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