Torn ACL and MCL

[GqArtguy]

Bill, I wanted to run something by you:

Recently I have recieved a client who has torn her ACL, MCL, and some cartiledge in her knee a few years ago. She had part of her patellar tendon used to reconstruct the ACL, but shes not sure if the MCL was reconstructed. Her knee is fine and shes not really inhibited by many movemnts.


Squatting was an issue (at least with her last issue). When she squats, you can feel something on the inner edge of her knee popping around. Feels like something is rubbing over something.

Anyway, if she squats with a narrow stance and feet foward, she doesnt feel to much crap, however her squat sucks because its so narrow that shes sitting on her thighs. If she squats with a shoulder width stance and toes out, that is uncomfortable for that area that I described above. If she does a PL squat, she says it still aggravates that area, but not as much as the oly stance.

My question is: should I ditch squatting? I think part of her issue is postural (she leans when standing and pronates, also has a high inner arch), but I wonder if squatting is just a matter of strengthening the leg. When she does a glute dominant lunge (knee is about at 90 degrees, step is wide, and upper body is verticle) she feels no stress as opposed to a regular lunge which has a narrow step and is more quad dominant.

Thoughts?

[Lisa~]

Hey GQ,

I know you want Bill to answer and I hope he does, but I wanted to add that I had a client with similar knee problems. She'd had her ACL reconstructed and then ripped it again and never had a second surgery. Through mostly trial and error I ended up working her mostly with single-legged exercises. She controlled her body position much better with a single-leg exercises and we were able to get to some moderately heavy db's on Bulgarian squats. She did King deads, single-leg leg press, single-leg partial squat to a bench, etc.

I never got her back to bilateral squatting. It always hurt her. But with improved body composition being her only goal, the single-leg work seemed to be sufficient.

Lisa

[Bill Hartman]

Originally Posted by GqArtguy

Bill, I wanted to run something by you:

Recently I have recieved a client who has torn her ACL, MCL, and some cartiledge in her knee a few years ago. She had part of her patellar tendon used to reconstruct the ACL, but shes not sure if the MCL was reconstructed. Her knee is fine and shes not really inhibited by many movemnts.


Squatting was an issue (at least with her last issue). When she squats, you can feel something on the inner edge of her knee popping around. Feels like something is rubbing over something.

Anyway, if she squats with a narrow stance and feet foward, she doesnt feel to much crap, however her squat sucks because its so narrow that shes sitting on her thighs. If she squats with a shoulder width stance and toes out, that is uncomfortable for that area that I described above. If she does a PL squat, she says it still aggravates that area, but not as much as the oly stance.

My question is: should I ditch squatting? I think part of her issue is postural (she leans when standing and pronates, also has a high inner arch), but I wonder if squatting is just a matter of strengthening the leg. When she does a glute dominant lunge (knee is about at 90 degrees, step is wide, and upper body is verticle) she feels no stress as opposed to a regular lunge which has a narrow step and is more quad dominant.

Thoughts?

I think you know the answer already, eh?

First rule...do no harm. If it hurts do something else. She obviously has a mechanical issue and trying to work through it will eventually cause a more serious problem. It may or may not improve as strength improves as it could be several things. Revisit as squat variation every so often if you can identify an improvement in hip strength and lower extremity mechanics. Check the hip for isolated weakness and core weakness and address that as well. Consider sending her to a soft tissue therapist to address any scarring or other soft-tissue issues that may be causing the problem. The MCL attaches directly to the meniscus so there may be an issue there (it's also a great way to get referrals).

Hope that helps.

Bill

[GqArtguy]

Originally Posted by Bill Hartman

I think you know the answer already, eh?

I just need verification

First rule...do no harm. If it hurts do something else. She obviously has a mechanical issue and trying to work through it will eventually cause a more serious problem. It may or may not improve as strength improves as it could be several things. Revisit as squat variation every so often if you can identify an improvement in hip strength and lower extremity mechanics.

Good, I was thinking about that.

Check the hip for isolated weakness and core weakness and address that as well.

Oh totally. Her core is super weak and she has back pain as a result. Once she gets things secure and activated, shes able to take the stress off the back and perform things that I want her to do.

Her adductors are weak as well. So like Lisa suggested, single leg stuff is in order.

Consider sending her to a soft tissue therapist to address any scarring or other soft-tissue issues that may be causing the problem. The MCL attaches directly to the meniscus so there may be an issue there (it's also a great way to get referrals).

Hope that helps.

Bill

Werd.

Thanks for the validation guys