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More ACL Info - Page 2

post #31 of 54
My ACL reconstruction was in April 2001 and I had it scoped to clean out scar tissue (Cyclops lesion) in November 2001.

I certainly didn't do leg extensions early in my rehab (for at least the first six months), but it is part of my routine now on the recommendation of my PT. Early on, I was advised that it did create too much strain on the knee joint when it was in the healing stage. Now apparently, my PT must feel the knee has healed enough to handle it. Any thoughts on this time frame or do you feel leg extensions are bad for post-ACL patients forever? I do squats, leg press, ham curls also. Do you think leg extensions are bad even if it's one of many exercises?

I've also had a tough time getting my VMO to get going again. I'm actually using a stim unit this month. I've been doing leg presses with a rubber "4-square" ball squeezed between my knees to isolate the VMO. That was interesting info about the 20 degrees of flexion working that muscle during leg press. Any other thoughts would be appreciated.


<FONT COLOR="#800080" SIZE="1">[ March 26, 2002 06:49 PM: Message edited 1 time, by Wags ]</font>
post #32 of 54
Thread Starter 
In terms of time frame, ONLY your PT can recommend this. As to whether its a "bad" exercise or not, that is also your PT's personal decision. If there is no, or never has been any injury, they are no more contraversial than any exercise.

Keep in mind, an exercise may be perfectly acceptable for general fitness, but the question to ask, is how effective is the exercise for sports conditioning?

In the long run, muscular isolation is great for muscular definition. Not a darn thing wrong with that! But when do we isolate muscles in ANY sport??

In the same way, people try to look for a SINGULAR misalignment or weakness that causes an injury. Ah, if it were all that simple!
post #33 of 54

The reason why you hate skiing cat tracks is because you fell and broke your ankle in a crowd at the marathon.

So when you get on a cat track, you get all tense.

post #34 of 54
per my orthopod, a fairly reknkown specialist in ACL reconstructions for top athletes, leg extensions ALWAYS are bad and NEVER should be used.

there are MANY other exercises that can hit the quads with similar efficiency. they're just not part of the old school's repetoire.

the same folks that suggest quad extension exercises are responsible for the view that only scholarship or professinal athletes should have ACL reconstruction.

now, why would you trust such antiquity?
post #35 of 54
i'm tellin' ya, leg presses are the way to go. you're hitting more of the muscles, you're getting quads AND hamlets, and less stress than extensions and squats.
(but you will still want to do the leg curls.)
and get on the bike.
post #36 of 54
Thread Starter 
Gonz, Ryan, I agree with you both. Trying to be a bit of a diplomat, here. Presses are an integrated closed chain exercise, which is the best way to work the body.
post #37 of 54
This is a great thread. Actually, I think my therapist went to that same seminar on St. Patrics day that LM went to, and he came back with some GREAT ideas and excercises, he was really jazzed up about the whole thing..stressing balance and stability...we discussed making sure weight training was always with the foot connected to something, leg extensions are not good...etc. It seems as though it was a great workshop.

unfortunately I have "graduated" from PT and didn't get the chance to speak with him too much about it. If there is anything else you can remember from that please share it!

One of the only problems I am having is stability, its still really wobbly, and Im wondering how much that has to do with proprioception...we never really discussed that all that much...mabey im just not understanding the whole concept?
post #38 of 54
Thread Starter 
Linda, what is your PT's name? I think it would be great if we had a list of "clueful" physical therapists on this forum.

The stability/proprioception link is a bit tricky, but here goes.

We've spoken about the transverse abdominal muscle, responsible for , among many things, stability. Recent research has found that if ANY body part is injured on one side, the transverse abdominal muscle on that side receives less innervation. So, combine that with the healing process involved with the muscles and ligaments, it may feel a bit wobbly for awhile, but it can be worked on.

Is your PT taking the seminar next week with Juan Carlos Santana? Two full days with the "master", he will be even more loaded with info. I will give another update after attending, if people are interested.

This topic has been spread out into different threads, some of them are unfortunately not available on the 2 pages shown. I was thinking perhaps there should be one thread that just sort of summarizes everything, The Vermont Ski Safety Site, the "who's at risk" issue, which would include the Q angle stuff, prevention and post rehab. Much of it would be repeat information, but at least it would be in one thread. I can also find the photos of the stability exercises, some of which I think Linda has done in her therapy.

Let me know if you think this would be redundant.

I want to address once more the isssue of the leg extension machine. Lets take this apart logically.

If you feel your quads are working too hard while skiing, chances are you are in the back seat. As stated in the Vermont Ski Safety study, being in the backseat is ONE of the factors leading to an ACL injury.

If your quads are working too hard, chances are you have a muscular imbalance. One of the recommended ways of preventing an ACL injury is to increase you hamstring strength.


We have the leg press, squats, and, if done at the correct seat height, stationary bicycle, that are closed chain integrated exercises, that work the quads, hamstrings, glutes, and can work the vastus medialis.

The leg extension machine is one of the few pieces of equipment that pretty much ISOLATES a muscle group, in this case, the quadriceps.


What are we trying to do, here. We want to get the hammies more in balance with the quads, why are we doing an exercise that pretty much isolates the quads? And as WTG has pointed out, many hamstring machines are not that well manufactured.


For SKIING, our goal is to get the quads to work together with the hamstrings. Remember the kinetic chain thread? When we work out for SPORT, we are talking about not just training muscles, but the nervous system.

So wouldn't it be more effective to use exercies that utilize a more integrated approach to training?

Does this make sense?
post #39 of 54
My PTs name (and I hope he doesn't mind my posting his name) is Scott Plourde from Performance Rehab in Nashua, NH. (he works out of World Gym in Nashua, as well as the office...) He is definetly "clueful", we've discussed just about everything in PT that has been discussed in these threads, he seems to be on top of everything. He is also the athletic trainer for the high school here, and extremely sports oriented.

im not sure if he is taking that seminar next week, but i may call him for other reasons and ill ask.

<BLOCKQUOTE>quote:</font><HR> Let me know if you think this would be redundant. <HR></BLOCKQUOTE>

Actually no, i think this one thread is actually something i am looking for...being a "lay person" it would be good to have something that ties it all together, so to speak, Now that I am "on my own" part of ACL recovery. And, since my injury, the NUMBER of people i have met with this injury, warrants that kind of thread. if you have the time it would be nice, thank you.

just as a side note...on a couple of gym "machines"--- hamstring curls hurt...it would seem that that "shear" force would be present here?....Stairmaster climber...ten minutes on that and my knee feels like it was never injured...
post #40 of 54
Lisa M, you rock! As a physical therapist/personal trainer, you asked me to comment on your messages so here I am:
You are very correct about the need for closed-chain activities and "functional" exercises over "traditional" maching based exercises. And YES, the hamstrings are a major key to protecting the ACL.
Also, Top Gun has it right when referring to the ITB. When you flex (and extend) at the knee, ideally your patella should move in an arc-shaped motion. The VMO functions to pull the patella medially during the middle phase of the tracking--BUT, if the ITB is too tight, even a strong VMO won't be able to do its job. There are many causes of a tight ITB, the most common being a large Q-angle, or over pronation of the foot.
Regarding the skier who said her knees felt wobbly (I am so sorry I don't remember the name and didn't re-read the messages to figure it out), you may be having difficulty with co-contractions of either the quads/hams or hip abductors/adductors.
As for those of you who are not convinced that the knee extension machine is dangerous for the ACL and insist on using it to target your quads, the "safest" way to use the machine is to have a pad up close to the knee (along the proximal aspect of the tibia)to serve as an "anti-shear" mechanism. This helps prevent the tibia from being pulled forward under the femur due to a strong muscle pull from the quads. But I still feel that quad extensions are the least effective and most risky way to FUNCTIONALLY rehab a knee. There is not a big shear stress to the ACL when doing hamstring curls because the pull of the hamstrings on the tibia is a posterior force, thus going in the exact opposite direction the mechanism of an ACL injury.
I hope my babbling has cleared up some of the questions y'all have about the knee.
post #41 of 54
Thread Starter 
Oh Yeah!!! Welcome Mia! Mia has been the missing link in the "Dynamic 3" {includes Top Gun} who work together. So often, when one of you asks a question about a specific exercise, you can find the 3 of us huddled together at our gym coming up with solutions.

Since Mia is also a Physical Therapist, we run our posts by her first, to make sure we are not making idiots of ourselves! [img]redface.gif[/img]

All 3 of us attend the same workshops, so if one of us forget something, the other brings it up.

I will compile all the info from the various ACl threads this weekend.
post #42 of 54
thanks, LM and Mia.

now, someone asked why Hammie curls hurt on some machines.

First, I suggest that you first check to see where the pad rests on the back side of your leg.

Second, I suggest that you use only enough weight to create resistance. Add weight when it feels about as easy as doing the hammie curl against simple gravity.

Third, all exercise causes at least a wee bit of discomfort. It has to - it's WORK!
post #43 of 54
Thank you, the info is great...Thanks and welcome, Mia.

gonzostrike...hamstring curls seem to hurt my bad...ok we dont like to use the word bad...my "involved" knee...the one i recently had the acl installed. I will definetly check form...but I really hate them...they scare me because they hurt.
post #44 of 54
Thread Starter 
Interesting, the hamcurl machine bothers the knee on both linda and Who's that Girl.
I said earlier that many of these machines are not set up for optimal biomechanics, especially for women.

You know, this sort of perpetuates the whole problem. I see it all the time in the gym. The girls will do about 4 sets of leg extensions, but after messing around with the adjustments on the hamcurl machine and not really finding a comfortable position, they end up doing only one set.

Another problem. Some companies make machines where even the lightest weight is too heavy for some people, especially if they are recovering from an injury.

From her past posts we can hardly accuse Linda of having a low pain threshold, so I don't think she's wimping out.

But you mentioned that you are still having some balance problems on that leg, so the ligament may still have a bit of instability.

Check this out with your PT, but maybe you should work the legs unilaterally for awhile? I gave WTG some ideas of things she could do on a cable machine.

Also, do you have a small resistance band/ You can place it on your ankles, lie on your stomach, weight bench or stability ball, and do one legged curls.

Also, you may not ne ready for stability ball bridges, but ask your PT if you can do bridges with one foot flat on the floor, and the other knee on your chest.

In case some of you only read whatever is on the first page of a topic, the ACL summary thread is done. You can get a more cohesive idea of what the risk factors are, and what's the best prevention. Some cool pictures, too.
post #45 of 54
Thanks lm, I have been doing stability ball bridges and they have helped, and I did buy a theraband but didn't think of doing one legged curls. sounds like a good one, must try that.

funny, in pre-op therapy I was doing hamstring curls everyday...without a problem.
post #46 of 54
Thread Starter 
Hmm, you are already able to hamstring bridges? You are further along in your rehab than I thought.

This is the exercise;

IMHO, this is the BEST hamstring exercise for skiing, and in many ways, infinitely more challenging than the hamcurl machine.


Take a look at the ACL Summary thread: http://www.epicski.com/cgi-bin/ultim...&f=11&t=000129

The stability ball bridge is a Closed Chain exercise.

It engages the Transverse Abdominal Muscle, otherwise she would not be able to balance on the ball.

The Hip Flexors are in a stretched position, which allows her gluteals to work.

This exercise helps reinforce proper knee Tracking

Then there's that Neuro Muscular Coordination, thingy. The stability ball bridge is an awesome way to train the reaction time of the hamstrings. The surface is unstable, the hamstrings need to react quickly to protect the ligaments.

Most imported, the exercise is a form of Integrated Training, incorporating strength, coordination, balance, and using more than one muscle group, simultaneously.
Hey, sounds like something that would be great for skiing

You know what? Ask your PT, but possibly you can get away with doing the bridges instead of the curl, at least for awhile.

BTW, these pictures were found on a search performed on Google. Even though it is supposedly a "members only" site, these pictures were available to the general public.

<FONT COLOR="#800080" SIZE="1">[ March 30, 2002 09:45 AM: Message edited 1 time, by Lisamarie ]</font>
post #47 of 54
Out of curiosity, I'd like to know what kind of ACL reconstruction Linda A had. Often, surgeons use part of one of the hamstring tendons to replace the ACL. In many, this could contribute to discomfort with hamstring curls. Foot position and/or weak gastrocs could also result in pain behind the knee--the gastroc tendons cross the knee joint very near the hamstring tendons.

If the discomfort occurs in the front of the knee or feels like it is in the joint, well, that pretty much confirms the argument that close chain or "functional" training is more appropriate to rehab after ACL surgery. Simply put, on a machine you are strictly isolating one muscle (the hamstrings in this case) but your quads are not involved in anyway whatsoever. With a closed chain exercise (or even a stability ball exercise) your quads do activate as a co-contraction to help with stability and balance. This co-contraction is much more similar to the movements which occur in real life activities.
Another addition to the stability ball exercises shown is Juan Carlos Santana's "triple threat."
part 1: from a supine position on the floor with your heels on the ball (legs straight) lift and lower your hips.
part 2: from the "up" position in part 1, roll the ball back toward you and then out to a straight leg position again.
part 3: reposition your contact on the ball (hips still in the "up" position) so that your are contacting the ball with your toes/ball of your foot--knees minimally flexed. Now lift and lower your hips similar to part 1.
Begin this exercise with 5-8 reps per section with no rest between each phase. Progress to doing 10+ reps. If you can do 15 reps of each phase, try doing this exercise on only 1 leg. It's a killer but it works!! But please check with your PT prior to doing this exercise if you have had any knee "issues" I know Lisa M (and Top Gun) know this exercise well and I think they'll agree to its effectiveness.

<FONT COLOR="#800080" SIZE="1">[ March 30, 2002 12:01 PM: Message edited 1 time, by Mia S. ]</font>
post #48 of 54
Thread Starter 
Yeah! Subtle difference from the bridge, but that would add some gastroc work, and proprioception around the feet, which is tha beginning of the kinetic chain for skiing.
post #49 of 54
I have done the stability ball bridges that lM has depicted...in fact, somwhat early on in my therapy. in fact, those with the scissor kicks in the same bridge position was around the one month mark. one leg at a time as well. April 3rd will be the three month mark...

Mia, I had an allograft, with donated tibial tendon, so i began to feel better sooner than with my own tissue. this put any twisting motion back a month or two though, apparently donated tissue doesnt heal as fast.

Thanks, you guyzes info reinforced the commitment to go purchase a stability ball...now that I am not in structured therapy anymore...and continue those excersises...ill lay off the hamstring curls for a while....
post #50 of 54

Welcome to epic ski! It will be great as usual to hear your opinion and expertise on matters.
post #51 of 54
Thread Starter 
Learned some more interesting stuff from Juan Carlos today.

Can anyone guess which sport has the LOWEST incidence of ACL tears?

MARTIAL ARTS!! Why? Think about it. Martial Arts is done in bare feet, on mats, which constitute an unstable surface. Since ONE of the factors that predisposes people to ACL injuries is poor proprioception and misalignment in the feet, this makes sense. We also know that ACL injuries have become, ironically more prevalent as equipment and footwear has become more technological.

This is NOT to suggest that martial artists do not get other injuries, BTW>

Linda, I asked JC about your leg curl dilemna. Of course, your PT has the fin al say, but he said that if you can do a one legged hamstring bridge on the ball, sc*ew the legcurl machine!
post #52 of 54
hamstring graft? only hacks use those. good thing you didn't have that, LindaA.

now a further point on surgical technique...

it might be that the method used to attach the allograft caused bone tenderness near the hamstring insertion. my current orthopod, a true ACL recon wizard, attaches autograft patellar tendon to the femoral head with a screw and epoxy. The area of the screw attachment is tender for about 6-8 mos, and you can feel it when you do plyo exercises.

Anatomically, I don't recall where the hamstring insertion is located. Perhaps LindaA's surgeon anchored the allograft in a way that affects the hamstring insertion?

I cannot think of any other reason why LindaA's hamstring would hurt AFTER surgery but not BEFORE surgery using the same machine.

Again, LindaA, are you using too much weight? I would start with minimal weight -- my first hammie curls post-ACL Recon were done on individual legs, on a cable pull machine with ankle collars attached to the cable. I started with 10 lbs. MY normal training season hammie curls are done with 80-100 lbs.
post #53 of 54
thanks for great advice, LM thanks for talking to JC for me..more bridges it is. (hate those, they are alot of work, but that is a good thing!)

Not really sure how he anchored them, (I had a spinal so that I could be alert during the surgery, but was so nervous about the spinal they gave me meds to calm me down and THAT put me to sleep....damned. wonder if I can get the video...) but I could ask.

if it makes any sense what hurts during hamstring curls is actualy in the areas the graft was anchored. with minimal (40lbs), It feels as though it is going to pop. Scary feeling. any more weight and it just plain hurts. havent done them in a while, it could be its changed now, with a little more stability. need to try them again.

It is feeling better every day though!
post #54 of 54
Thread Starter 
The other thing about the bridges, and warning, I'm going to be politically incorrect, is since you are probably already pretty lean, you are ging to see some AWESOME, hamstring/glute definition from those things! {nowadays, we're not supposed to talk "vanity" anymore : , but I think that's BS!}

One thing I compltely forgot about about for the hammies is Dead Lifts, providing you don't have back problems. They are a bit hard to feel, so you may want to have a trainer spot you on them.
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