ACL Rehab Question

Training Injuries
1

I’m back in physical therapy and doing leg work in the gym 1 year after ACL surgery and have a couple of questions about my workout. Currently it’s:

Hammer Strength uniateral leg press: 4 sets
front squats: 3 sets after warmup
1 leg lysing leg curl: 4 sets
Lifefitness leg press machine (high and wide to hit hams and glutes): 3 sets
Hip adduction machine: 4 sets

All sets are ramped. Goal is to do this every 5 days.

How does this workout look? I have a separate workout I do during PT but it’s mostly stretching and so light that I don’t think I get much out of it. Anything I should add or leave out?

Also, I’m not sure how I should do the single legged work. My right knee is the injured one. Do I keep progressing on both legs aggressively or should I just work at a maintenance level on the good leg and let the bad leg catch up.

Some background: I also have a hernatied L3-4 disc and bulging L4-5 (probably also hernaited by now), and I’m pretty sure I’ve torn my groin a few years ago. I was out of commission for 3 months but never got an MRI. I have a problem with tight hips according to my PT and ortho as well.

More info about the surgery and MRI is here if needed:

Edit: As of right now, I can’t run or jump and still have pain the knee. Mostly likely due to a protruding self absorbing screw according to the ortho and the MRI. On the HS leg press, my right knee is 50% as strong as the left.

Basketball GPP/Rehab/Bodybuilding
2

Sorry to hear you are still having problems. Why did you return to therapy? Due to pain? Or poor function? Or just because you wanted to?

How is the initial pain that you posted about around the screw doing? You stated that they are doing light stuff during physical therapy, what exactly does a day look like with them? Has the doctor cleared you to begin lifting again?

Assuming the doctor has cleared you to return to lifting, I would recommend not doing as much machine based work (you have 4 out of 5 exercises machine based) and add in more DB/BB ground based work. Lunge variations, DL variations, and split squat variations will all be appropriate for you to get in that single leg work needed and if done under proper load and with proper technique, will not effect your disc pathologies.

3

[quote]LevelHeaded wrote:
Sorry to hear you are still having problems. Why did you return to therapy? Due to pain? Or poor function? Or just because you wanted to?

How is the initial pain that you posted about around the screw doing? You stated that they are doing light stuff during physical therapy, what exactly does a day look like with them? Has the doctor cleared you to begin lifting again?

Assuming the doctor has cleared you to return to lifting, I would recommend not doing as much machine based work (you have 4 out of 5 exercises machine based) and add in more DB/BB ground based work. Lunge variations, DL variations, and split squat variations will all be appropriate for you to get in that single leg work needed and if done under proper load and with proper technique, will not effect your disc pathologies. [/quote]

x2

One of the problems I have experienced is simply the control of the knee joint.
Try these

then try doing it face the opposite direction (you could and should probably throw the band on the other leg as well)
work on really controlling the movement.
Also try VMO squats

on these try and focus on not drifting the knee too far forward.
End range hamstring strength is also important (work the hamstring in the extreme degrees of flexion).

Focus on some proprioceptive work too such as the star touch
(you get down into a “landing” position on one leg then try and touch the toes of the free leg to all the clock hours originating from the planted foot)
as well as something as simple as step ups where there is a disconnect between the foot and the floor to build the afferent proprioceptive neural pathways always focusing on maintaining the correct athletic posture (hips and knees braced)

These are some exercises that will help improve function. The biggest issue is get stability in the knee back (read: neuromuscular control) rather than just the muscle strength itself (which is also important but only addresses half the problem)

4

[quote]LevelHeaded wrote:
Sorry to hear you are still having problems. Why did you return to therapy? Due to pain? Or poor function? Or just because you wanted to?

How is the initial pain that you posted about around the screw doing? You stated that they are doing light stuff during physical therapy, what exactly does a day look like with them? Has the doctor cleared you to begin lifting again?

Assuming the doctor has cleared you to return to lifting, I would recommend not doing as much machine based work (you have 4 out of 5 exercises machine based) and add in more DB/BB ground based work. Lunge variations, DL variations, and split squat variations will all be appropriate for you to get in that single leg work needed and if done under proper load and with proper technique, will not effect your disc pathologies. [/quote]

Actually my spirits are up because the new orthopedist looked at the MRI and said my knee looks great. The pain which is assumed to be from the screw which is barely protruding should be gone within 3 months when it absorbs into the bone by the doc’s estimation. He has cleared me 100% for strength training and I can already feel the difference since I stopped babying the knee and hit the weights. There is still pain everyday, but as long as it’s not permanent I can deal with it.

The doc recommended going back to PT. Oddly enough, he recommended the one I was already going to by coincidence. He said they were good. Typical day is:

PT stretches out my hips, quads and hamstrings.
2 sets of 10 weighted (2 lbs) 1 legged leg lifts
Same as above but with foot turned out.
2 sets of 10 squats (above parallel) with my back against wall and rubber ball I squeeze between knees simultaneously.
2 sets of 2 minutes on Kinetron (sp) machine. Its a big chair with steps that I push down on with feet. Almost like a seated stair master.
2 sets of 10 1 legged seated leg curls with Mickey Mouse weight. 15 lbs
2 sets of 10 1 legged leg extension machine with like 5 lbs.

20 minutes of electricty, 5 minutes of ice at the end.

Thanks for the exercise selections. Now on the 1 legged exercise, theres a big strength difference between legs (quads especially). Should I wait for the weak leg to catch up, or should I push both legs as much as I can?

Thanks.

5

I don’t know your PTs, nor do I know their rationale behind their exercise protocol, but with the information you’ve given and being 1 year post-op that seems like a waist of time to do that style of light weights/reps schemes. Again, to repeat, I don’t know what they have found in your eval and if they have found some underlying issue and feel this is the best way to approach addressing that issue, but just from the information we have here, you should be much more advanced than those kinds of exercises.

Have they worked on any types of mobility drills for your hips, especially since you’ve stated that being a main problem of yours in the past? Did they take a detailed history from you, discussing your past issues and injuries?

I would not be overly concerned with creating an imbalance between your legs. The injured leg will catch up to the uninjured leg in time. If anything, training your uninjured leg to its normal potential will help prevent issues down the road for that leg and will probably help the injured leg with neurological recovery due to the neurological cross-over.

6

[quote]LevelHeaded wrote:
I don’t know your PTs, nor do I know their rationale behind their exercise protocol, but with the information you’ve given and being 1 year post-op that seems like a waist of time to do that style of light weights/reps schemes. Again, to repeat, I don’t know what they have found in your eval and if they have found some underlying issue and feel this is the best way to approach addressing that issue, but just from the information we have here, you should be much more advanced than those kinds of exercises.

Have they worked on any types of mobility drills for your hips, especially since you’ve stated that being a main problem of yours in the past? Did they take a detailed history from you, discussing your past issues and injuries?

I would not be overly concerned with creating an imbalance between your legs. The injured leg will catch up to the uninjured leg in time. If anything, training your uninjured leg to its normal potential will help prevent issues down the road for that leg and will probably help the injured leg with neurological recovery due to the neurological cross-over. [/quote]

It feels like a waste of time to be honest. The only reason I went back to this office is because the 2nd Dr. recommended her even though he didn’t know I was seeing her previously. I figured 2 respectable surgeons can’t be wrong. But I think after these 6 pre-approved visits, I’ll get my PT done elsewhere. The PT is aware of my back and groin issues, but as long as I stretch the groin before exercise it’s fine. The tight hips is a new diagnosis that the new orthopedist noticed.

No mobility drills, only stretches for the hip. Are there any you recommend or maybe a site that has them?

Thanks for the advice on the single leg stuff. I’ve been pushing both legs so far, just wanted to verify I wasn’t doing more harm than good as far as imbalances.

7

[quote]rehanb_bl wrote:

[quote]LevelHeaded wrote:
Sorry to hear you are still having problems. Why did you return to therapy? Due to pain? Or poor function? Or just because you wanted to?

How is the initial pain that you posted about around the screw doing? You stated that they are doing light stuff during physical therapy, what exactly does a day look like with them? Has the doctor cleared you to begin lifting again?

Assuming the doctor has cleared you to return to lifting, I would recommend not doing as much machine based work (you have 4 out of 5 exercises machine based) and add in more DB/BB ground based work. Lunge variations, DL variations, and split squat variations will all be appropriate for you to get in that single leg work needed and if done under proper load and with proper technique, will not effect your disc pathologies. [/quote]

x2

One of the problems I have experienced is simply the control of the knee joint.
Try these

then try doing it face the opposite direction (you could and should probably throw the band on the other leg as well)
work on really controlling the movement.
Also try VMO squats

on these try and focus on not drifting the knee too far forward.
End range hamstring strength is also important (work the hamstring in the extreme degrees of flexion).

Focus on some proprioceptive work too such as the star touch
(you get down into a “landing” position on one leg then try and touch the toes of the free leg to all the clock hours originating from the planted foot)
as well as something as simple as step ups where there is a disconnect between the foot and the floor to build the afferent proprioceptive neural pathways always focusing on maintaining the correct athletic posture (hips and knees braced)

These are some exercises that will help improve function. The biggest issue is get stability in the knee back (read: neuromuscular control) rather than just the muscle strength itself (which is also important but only addresses half the problem)
[/quote]

Thanks alot. I’ll try some of these suggestions on my next leg day and see how it goes. My stability on the right leg is definitely an issue right now.

9

[quote]bushidobadboy wrote:

[quote]sam_sneed wrote:
I’m back in physical therapy and doing leg work in the gym 1 year after ACL surgery and have a couple of questions about my workout. Currently it’s:

Hammer Strength uniateral leg press: 4 sets
front squats: 3 sets after warmup
1 leg lysing leg curl: 4 sets
Lifefitness leg press machine (high and wide to hit hams and glutes): 3 sets
Hip adduction machine: 4 sets

All sets are ramped. Goal is to do this every 5 days.

How does this workout look? I have a separate workout I do during PT but it’s mostly stretching and so light that I don’t think I get much out of it. Anything I should add or leave out?

Also, I’m not sure how I should do the single legged work. My right knee is the injured one. Do I keep progressing on both legs aggressively or should I just work at a maintenance level on the good leg and let the bad leg catch up.

Some background: I also have a hernatied L3-4 disc and bulging L4-5 (probably also hernaited by now), and I’m pretty sure I’ve torn my groin a few years ago. I was out of commission for 3 months but never got an MRI. I have a problem with tight hips according to my PT and ortho as well.

More info about the surgery and MRI is here if needed:

Edit: As of right now, I can’t run or jump and still have pain the knee. Mostly likely due to a protruding self absorbing screw according to the ortho and the MRI. On the HS leg press, my right knee is 50% as strong as the left.[/quote]

Why no hip ABduction, my friend?

BBB[/quote]

Is that the where your forcing your knees outward? I only do the one squeezing my knees in because a past physical therapist said it was good for rehabbing my groin. In therapy she put a rubber ball between my legs and had me squeeze and hold. Do you recommend abduction as well? Is the machine the chic’s always use good enough or is there a better way to do it?

I do my long leg workout on Saturday, so I can spend as much time in the gym as I want. So if adding more exercises helps, I can do that. Time is not an issue. My shorter leg workout is on Wednesday and I can fit in about 4 exercises there.

10

Sam,

Firstly, IMO, you need to restructure your original training plan that you posted at the beginning of the thread as I already stated. You need less machine based exercises and more free weight/body weight movement with adequate single leg work to activate the hip stabilizers.

Secondly, you do not need to overload your workouts with tons of extra exercises. Keep it all simple. You don’t have to do everything everyday. Pick a focus for that training session, keep it simple, and follow that focus. If you want to make a focus on hip extension, do that. If you want a focus on hip stabilization with single leg exercises, do that. But do not try to do it all at once. Try to gain everything at once and you will end up gaining close to nothing.

Thirdly, you do not need to do the “girl machine” to hit your abductors. You can do activation drills, such as side lying clam shells or monster walks. Or you can wrap a band around your knees during squats or lunges. Also, during single leg movements, your abductors will get highly recruited in order to keep your knee from falling into valgum.

11

[quote]LevelHeaded wrote:
Sam,

Firstly, IMO, you need to restructure your original training plan that you posted at the beginning of the thread as I already stated. You need less machine based exercises and more free weight/body weight movement with adequate single leg work to activate the hip stabilizers.

Secondly, you do not need to overload your workouts with tons of extra exercises. Keep it all simple. You don’t have to do everything everyday. Pick a focus for that training session, keep it simple, and follow that focus. If you want to make a focus on hip extension, do that. If you want a focus on hip stabilization with single leg exercises, do that. But do not try to do it all at once. Try to gain everything at once and you will end up gaining close to nothing.

Thirdly, you do not need to do the “girl machine” to hit your abductors. You can do activation drills, such as side lying clam shells or monster walks. Or you can wrap a band around your knees during squats or lunges. Also, during single leg movements, your abductors will get highly recruited in order to keep your knee from falling into valgum. [/quote]

I was planning on changing up the program, so I hope you don’t think your earlier advice fell on deaf ears. It’s just a little challenging for me because I know how to build big legs. I’ve always gotten comments on them when I wear shorts. So that’s how I came up with the original workout (minus the girlie machine). I’m not surprised that it ended up sucking for rehab. I know you’re right and need a different approach but my PT’s are a woman and guy that never workout and never took part in athletics so they’re not much use in helping me design a program to get back to my former strength, size and athleticism.

I workout my legs Wednesdays and Saturdays. I like going heavy on Saturdays since I get a couple days to recover afterward. So how does this workout look:

Saturday

Front Squats
Lunges
Split squats
Hammer unilateral leg press (I’d like to keep this since I’ve never felt my quads work as hard as doing this exercise)

Wednesday

This is where I’m lost. I really don’t know any mobility or stability exercises. I vaguely recall single legged squats giving me knee pain before I tore my ACL but I can try them today. I’ll google clam shells and monster walks and try them today as I planned on working legs today during my lunch break. But if you could suggest how to organize this workout, I’d really appreciate it. Or even if a exercise(s) needs to be swapped out in the Saturday workout.

Thanks for you patience. On a positive note, today I was late for the train and had to jog 1 block. Last time this happened 6 weeks ago, I almost fell down every few steps due to lack of strength and stability. If you saw me jog today you would know something was wrong but I was much more balanced and I could feel the leg was a lot stronger. My leg wasn’t giving out like last time.

12

Hey Sam, I’d listen to LH here, but just my 2 cents as well:

I’m recovering from ACL reconstruction as well and just over 6 months out. Two single-leg exercises I’ve used that have helped immensely are Bulgarian split squats with a barbell and single-leg RDLs with a barbell. I’m sure you’re familiar with these. I feel like the BSS have helped immensely in getting my injured leg caught up with my good leg.

Recently, I’ve started each session with one heavy bilateral compound lift (back squats, box squats or deadlift variation) and then followed with unilateral exercises for the rest of the session. I’ve recently started doing 2 extra sets of the unilateral exercises for my recovering leg (single-leg RDL, Bulg. split squat, single-leg squat), and I feel like that’s helped immensely with stability and muscle control.

Hope this helps. Good luck the rest of the way.

13

Sam, no worries with me thinking my words fell on deaf ears. Just wanted to reiterate my point. I think the program you wrote up for Saturday looks good, especially since you know how your body reacts to specific exercises. Right now I am crunched for time getting ready for work, but if I find videos of the clam shells/monster walks, I will post them up later.

As far as Wednesday training for you, based off of your Saturday workout, I would make Wednesday a more hip extension focused workout. As TripleC recommended, RDLs (single leg or double leg) will be beneficial. Weighted glute bridges (single or double leg), hip thrusters, pull throughs, etc will all be good.

I also like TripleC’s method of the one heavy compound lift followed by assistance lifts with a good focus on single leg work. If single leg squats hurt your knee before ACL reconstruction, I’d probably avoid them now as well. Wait until you have built up some good strength and function in the knee then attempt them.

Sorry if you have already told us this, but how did you tear your ACL to begin with?

14

[quote]LevelHeaded wrote:
Sam, no worries with me thinking my words fell on deaf ears. Just wanted to reiterate my point. I think the program you wrote up for Saturday looks good, especially since you know how your body reacts to specific exercises. Right now I am crunched for time getting ready for work, but if I find videos of the clam shells/monster walks, I will post them up later.

As far as Wednesday training for you, based off of your Saturday workout, I would make Wednesday a more hip extension focused workout. As TripleC recommended, RDLs (single leg or double leg) will be beneficial. Weighted glute bridges (single or double leg), hip thrusters, pull throughs, etc will all be good.

I also like TripleC’s method of the one heavy compound lift followed by assistance lifts with a good focus on single leg work. If single leg squats hurt your knee before ACL reconstruction, I’d probably avoid them now as well. Wait until you have built up some good strength and function in the knee then attempt them.

Sorry if you have already told us this, but how did you tear your ACL to begin with?[/quote]

I think today will be experimentation day. I’m going to google and try the exercises above and see what hurts and what doesn’t. I tore my ACL playing football. I was wearing cleats and the cleat stuck in the grass while I was rushing against a huge lineman and my body twisted. My orthopedist said I messed it up pretty bad when he opened it up and repaired it.

15

Got some down time at work. Here are some vids of the clam shells and monster walks.

Clam Shells: Band Resisted Clam Shell Exercise - YouTube

Monster Walks - here is a video of XBand walks http://www.youtube.com/user/HurstTony#p/u/131/C9IcLbu8ThY
Xband walks are a good exercise selection as well.
The side step movement of Xband walks is basically the same as the movement in Monster walks. The difference with the Monster walks are you just have a small band wrapped either around your ankles or feet (feet are more advanced). If they are around your ankles, it becomes purely hip abduction. If they are around your feet, the difficulty increases as you have to resist the band pulling your hip/leg into internal rotation, so your external rotators get a bit more activation.

16

[quote]LevelHeaded wrote:
Got some down time at work. Here are some vids of the clam shells and monster walks.

Clam Shells: Band Resisted Clam Shell Exercise - YouTube

Monster Walks - here is a video of XBand walks X-Band Walk - YouTube
Xband walks are a good exercise selection as well.
The side step movement of Xband walks is basically the same as the movement in Monster walks. The difference with the Monster walks are you just have a small band wrapped either around your ankles or feet (feet are more advanced). If they are around your ankles, it becomes purely hip abduction. If they are around your feet, the difficulty increases as you have to resist the band pulling your hip/leg into internal rotation, so your external rotators get a bit more activation.[/quote]

Thanks for the videos. I tried the following yesterday during lunch:

Weighted Glute bridge: worked out real well, no issues

Single RDL: I don’t know if it was my lack of flexibility but something felt off in my back. I might video them and post them up this weekend if you don’t mind taking a look. I’m sure I’ve done them in the past with no issues.

Hip Thrusters: No dice. Lower back couldn’t take it. Maybe I’ll look for a single legged version.

Pull through: These were pretty good. I think I need to work on my form though as I felt it in my back more than my glutes. Not in a bad way though. I might take a video of these too just to see what I’m really doing.

Overall, I think I can keep 3 of the 4 movements once I get the form right so thanks for the suggestions.

17

I’d be interested in seeing your form during the hip thrusters as well. I’ve found it rare for somebody to experience low back pain during the exercise unless they used improper technique.

Here is a video of a BB weighted hip thruster - Hip Thrust with Kellie Davis: Best Butt Exercise - YouTube

Here is a video of a single leg hip thruster with the foot set up on a bench as well - 1 Legged Hip Thrusters - YouTube

18

Hmm. That doesn’t look like the movement I was doing. I tried this hip thruster but on a flat mat: