Home Posts tagged "Knee Surgery" (Page 2)

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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Foam Rolling and Knee Clicking

Q: A PT recommended me to do foam rolling on the IT band for the clicking sound on my knee. I've been rolling for quite some time but the clicking hasn't gone yet. I read your article on the subject at T-Nation and figured you’d be a good person to ask.

Anyway, I have a question. A trainer on an online forum advised against rolling on painful areas. Instead, we should just put pressure on that area for 30 secs. Rolling would just make the tissues tighter. Is this true?

A: As always, the answer is: it depends. Pain tolerance is an individual thing. If you just have some minor discomfort – not a shooting pain or something that would lead you to believe that there are other issues at hand, it’s fine to work through it. If, however, the pain is so intense that you find yourself guarding, then you’re likely working against yourself.

The problem is that foam rolling alone won't fix the issues entirely; it just works on tissue quality (treating the symptoms). You likely need to look at ankle and hip mobility, glute activation, and soft tissue quality at several other joints. Footwear can be an issue, and the same can be said of activities of daily living and the rest of your training program.

Mike Robertson’s Bulletproof Knees Manual would be an excellent resource for you to pick up for more information.
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Advice for Sore Knees

Q: What advice do you have for sore knees? It might be from over use, squats, dead lifts, cardio, but I'm sure joggers run into this all the time. Do you cover it in you Mobility DVD? A: "Knee issues" is a very broad topic. You can have dysfunction at the ankle, hip, or knee itself - and that's just the tip of the iceberg. We most commonly see issues at the ankle, hip, or both, though. It could be mobility deficits, soft tissue restrictions, capsular issues, or even congenital issues (femoral-acetabular impingement, for instance). Issues like you describe can simply be a result of imbalanced training programs, too. Most people tend to be very quad dominant and do a lot more squatting work than hip-dominant exercises. With Magnificent Mobility, we've definitely had some excellent results in people with nagging knee issues. However, given that you have more of a "amorphous" issue, you'd be better off picking up a copy of Mike Robertson's Bulletproof Knees Manual. Mike goes into great depth on knee issues, their causes, and solutions - all while educating the reader in an easy-to-understand manner. Eric Cressey
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The Truth About Leg Extensions Part 2

This blog is continued from part 1. Rule #4: You can never have too much information. Ask a lot of questions and consider every angle — and know when to refer out to a professional more qualified than you to handle the problem in question. Your Take-Home: It will never hurt to get diagnostics done on your knee from a qualified physician. Some of your problems could be related to a meniscus issue; it would explain some of the problems with weight-bearing exercise (although you would still be able to do some exercises in the standing position). That said, though, you still likely have a big window of adaptation ahead of you, so read on. Rule #5: Think "correct" before you think "different." If an exercise causes pain, stop performing it. Evaluate technique before moving on, though. If performing the exercise correctly alleviates pain, keep it. Chances are that correctly performing the exercise will actually help correct the imbalance. Your Take-Home: Have you considered that it might be the way that you squat that is the problem? Are you breaking the knees forward or hips back first? Perhaps front-squatting is a better option for you now. Is box squatting painful? Rule #6: Make the athlete feel like an athlete — not a patient — both physically and psychologically. Tell them what they can do. Your Take-Home: I can almost guarantee that deadlift variations, pull-throughs, various single-leg movements, and glute-ham raises would allow you to train pain-free in closed-chain motion if you performed them correctly and with appropriate progressions. Rule #7: Before you go changing what's going on in the gym, figure out what you can do to improve what's going on outside of it. Think posture, repetitive motions, sheer lack of movement, sleeping posture, footwear, and even poor diet. Your Take-Home: What is your footwear like? Is it appropriate for your foot-type? Are you taking fish oil? Glucosamine? Are there activities in your daily life that you do repetitively that could be avoided or revised to keep you healthy? Rule #8: Soft-tissue work serves a valuable role in preventing and correcting imbalances, without making any programming modifications. Foam rolling and lacrosse ball work is cheap and effective. Just do it. Your Take-Home: I’m willing to bet that you aren’t foam rolling or doing any work on your calves or glutes with the lacrosse ball. And, I’m guessing that massages aren’t a common occurrence in your life. All three are great interventions (the former two are very affordable, too). Rule #9: Implement mobility and activation work in your warm-up. It only takes 5-10 minutes, which is a lot less time than it takes to recover from an injury. You'll be amazed at what shakes free when you enhance stability through full ranges of motion. Your Take-Home: I’m guessing that you haven’t done anything to improve hip internal and external range of motion, hip extension ROM, or ankle dorsiflexion ROM. You should be. Rule #10: As a last step, modify the training plan — and only on a small-scale, if possible. This is the most "sacred" aspect of an athlete's preparation, so you should butcher it as little as possible. The more you screw with things, the more the athlete is going to feel like a patient. Your Take-Home: I’m guessing that the leg extensions are causing more harm than good. I would try some lower intensity rack pulls and/or pull-throughs, plus some split squat isometric holds. See how it goes. I would also highly recommend picking up a copy of Mike Robertson’s Bulletproof Knees manual. Mike goes into far more detail in several hundred pages than I ever could with a single blog post. Good luck, Eric Cressey
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The Truth About Leg Extensions Part 1

Hello Eric, I just read “The Truth About Leg Extensions.” Because of my standing work , I can`t do any leg exercises that press under my feet (deadlift, squat, and leg press), more that once a week, without getting trouble with my knees. They get full of water and hurt. When training full-body, three times a week, I do leg extensions Monday and Wednesday and then squats on Friday. This way, I don’t have to stand up for 8 hours the day after squats. I just tried to do squats twice a week (Monday and Friday), also with bad results. So I am happy to have the Leg extension. With Friendly Regards from Denmark, Bent A: You know, I can only imagine how challenging your life must be if you can only go to the bathroom once a week. I mean, honestly, not being able to squat down to the toilet more than once every seven days? You must have a pretty strong colon! Kidding aside, I’m the last person from whom you will get sympathy. I regularly train clients and athletes anywhere from 7-13 hours per day – and those are on some pretty hard rubberized gym floors (rubber is on top of turf). I also happen to have supinated feet (very rigid feet that don’t like to cushion the body), so I regularly wear through the insoles I put in my shoes. Still, I do a wide variety of lifts – from deadlifts, to squats, to various single-leg movements – and sprint 2-3 times a week on top of that stimulus. Now, getting to your issue… First off, go check out my article, The Ten Rules of Corrective Lifting, at T-Nation. It will give you an idea of the direction I’m going to take with this reply. I would actually recommend opening it up in another window as I go through step-by-step what could be your problems. Rule #1: Fit the program to the lifter, not vice versa. The best way to correct dysfunction is to prevent it. If you're blindly following cookie-cutter programs, stop. Your Take-Home: Stop reading your favorite muscle magazine; it takes more than leg extensions and squats to build solid legs that are pain-free. Rule #2: Learn to program for yourself. Establish a small group of people who will give you honest feedback on your programming ideas, and then use your intuition when it comes to modifying things on the fly. Your Take-Home: Seek out the help of others who understand the dynamics of your knees better than you do. Rule #3: Some exercises just aren't worth it. Don't bother with them; there are better options available to you. Your Take-Home: Cough…leg extensions….cough. See the rest of this article in tomorrow's update!
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Ask Eric: Runner’s Knee

Will the excercises on Magnificent Mobility help treat runner's knee, along with the tight IT bands and hamstrings? Are there different exercises which you would recommend for the knee/IT band problems? I haven't bought the dvd's yet, but if they'll help my knees I'd consider it.
Absolutely, Peter. Most knee issues arise from lack of mobility at the ankles and hips - so one goes to the knee (what should be a stable joint) and creates range of motion. We've had a lot of great feedback from people with bum knees who have seen great results with the DVD. Mike and I are more than happy to help you customize the drills to your needs. I'd also recommend that you pick up a foam roller to work on soft tissue quality in the ITB/TFL. You can read more about it here. I'd also recommend that you take a lacrosse ball to your calves and glutes to free up any restrictions that are there - very common in anterior and lateral knee pain.
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When Knee Met Dashboard

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?

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.

Eric Cressey
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