Anyone know good exercises for recovering ACL tear?

[Guest dragonsword5]

Hey everyone,

I had a ACL/Meniscus surgery in April and finished therapy in June. I've been working out a lot at the gym trying to regain muscle I lost during the post-surgery but I was wondering if anyone knew some good excercises I could do (besides squats, I can do them but they still kill my knee) that wouldn't be to hard on my knee and help me get ready for the season.

Thanks a bunch. I can't wait for winter to come back!!

[Buell]

Bike riding was great for my ACL reconstruction recovery.

Buell

[skatha]

Bike riding is good....you need to remember to exercise your hamstrings, too.

Did the docs get your replacement ACL from your patella tendon, a cadaver, or your pes ancerus tendon?

I liked doing the stairmaster, too....

Did they shave your meniscus or just remove it? If they removed it, you might find that jogging is very uncomfortable, so avoid it.

I used to run 6-7 miles a night prior to ACL recon #2, now I can't run at all( I guess I could if a black bear was chasing me )

Also, I heartily recommend taking at least 1500 mg of glucosamine every night.

I had first recon in 1981, the second in 1989. I have no knee pain at all, and I was told to expect to need a replacement before I was 50(42 now)

[UK2TX2CA]

Hello Dragonsword5,

Knee Guru has tons of stuff on rehab, be sure to check the forums for tips too.

[Sinecure]

Swimming is awesome and no impact. Balance exercises are good because they don't stress you too much, but develop all the small muscles.

[jdgang]

good luck with that I had mine done in 99 and didnt do anything other than the rehab but I also stayed off the board for 3 years...but I find walking (brisk) to be the most enjoyable...and dont forget to wear your brace

[Guest dragonsword5]

Hey thanks for all the advice.

I do a lot of walking because I have two dogs so they get me out and I've got the greatest tan line from my sports brace :lol: My friend calls me a zebra.

Haha, I tried bike riding and when I told my doc he got kinda mad at me :rolleyes:

[tex1230]

Hey everyone,

I had a ACL/Meniscus surgery in April and finished therapy in June. I've been working out a lot at the gym trying to regain muscle I lost during the post-surgery but I was wondering if anyone knew some good excercises I could do (besides squats, I can do them but they still kill my knee) that wouldn't be to hard on my knee and help me get ready for the season.

Thanks a bunch. I can't wait for winter to come back!!

Make sure you don't flex past 90 degrees in your squats - you can do a lot of damage esp. if you had the patellar graft

[Guest Zach Davis]

No,

DO squat past 90 degrees... there is nothing wrong with squatting past 90 degrees; it's a perfectly natural movement. Try this: Lay down on your back, on the ground. Then stand up without squating past 90 degrees.... it should be a fun experiment.

Here's the deal, though. Don't use any weight. Do squats with no weight... maybe 100 a day, with a rest day every 2 days, and your recovery will be dramatically faster.

Another good one is the kettlebell swing... but wait until your squat form has matured and strengthened.

Since you live in Jersey, I would take the time to go see the folks at:

www.crossfitphilly.com

Zach

www.trainlikeitmattters.com

[Buell]

Haha, I tried bike riding and when I told my doc he got kinda mad at me :rolleyes:

Doc got mad at you riding a bike. Funny. Mine was only upset that I was riding on the street so soon after surgery. He wanted me on a stationary bike so I could not wreck. This was 10 years ago though.

[tex1230]

No,

DO squat past 90 degrees... there is nothing wrong with squatting past 90 degrees; it's a perfectly natural movement. Try this: Lay down on your back, on the ground. Then stand up without squating past 90 degrees.... it should be a fun experiment.

Here's the deal, though. Don't use any weight. Do squats with no weight... maybe 100 a day, with a rest day every 2 days, and your recovery will be dramatically faster.

Another good one is the kettlebell swing... but wait until your squat form has matured and strengthened.

Since you live in Jersey, I would take the time to go see the folks at:

www.crossfitphilly.com

Zach

www.trainlikeitmattters.com

sorry - my comment was meant to be restricted to if he had the patellar graft repair - All my PT's told me the same thing - no squats/leg presses past 90 degrees for 2 years after surgery. your lower patellar ligament is weakened and needs to regrow.

of course my surgery was 15 years ago so the recomendations may have changed.. but it makes sense to me.

[patmoore]

Also, I heartily recommend taking at least 1500 mg of glucosamine every night.

I had first recon in 1981, the second in 1989. I have no knee pain at all, and I was told to expect to need a replacement before I was 50(42 now)

I'll echo the endorsement for Glucosamine. My knee doctor recommends it and I can tell when I've skipped a day. Liquid form is much easier to take. I buy 33 oz bottles of Ultimate Joint Care at Sam's Club. Referigerate it after opening (it tastes much better that way too). See www.drinkables.com

Also, my doctor is a big believer in biking as therapy. I prefer unicycling but whatever floats your boat....

I tore my ACL at a skydiving competition in 1969 but didn't have it repaired (patella tendon) until I took up skiing in 1997. Since then I've had two more "tuneups" on the same knee to repair miniscus damage, the most recent being in April. One discouraging result of the injury is the onset of arthritis. It's progressed to the point where no artificial cartilage or injections would be of any help. Like Skatha, I'm a candidate for full replacement but they want to do that only as a last resort. I'm told that replacements don't allow a knee bend of more than 105 degrees and that would put a real crimp in my racing. The other issue is that I'm told that it is extremely painful to kneel after you've had a replacement.

Best of luck and do a lot of biking and swimming.

[skatha]

Ha...it's painful for me to kneel now...good thing I'm not Catholic :D

Squats past 90 degrees are not good for anybody-it's puts too much strain on your knee ligaments and doesn't add anything to the benefit of the exercise...

Not only have I had 2 recons but I spent many years lifting...

In fact, my med fraternity nickname was "Ramba"

I'll show you my biceps if I ever get to a SES....

[Guest Zach Davis]

Doesn't add anything to the lift???

Do you ever snowboard with your knees bent past 90 degrees? Do you ever jump, run, swim, hike, etc...?

Do you ever pick anything up off of the floor?

If the only purpose of squats for you is to get big quadriceps, then maybe bending past 90 degrees is a waist. The squat, though, is a beautifully functional movement that is the gateway to all sorts of other lifts:

deadlift

Clean

Snatch

People who don't squat past 90 degrees become quad-dominant and loose all of the functionality and power of their hip flexors... it's kind of sad, really... We call it "Muted Hip Syndrome".. an ugly byproduct of the narcisistic culture of mos "big-box" gyms.

Look into any NFL weightroom and you will see tons of athletes doing Cleans, Deadlifts, and Snatches.... all bending past 90 degrees... Now, tell me, do you want to be as fit as an NFL linebacker, or the chump personal trainer who told you not to bend past 90 degrees?

Zach

[Thor VonRippington]

I'm currently rehabbing my fourth blown knee. The Total Gym (think Chuck Norris and Christy Brinkley) is great along with cycling and lots of beer for lubrication and pychological dispare

[kjl]

Doesn't add anything to the lift???

Do you ever snowboard with your knees bent past 90 degrees? Do you ever jump, run, swim, hike, etc...?

I agree with Skatha - squatting past 90 degrees seems to put a huge amount of strain on my knee (patellar tendon mostly, I think), and I don't think you're going past 90 degrees (certainly not with power; maybe with depowered followthrough movement) in any of the activities you mentioned: running, jumping, swimming, hiking, or snowboarding. That is, unless you really want a knee rupture.

Look into any NFL weightroom and you will see tons of athletes doing Cleans, Deadlifts, and Snatches.... all bending past 90 degrees... Now, tell me, do you want to be as fit as an NFL linebacker, or the chump personal trainer who told you not to bend past 90 degrees?

I definitely do not want any part of the wear and tear of the NFL linebacker's body.

[Guest Zach Davis]

A bunch of guys lifting more than twice their body weight from below 90 degrees in a squat.

http://www.youtube.com/watch?v=1X2Z1ZtZJao&mode=related&search=

Of course, what do I know:

SST Head Coach, Strength and Conditioning; CrossFit Level 1 Coach; Going for my USAW Level 1 Coach in September.

The idea that you can not generate power from a position of acute flexion of the legs, is largely a myth of our modern fitness culture that is more concerned with avoiding liability than producing fit individuals.

With a strong and mature posterior chain (Glute, Hamstrings, Hip Flexors), the inverse is true. Below the point of acute flexion of the legs, an athlete should be able to initiate an enormous amount of power by pushing their hips forward.... a mechanically similar action to shifting your hips in a snowboard turn.

If your trunk is anything beyond nuetral or your hips are flexed acutely, then yeah... your'e screwed.... that's a recipe for collapsing vertebra.

So, if you don't like the example of an NFL Linebacker (because, you can't separate training from sport), then how about an Olympic ski racer? Eva Twardokens (Former US Team) will be coming to my training facility in Reno on November 18th for a ski fitness and nutrition workshop.

Zach

www.trainlikeitmattters.com

[kjl]

I'm not saying you can't, just that I won't. I don't know anything about fitness culture, but my knees definitely feel more vulnerable in a deep squat then they do anywhere between ~0 to ~80 degrees flexed. In fact, two summers ago I actually tore a recently reconstructed PCL while in a deep squat, and I was not under a weighted load - I was kneeling down on the floor to watch TV, apparently with an unintended weird twisting motion.

For me, it's not that the motions are intrinsicly unsafe, it's that "if something were to go wrong (like I slip, or I lose my balance, etc.), and I am under load, chances of my knee exploding again are higher if my knees are very bent."

Having said all that, I will happily admit:

1) I have no idea what I'm talking about.

2) I fully understand that you can't extrapolate from a single data point (i.e. because I tore my PCL graft in a deep squat doesn't actually mean deep squats are dangerous - you have to look at the overall statistics).

However, all of my various PTs (and I have had a lot of PTs over the last ~8-10 years) have pretty much universally told me not to go beyond 90 degrees in my rehab.

[Guest Zach Davis]

I realized I may have come off a little harsh.... sorry.

Anyway, if you've been doing PT off and on for the last 8 to 10 years, and things haven't improved to the point where you can squat past 90 degrees... it may be time to rethink your training strategy.

As an aside, the region of the world with the fewest recorded knee injuries is Southeast Asia... not surprisingly, where the default sitting position is in a deep squat. Their knees, and in fact their entire lower bodies are conditioned to it.

Another interesting thing to look at is the growing number of reported lower back injuries in parts of Southeast Asia that are modernizing.. where people are sitting in chairs and not being conditioned to a functional range of motion.

There is a certain logic behind a PT or trainer telling their clients not to squat past 90 degrees, but it is akin to a CPA telling their clients just to not spend any money. Sure, the PTs' clients are less prone to reinjury, but they are also sacrificing a huge range of functional movement for which they wil suffer later in life. They will also likely experience a loss of bone density in their shins and pelvis.

My personal belief is that PTs don't bother to learn and teach their clients proper, safe techniques to achieve full, functional range of motion, because:

a. It's too much work

b. Most of their clients are not long term or really even that interested.

Zach

[Guest dragonsword5]

Waah So much advice! That laying on your back and getting into squat excercise sounds fun.

Ya, my doc said that I would be at higher risk now to have arthritis but seeing as how I'm 17 I'll worry about that a little later.

My dad had a total knee done and refuses to get the other one done. He was in so much pain for a few years after his surgery. Definitely not looking forward to that. :rolleyes:

[Guest *Ryan*]

Zach,

Logic indeed. The shear and compressive forces between the patella and femur, and between the tibia and the femur increase as knee flexion increases, reaching a maximum near end range knee flexion. The 90 degree suggestion is a number, nothing more. But patients want specifics, they rarely want to understand the arthrokinematics of the knee. So 90 is giving the patient what they want and providing them with a ball park guideline to hopefully prevent re-injuring their knee. This refers to exercise, squats, lunges, repetitive movements under force. This does not limit functional range of motion. Increasing knee flexion post-op is a priority. But to have successful outcomes you have to balance strength training and joint protection as the graft and donor site heal. Strength training, squatting etc takes on significantly more complexity when you are dealing with a ACL deficient or otherwise abnormal knee. PT's certainly understand what it takes to rehab a knee to "achieve full, functional range of motion", unfortunately many patients listen to what coach has to say, and end up back in the Orthopods office.

dragonsword5: If you are a few months out you should be doing some agility drills like lateral shuffles, cariocas, cross over drills, and backward running. Work unilateral exercises (single leg squat/hack squat) single leg jump rope etc.

ps. The posterior chain is made up of the extensors on the lumbar spine, glutes, hams and gastroc/soleus. The Hip flexors (iliopsoas) insert anterior to the hip joint.

Bone density has little to do with ROM or flexibility. I can introduce you to many paraplegics that are incredibly flexible with terrible bone density. Weight bearing or more specifically forces that cause the bone to deform or bend stimulate calcium deposits and increasing bone density.

Rant over, back to patients

Ride on

[Guest Zach Davis]

Ryan,

Good call on the Posterior chain... My typical description of the Posterior Chain (to an athlete) is: Glutes, Hams, Hips... I inserted "flexors" inadvertantly. When I look for a strong posterior chain, I want to see an athlete be able to hold an L-sit for 10 seconds, sit into a full squat and be able to catch a 20-pound medicine ball without falling over, and eventually Overhead Squat their body weight 15 times (pretty advanced).

Given a responsive, attentive patient, wouldn't you reccomend a full squat? I'm not talking about stacking on weight, or even using a bar, just simply sitting into a full squat and standing back up again... hell, he'll end up doing it just getting up and down from chairs. We often train an athlete's squat by having them sit down onto a 15" box, then stand up again.. .repeat 50 times.

I've gone through PT myself a few times (not on a knee), and I've talked to plenty of athletes who have done it for knees. I've only met one who got any sort of real attention from it. Oddly, that one was taught to squat just past 90... about 1/2 an inch into the acute angle.

Sure, the shear forces between the Patella and Femur increase the lower you get, but you can easily monitor an athlete's control of the movement by their ability to track their knees directly over their feet. You can also watch for failures in the Lumbar, etc...

I've seen good and bad coaches, good and bad PTs.... a pretty good indicator of a bad one is the phrase: "Don't squat past 90 degrees." That just sais to me that they don't have enough patience or interest to be of any real help. I have yet to see an athlete be hurt by going past 90 in a squat, when they were properly coached.

Anyway, considering that the "patient" is 17, I think it would be a crying shame if he were to take advice that limited his functional strength later in life...

I can also introduce you to 85 year-old ladies who have had huge increases in bone density in their pelvis (damn, can's suss out the plural of pelvis), from increasing their range of motion and intensity in exercise. I'm not 100% certain on the science behind it, but I'm fairly certain it has to do with increased quantities and capacities of capilaries near the bones, in the area if stress.

I had a similar experience with my Scaphoid...Broke it once, casted for 12 months, then re-broke it. I had a non-union the first time. My second surgeon, put a screw and a bone graft in it, and he had me exercising my arm within 3 months. I had calcification and union within 6 months.

It's fun to watch a person who has been drilled into believeing that they shouldn't squat past 90 degrees try to pick something up off of the floor... the lumbar curls into flexion, their hamstrings go taught, and they are set up for lower back injuries.. from something as simple as picking up a candy bar.

Another interesting point to me, that I think reinforces my belief that most PTs and coaches are conditioned to mediocraty: 9 out of 10 PTs that I know have automatic disdain for coaches, and the same goes for Coaches to PTs. When "covering your ass" is the unstated goal of either, they are inherently conflicting.

[Guest Zach Davis]

(Sorry to be so long-winded)

BTW - As I read it, Dragonsword is 5 months post-op and completed rehab in june. Would you seriously tell him at this point to continue to limit his range of motion? I can see limiting the weight, but range too?

Zach

PS - I probably should have said "find a good strength & conditioning coach and put them on the phone with your PT," but being busy, easily distracted, and generally cranky when I hear people say "dont' squat past 90 degrees," I didn't

[Guest *Ryan*]

Zach,

recommend full squat - no. Not as an exercise. I think there are better ways to improve the stability and strength of a recovering acl tear. Limit ROM - absolutely not. But should be a non issue by now. I would expect full rom in the first few weeks. When patients are told not to squat past 90 that does not apply to all activity. Only strength training, unlilateral and bilateral squats. These are generally part of someone's rehab early on (Bilateral)when joint protection is a priority. Becomes less of an issue as tensile strength of the graft improves.

Monitoring someone's form during the squat exercise does nothing to limit the forces exerted on the ACL, PCL etc. They still reach a maximum and end range flexion. Again there are better/safer ways to rehab and acl.

Exercise stimulates bone density by deforming the bones-the bending causes a negative surface charge stimulating CA+ deposits. Bone stimulators capitalize on this mechanism to improve bone formation

Capillary formation results from the exercise - helps to supply the formation of the bone, but does not stimulate.

It comes down to understanding the healing process. How much stress can a 2 , 6, or 12 week acl handle. No one knows because every surgery/recovery/patient is different. Progressively improving the strength and stability of the knee is the deal. The squat (past 90) is an excellent way to improve lower extremity strength, but a crummy one to improve the stability of the knee. Exercises that challenge the patients ability to stabilize the knee while strengthening the flexors/extensors are what they need.

Its the difference between healthy and surgical knees. Risks and benefits without black and white. Choose wisely:)

[kjl]

I realized I may have come off a little harsh.... sorry.

It's hard to not sound harsh online about something you're passionate about. Ask Jack about extremecarving or me about Star Wars :p.

Anyway, if you've been doing PT off and on for the last 8 to 10 years, and things haven't improved to the point where you can squat past 90 degrees... it may be time to rethink your training strategy.

Well, it's more like I keep tearing things, getting surgery, and going through PT again. But you have a point - I am a year out from my last surgery, and while I can do squats past 90 degrees and feel perfectly strong, I don't fully "trust" the knee in those ranges. Also, I have not gotten full ROM for the knee (I am stuck at around -1 or -2 degrees full extension - the other one goes to maybe -7 or -8; and I am off by maybe 10 degrees for full flexion compared to the "good" knee, though I have way more than the functional ROM for any sport I do - no weightlifting for me, thanks).

Thanks for the insights.