that also include the lateral meniscus are typically much more serious and potentially career-threatening. With all ACL ruptures, they'll usually have folks wait at least a few days to allow the swelling to go down. In some cases - particularly with really deconditioned individuals, they might opt for a period of physical therapy prior to the surgery to strengthen the surrounding musculature, reduce swelling, and ensure full knee extension ROM to improve post-op outcomes. If you're interested in learning more about knee function and injuries, Mike Robertson has actually pulled together some great stuff with his Bulletproof Knees Manual. It's definitely worth checking out. All that said, best wishes to Brady for a speedy recovery. Us Pats fans look forward to seeing him back on the field.
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Random Friday Thoughts: 8/29/08

1. As you probably know, I haven't been updating here quite as frequently of late, but fortunately, it's with good reason. The summer's winding down, so we've been getting our fall schedule all squared away with the high school guys - plus some local college guys at programs that don't have organized S&C programs. Additionally, all of our minor leaguers are in the final few days of their seasons right now, so coordinating with them and a few agents has been a priority right now. Fortunately, though, there are also some exciting things in store for this blog... 2. Basically, we're going to be combining EricCressey.com with EricCressey.Blogspot.com. So, my blog will be available directly from EricCressey.com. In the process, we have to transfer a ton of content - but the good news is that the finished product will look a lot more professional and organized when all is said and done. In the meantime, thanks for your patience as we make this switch. 3. I was chatting yesterday with Doug Carroll, a great hitting coach with whom we work. Doug played professional baseball to a very high level in both the Mariners and Devil Rays organizations. We both agreed that one thing you’ll notice in the majority of high level athletes is that they really don’t give a crap what anyone outside their family thinks of them. I think that if more people approached their lifting with this mindset, we’ve have a lot more people who were really big and strong. Interestingly, this closely parallels my approach to internet forums - and, thus far, ignoring what the haters say has been a great decision. 4. Never forget that you don’t have to leave the gym exhausted for the session to be considered productive. Take a 300-pound lineman and have him run five miles; he’ll be completely exhausted by the end of the session. He’ll also be slower, more likely to get injured, and definitely more likely to want to kick your teeth in. 5. Something you might not know: there are estrogen receptors on the anterior cruciate ligament (ACL) that – along with several other factors – make females more susceptible to ACL ruptures. The cyclical nature of estrogen and progesterone markedly influences ACL strength via fibroblast activity – so at certain times of the month, the ACL is more likely to tear. The ACL may also be predisposed to dramatic mood swings that make everything your fault, fellas. 6. I had a new article published yesterday, in case you missed it: 5 More Common Technique Mistakes. 7. I got two separate bills from Comcast in the past two days for a total of over $314. Do you think they read my blog, or is their billing system simply as hopelessly inadequate as their customer service? 8. Someone asked me yesterday, "Are single-leg leg press a good unilateral leg exercise? I hate lunges." Sorry, dude; single-leg leg presses don't count for anything. 9. I'm working on a detailed write-up on my views on running for pitchers right now. I think it'll open a lot of eyes - if I ever get time to finish it! I also have a new e-book in the works that I think will open a lot of eyes. 10. Have a great holiday weekend, everyone.
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Preventing Plantar Fasciitis

Q: Another guy from my favorite basketball team went on the injured list with plantar fasciitis this week. What can be done to prevent this? A: Welcome to professional basketball! The average NBA player has very little dorsiflexion range of motion (ankle). The only way the epidemic of plantar fasciitis, Achilles tendinosis, high ankle sprains, and patellofemoral pain is going to stop is if the players quite wearing 10-pound high top sneakers and taping their ankles. Or, at the very least, lose the tape and focus on barefoot training, low-top shoes off the court, and plenty of ankle mobility work. Just ask Shaun Livingston:
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Active vs Passive Restraints

I’m of the belief that all stress on our systems is shared by the active restraints and passive restraints. Active restraints include muscles and tendons – the dynamic models of our bodies. Passive restraints include labrums, menisci, ligaments, and bone; some of them can get a bit stronger (particularly bone), but on the whole, they aren’t as dynamic as muscles and tendons. Now, if the stress is shared between active and passive restraints, wouldn’t it make sense that strong active restraints with good tissue quality and length would protect ligaments, menisci, and labrums (and do so through a full ROM)? The conventional medical model – whether it’s because of watered-down physical therapy due to stingy insurance companies or just a desire to do more surgeries – fixes the passive restraints first. In some cases, this is good. For instance, if you have an acromioclavicular joint separation with serious ligament laxity, you’ll likely need surgery to tighten those ligaments up, as the AC joint is an articulation without much help from active restraints. In other cases, it does a disservice to the dynamic ability of the body to protect itself with adaptation. Consider the lateral release surgery at the knee, where surgeons cut the lateral retinaculum on the outside of the knee, allowing the patella to track more medially. I’ve seen a lot of people avoid the surgeries (and, in turn, the numerous possible complications) with even just 2-3 weeks of very good physical therapy focusing on the active restraints. I’m not saying all these surgeries are contraindicated – just that we need to exhaust other options first. So, the next time you’ve got an ache or pain, consider whether it’s an active or passive restraint giving you problems – and if it’s the latter, work backward to find out which active restraint you need to bring up to par.
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From Old School to New School

Q: I just ordered and downloaded your e-book, The Art of the Deload. I am going to scour and devour it, I am curious about my situation, I am about to turn 50, I am entering my 22nd year of competitive powerlifting, I am used to linear cycles ( I know, seriously old-school) I have toyed with a Westside type template, where I took their standard Max-effort/Dynamic Effort and rolled it over on a three day program (Mon-Wed-Fri Mon), But, when I jump-started my lifting career last Sept for a Push-Pull meet I went back to the standard linear cycle. After that long winded intro, here is my dilemma, I have a full meet on the last Sat of April (first time for a full meet in 5 years due to Five knee operations) Would a jump into a deloading cycle help me of hurt me this close to a full meet (Raw, no Gear, and no "Gear")? I have already written out and started lifting my typical Cycle, Should I "dance with the girl who brung me" or kick the old girl to the curb and consider a cycle with the deloading weeks built in? A: Thanks for your email - and your purchase. As you can probably tell from my e-book, I'm not a fan of linear periodization at all. If you look at the research (Rhea et al from Arizona State), you'll see that it's been proven inferior to undulating models on multiple occasions. And, anecdotally, the conjugated periodization have had much more success when they switched away from linear. And, to be honest, if you've had five knee surgeries in five years, you ought to take some PLANNED deloads so that you don't have to take UNPLANNED ones. Give this article a read; I think it'd interest you in how I structure my stuff: You can count backward from the date of your meet.
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Smith Machine Salaries

As of July 1, 2006, the IHRSA reported that there were 29,000 commercial fitness centers/health clubs in the U.S. Now, this is a few years old - and we're in a growing industry (this number had more than doubled since 1995). So, just for the heck of it (and because I'm not going to search around too hard to find the new info), let's say that there are 32,000 now - plus another 3,000 hotel gyms. Next, assume that of these 35,000 exercise facilities in the US, 80% have purchased Smith machines; that's 28,000 Smith machines in the country. I've seen these retail at anywhere from $1,000 to $2,500 - so let's just say that retail at $1,500. Figure a 30% profit on each one, and here's what you get: 28,000 x $1,500 = $42 million $42 million x 30% = $12.6 million Let's assume that these gyms replace their Smith machine, on average, every three years. $42 million / 3 years = $14 million $12.6 million / 3 years = $4.2 million So what does this tell us? Smith machines are a $14 million/year industry in the U.S alone. There may be 42 people in the U.S. grossing six figure incomes from Smith machines alone. Scary thought.... Now, just imagine: leg extensions are even more popular than Smith machines. Scary thoughts, indeed.
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5 Keys to Bulletproofing Your Knees

Mike Robertson flew up from Indianapolis to check out a seminar up here in Boston this past weekend. We really enjoyed watching Kevin Wilk, Bob Mangine, and Mark Comerford, three fantastic rehabilitation specialists. Additionally, I enjoyed catching up with Mike just as much, as he’s a wealth of information, particularly with respect to the knees. From just talking with Mike this weekend, I picked up some really good stuff – in addition to the entire day the presenters spent on the knee this weekend.

With that in mind, on Sunday, I wrote down five things that caught my attention this weekend. Then, I handed them to Mike and asked him to elaborate on them on his laptop on the plane ride home for a “guest spot” in my newsletter. Here’s what you’ve got:

5 Keys to Bulletproofing Your Knees

1. VMO specific work is currently poo-poo in the strength and conditioning industry. While I agree that we need to focus on strengthening the hip abductors/external rotators (especially glute max and posterior glute med), current literature leads us to believe that there’s more to the VMO than we might have expected.

Several studies in the past two years have indicated that there is a definite change in fiber pennation between the vastus medialis longus (VML) and the vastus medialis obliquus (VMO). Beyond that, while your other quad muscles like rectus femoris and vastus lateralis only have one motor point, the entire vastus medialis actually has THREE motor points! We may not totally understand the VMO yet, but I’m not willing to write off its importance with regards to knee health.

2. When looking at the body as a functional unit, we can’t overlook the core with regards to knee health. More specifically, we know the rectus abdominus and external obliques work to keep us in pelvic neutral and out of anterior pelvic tilt. Lack of strength in these core muscles increases anterior pelvic tilt, which drives internal rotation of the hip and valgus of the knee. Getting and keeping these muscles strong could go a long way to preventing knee injuries, especially in female athletes.

3. Are accelerated ACL rehab programs what we need? I’m not so sure, and I think making young athletes follow the accelerated programs the pros use may do more harm than good. Unlike the pros that are getting paid to play, we need to focus on the long-term outcomes of our young athletes, not simply getting them back on the field ASAP. Many have done an excellent job of rehabbing patients and getting them back on the field quickly, and quantifying strength and power production/absorption is critical.  Many of the leading PT’s and orthos, however, are moving back to a slightly more conservative approach to allow the graft itself more time to heal. The properties of a tendon graft slowly take on the properties of a ligament over time; this is called ligamentization. However, ligamentous changes can still be seen as late as 12-18 months post-surgery.

[Note from EC: so, if you have a patellar tendon graft for a new ACL, you might not really have what you want until 1-1.5 years post-surgery. Tendons and ligaments have different qualities.] 4. To piggy-back on the previous point, another factor that isn’t examined as often as it should is long-term outcomes of ACL rehabbed clients. Sure it’s great to get them back on the field in 6, 9 or 12 months, but what are the long-term ramifications? We know that females who have suffered ACL tears are much more likely to develop early osteoarthritis. If we can improve long-term outcomes by keeping them out a little longer, isn’t that worth it? As a PT or strength coach, it’s our job to help clients/athletes make the best decision for their long-term health, especially if they are too young to understand the long-term repercussions of their decision.

5. When an athlete tears their ACL, proprioceptive deficits are seen as quickly as 24 hours post-injury. What’s really intriguing, however, is that we often see this same deficit carried over to the healthy knee as well! Even after reconstruction this deficit can be seen for up to six years. To counteract this, don’t forget to include basic proprioceptive training (barefoot warm-ups, single-leg stance work, etc.), and train that “off” leg in the interim. For more tips, tricks, and programming recommendations on knees, check out Mike Robertson’s Bulletproof Knees manual. It’s by far the best resource I’ve seen on preventing and addressing knee pain.

New Blog Content

Just One Missing Piece

Training Around Elbow Issues in Overhead Athletes

Random Thursday Thoughts

Sturdy Shoulders: Big Bench

All the Best,

EC

PS - For those who missed it last week, be sure to check out my new e-book, The Truth About Unstable Surface Training, at www.UnstableSurfaceTraining.com.
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Newsletter #5

We’re five newsletters in, and while the feedback on our interviews has been fantastic, I’ve actually received several emails from people wanting to hear more from me.  In my infinite wisdom, I guess I never realized that people would actually sign up for an EricCressey.com newsletter to hear from Eric Cressey.  With that said, I figured that since I receive hundreds of emails on a weekly basis, I might as well pick a few from the pile and respond for everyone.  There will be some information, some sarcasm, and the occasional rant; I guess that’s part of the beauty of having your own newsletter.  As always, if there is something you’d like to see in the newsletter, just say the word; I’m all ears.

    Q: From reading your stuff and that of John Berardi, I’ve really begun to reconsider the traditional bodybuilding-influenced “bulk-cut” approach to improving body composition.  With respect to getting people to below 10% body fat, Dr. Berardi wrote that “people usually OVERESTIMATE the difficulty and UNDERESTIMATE the duration,” and that it is possible as long as:

    “1) They're willing to work out in excess of 5hrs per week (sometimes up to 8 hours/week).

    “2) They're willing to commit to eating better with each meal. Not follow a fat loss or bulking diet. Simply, every time they sit down to eat, they do better. “3) They're willing to learn a new normal.  We all have habits that are ‘normal’ and if you're 15, 20, 30% fat, your ‘normal’ = good for fat gain.  A diet is abnormal. You'll always get back to 15%, 20%, 30% if you're always doing something abnormal.  However if you re-learn a new normal, you can have a new body.” Judging from your writings, you seem to favor a similar approach.  I was just wondering if you would care to elaborate on any of these things.  I’ve really been thinking about how traditional bulking and cutting might very well be outdated, and would appreciate your thoughts.

    A:

    Those are definitely some statements with which I agree wholeheartedly, and I think that the more people that check out JB’s Precision Nutrition products, the less often I’ll have to encounter questions like this!  Once people start to adopt these ideals, I really think that we’ll see a paradigm shift in the world of training-nutrition interaction for body composition improvement.

    I, too, get really sick and tired of the “bulk and cut” mentality to which so many people adhere.  And, as a competitive athlete myself who has to maintain reasonably strict control over my body weight – yet has still seen consistent improvements in body composition over time – I feel that I have a solid frame of reference from which to speak.  In fact, as I look to drop a few pounds prior to APF Senior Nationals (June 2), my overall training and nutrition strategies aren’t changing much at all.

    With that said, I've got several problems with what has seemingly become the “traditionalist” approach:

    1. People adopt programs, but never habits. Consistency is more important than you can possibly imagine, but when you're constantly shuffling back and forth between programs, you're never really "getting it."  If you had the good habits in the first place, chances are that you wouldn’t have ever had to come to consider the extreme cutting or bulking, right? 2. Progress can be very tough to monitor in experienced individuals. Experienced natural lifters might be lucky to add five pounds of lean body mass a year. How realistic is it to really micromanage such subtle changes over a three-month period (assuming two bulks and two cuts per year)?  Spread five new pounds out over an entire body and you'll see that it isn't readily apparent.  Work with some guys who are 7-feet tall like I have and you’ll see that it’s even more hard to notice – especially when you see them on a daily basis. 3. Bulk/Cut is no way to live.  Let's assume that a year consists of two bulks and two cuts. So, basically, you're spending one half of the year gorging yourself until you become a fat-ass, and the other half in misery until you get lean enough to feel crappier and look better. Toss in a few root canals, a colonoscopy, and a few Ben Affleck movies*, and you’ve got yourself a year to be forgotten.  Yeehaw. 4. Think of the long-term consequences of the bulk/cut scheme.  If you read the research on weight regain and body fat distributions in recovered anorexics, you’ll see that central adiposity is extremely common.  Are severe cutting diets really that much different than clinical cases of anorexia?  Taking someone’s thyroid out and stomping on it would actually be a quicker means to the same end. 5. Do we really want to adhere to guidelines that are predominantly geared toward professional bodybuilders who are so juiced to the gills that you can smell GH on their breath?  They’ve got extensive anabolic arsenals in place to maintain muscles mass and optimize nutrient partitioning as they diet down, and thyroid medications to keep their metabolic rates up in spite of the reductions in calories.  Indirectly, all these substances improve strength and stave off lethargy, making training sessions more productive in spite of caloric reductions.  In the bulking scenarios, the nutrient partitioning effects are still in place, as these individuals are less likely to add body fat when eating a caloric surplus.

    Now, put a natural lifter in the same scenario, and you’ll see right away that he’s immediately at a disadvantage.  Drop calories too fast, and your endogenous testosterone and thyroid levels fall.  You get tired and weak, and your body has to find energy wherever it can – even if it means breaking down muscle tissue.

    I’m not trying to get on a soapbox here; I’m just trying to make people realize that they’re comparing apples and oranges.  You need to do what’s right for you.

    And what does that entail?  Adopt admirable dietary, training, and lifestyle habits, and you’ll build a strong body that moves efficiently and just so happens to look good.  Leave the quick-fix approaches for those with “assistance” and anyone silly enough to watch a fitness infomercial from beginning to end.

    *Note to readers: This reference was spurred on by my good friend, Tony Gentilcore, who was responsible for the quote of the week:

    “There are two kinds of people that irritate me: people who use the leg press, and Ben Affleck.”

    (For your information, Tony has a bit of a crush on Jennifer Garner, and it tends to make him a little biased when the time comes to review Affleck movies)

    Q:

    I was wondering what your thoughts on “finishers” to workouts are.  You know, tough stuff to test yourself at the end of a lift.

    A:

    Truthfully, I rarely add "finishers" to the end of sessions. In my opinion, this brings to light an amazing "phenomenon" that exists in the performance enhancement field. Those who make frequent use of finishers are the very same individuals who don't know a thing about volume manipulation for optimal supercompensation. If the finisher was such a valuable inclusion, then why wasn't it written into the program initially?

    Some people claim that these are an ideal means of enhancing mental toughness.  I can’t disagree, but I do think that your mental training stimuli should already exist in your programming.  If you need to search around for things to haphazardly incorporate at the end of a session, then you need to take a look at program design abilities.  I’d rather see a “finisher” just be considered an appropriately-planned “last exercise.”  Believe it or not, there should even be times when you leave the gym feeling fresh.

    There may be instances where I'll push an athlete (or myself) with increased volume and/or intensity based on the pre-training mood.  This is one basis for cybernetic periodization; effectively, you can roll with the punches as needed.

    I will say, however, that finishers have their place with younger athletes where you’re just trying to keep the session fun.  If you find something productive that they’re enthusiastic about doing, by all means, deviate from your plan a bit and build on that enthusiasm.  When they start getting more experienced, though, you’re going to have to know when to hold back the reins on them a bit.

    Q:

    In December of 2001, I was rear-ended going about 30mph; five cars were involved, and I was the first car hit from behind. My knee hit the dashboard when I was hit from behind and my head was jerked backwards when I hit the car in front of me.

    My knee started hurting soon after, although I never got it checked out.  It’s now become a sharp pain and a constant, dull ache as well with weakness on stairs and squatting-type positions especially.  In addition, there are tender areas, on the outside and top of the knee, that cause extreme pain when I am bending, squatting, lying down, or sitting down for too long. My hip has also been affected, also aching constantly. My right leg and knee also hurt and knot up easily.   The surrounding muscles are very weak with several knots in them, and I also have a very tight iliotibial band.  Any ideas what might be going on?

    A:

    I thought "PCL" (posterior cruciate ligament) the second I saw the word "dashboard;" it's the most common injury mechanism with this injury.  I’m really surprised that they didn’t check you out for this right after the accident; you might actually be a candidate for a surgery to clean things up.  Things to consider:

    1. They aren't as good at PCL surgeries as they are with ACL surgeries, as they're only 1/10 as common.  As such, they screw up a good 30%, as I recall – so make sure you find a good doctor who is experienced with this injury to assess you and, if necessary, do the procedure.

    2. It's believed that isolated PCL injuries never occur; they always take the LCL and a large "chunk" of the posterolateral complex along for the ride.  That would explain some of the lateral pain.

    3. The PCL works synergistically with the quads to prevent posterior tibial translation.  As such, quad strengthening is always a crucial part of PCL rehab (or in instances when they opt to not do surgery).  A good buddy of mine was a great hockey player back in the day, but he has no PCL in his right knee; he has to make up for it now with really strong quads.

    4. Chances are that a lot of the pain you’re experiencing now is related more to the compensation patterns you’ve developed over the years than it is to the actual knee injury.  For instance, the tightness in your IT band could be related to you doing more work at the hip to avoid loading that knee too much.  Pain in the front of the knee would be more indicative of a patellar tendonosis condition (“Jumper’s Knee”), which would result from over-reliance on your quads because of the lack of the PCL (something has to work overtime to prevent the portion of posterior tibial translation that the PCL normally resisted).

    5. From an acute rehabilitation standpoint, I think you’d need to address both soft tissue length (with stretching and mobility work) and quality (with foam rolling).  These interventions would mostly treat the symptoms, so meanwhile, you’re going to need to look at the deficient muscles that aren't doing their job (i.e. the real reasons that ITB/TFL complex is so overactive).  I'll wager my car, entire 2006 salary, and first-born child that it’s one or more of the following:

    a) your glute medius and maximus are weak

    b) your adductor magnus is overactive

    c) your ITB/TFL is overactive (we already know this one)

    d) your biceps femoris (lateral hamstring) is overactive

    e) your rectus femoris is tighter than a camel's butt in a sandstorm

    f) you might have issues with weakness of the posterior fibers of the external oblique, but not the rectus abdominus (most exercisers I know do too many crunches anyway!)

    Again, your best bet is to get that PCL checked out and go from there.  If you’ve made it from December 2001 until now without being incapacitated, chances are that you’ll have a lot of wiggle room with testing that knee out so that you can go into the surgery (if there is one) strong.

    Good luck!

    That’s all for this week; I hope everyone enjoyed it!

    All the Best,

    EC

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    The ACL Rupture Recovery

    Q: Dear Eric, I am a huge fan of yours, and a 21 year old Australian student studying exercise science. I am big fan of your Magnificient Mobility DVD, discovering it after I had written a paper on the effects of a six-week PNF stretching program. I wish I had owned your DVD earlier and used dynamic stretching as the main topic. I fully ruptured my ACL in April and have not had an operation yet, but since then I have regained all mobility. I have not, however, done any lower body weight training apart from some calisthenics. I have been cycling to maintain some strength and whenever I ask someone they tell me to strengthen the VMO and Hamstrings, which I have also been doing. However, now I am keen to start resistance training on my legs; I did a moderate volume session last week and it was fine. I am wondering if I do strengthening exercises for my lower body such as squats, deadlifts, leg extensions, lunges, etc. and I don’t feel any pain if I am doing it any damage? Any recommendations? A: Believe it or not, there are a lot of people – impressive athletes included – walking around with ACL tears that they don’t even know are there! Some eventually become symptomatic – possibly because of other inefficiencies – and others don’t. To that end, the best thing you can do is teach your body to move efficiently in light of the structural defect you have. You can do posterior chain stuff like deadlifts, back extensions, pull-throughs, and glute-ham raises until you're blue in the face; the hamstrings work synergistically to the ACL, so strengthening the hammies will help you long-term. When you optimize glute function to correct position the femur (i.e., eccentrically controlling excessive internal rotation and adduction during ordinary movements), you’re helping your cause even more. To that end, single-leg movements are very important. Along these lines, I would start with isometric exercises (split squat isometric holds) and gradually work toward incorporating more dynamic variations, starting with reverse lunge variations and eventually progressing to walking lunges and potentially forward lunging. Luckily for you, our Magnificent Mobility DVD just so happens to be on sale through December 12 (enter coupon code HOLIDAY2007), and it would be a big help, too. There are tons of useful glute activation and frontal-plane stability drills in there. As I have written in a previous article, leg extensions are crap for everyone: Chow (1999) examined patellar ligament, quadriceps tendon, and patellofemoral and tibiofemoral forces at different speeds of leg extensions execution. Tibiofemoral shear forces showed that the ACL was loaded throughout the ROM — not exactly what you want (passive restraints doing the work for active restraints). Squats variations may or may not give you trouble. I would recommend progressing from box squatting (sitting back, more hip dominant) to more quad-dominant variations. For more information along these lines, I’d highly recommend you check out Bulletproof Knees by Mike Robertson (same holiday discount applies). Best of luck! Tags: ACL, Knee Injury, Magnificent Mobility
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