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I had surgery YEARS ago to repair a fractured patella (kneecap) and never received any therapy post-op. Now I have some pain and instability going downhill when hiking or going downstairs. I finally went to an orthopod and he said I had weak quads and particularly flaccid VMO. This is surprising since I cycle, hike and lift weights, but I could feel what he meant and when I wear the brace he gave me I lose the instability going downhill. What are some good ex for this? I went to PT for a couple of weeks, but felt like it was the same thing I'd been doing at the gym (leg extensions, leg presses, straight leg raises with ankle weights and the Ellipses machine. I just don't feel like I'm getting any stronger.
Thanks
I am not even close to being an expert, but have you ever done any squats or lunges? If you really want to develop some great strength in your quads, which is what the ortho suggested, squats and lunges are the best exercises you can do IMHO. If you need some info on doing the exercises properly, go to www.exrx.net. Maybe Bill can shed some more light on the subject...
You're not getting any stronger. At least not eccentrically and isometrically.
One of the things about recovering strength is that all forms of contraction need to be trained. You've also probably lost some elastisticity of the tendon which provides a great deal of force for most activities.
Actually I thing bryanc's drop squat protocols (search under patello-femoral pain)and isometric holds in various degrees of knees flexion (squats and lunges) will do a great deal of good. Also work on very slow decent step-up/down from progessive heights starting with the maximum that you can control without pain.
You may also want to tell your therapist to learn some new exercises and how to gain strength.
1) Position/Body Alignment
-feet shoulder width apart
-knees pointing straight ahead
-knee caps aligned to drop over your second toe
-squat or lunge to a dept of no more than 45 degrees (1/4) depth at the knee
-bend at the knees and hips, but do not lean forward
2) Speed
SLOW- for the first week to allow you to become comfortable with the action and alignment
FAST- allow your knees to 'collapse' momentarily, then rapidly contract the quadriceps to stop further collapse, then stand slowly
3) Progression
Build-up phase: gradual increase in knee function and decrease in pain
Maintenance phase: to prevent recurrence of injury
The Build-Up Phase
You will perform one exercise session for 5 days out of the week. You can pick your 'rest' days. You can incorporate the exercise and stretches into your regular workout or do them separately. Each week you will have one exercise. You should perform 3 sets of 20 repetitions of that exercise.Stretching should be done before and after these 3 sets of 20 reps.
Week 1: Drop squat (SLOW no weight) (see above for description of SLOW and FAST).
Week 2: Drop squat (FAST no weight)
Week 3: Drop squat (FAST w/5lbs in each hand)
Week 4: Drop squat (FAST w/10lbs in each hand)
Week 5: Drop squat (FAST w/15lbs in each hand)
Week 6: Lunges (moderate speed, no weight, not walking lunges)
Week 7: Single leg drop squat (FAST, no weight)
Week 8: Single leg drop squat (FAST w/ 5lbs in each hand)
Single leg squats and lunges are 20 reps PER LEG.
After reaching the last stage of the Build-Up Phase, Maintenance Phase is just Week 8 (Single leg drop squats w/5lbs) performed 2-3 times a week instead of 5.
You are encouraged to continue your usual sporting activities _WITHIN YOUR PAIN TOLERANCE_. However, modification of the time and intensity of the activity may be required if it causes knee pain.
Stretches
There are three stretches in this program. Strech the hip and quadriceps muscles to the point that it is slightly uncomfortable. Do not bounce. Hold the strech for 20 seconds. Repeat each stretch 5 times on each leg.
Seated Spinal Rotation: Sit with both legs straight out in front of you. Curl one knee up and cross the foot over the straight leg. Turn your torso so that the tricep/elbow of the opposite arm to the flexed leg is resting against the flexed knee. Push against the flexed knee.
Lying spinal rotation: Lie down with your arms out to the side. Bend one knee and then rotate your hips into that knee (i.e. to the opposite side of that leg. If you bent your right knee, rotate to the left). Keep your shoulder blades on the floor.
Lying quadriceps stretch: Lie on your front. Grab the ankle of one leg and stretch your quadriceps. It's like the standing quad stretch. Only you're lying down.
There you have it. Some tips:
1) Your routine should look like this:
Stretch->drop squats->stretch
2) It is quite common to experience some pain in your knees during the Build-up phase. You can continue if the pain is mild, if the pain is severe, go back a stage (i.e. the previous week) for the remainder of the week before trying that stage again the following week.
3) You can do other strengthening exercises (leg press, leg curls) but leg extensions should be avoided.
Cycling is a great exercise for ther vastus lateralis, but doesn't work the VMO as much. Thus, us cyclists often develop an imbalance that can result in incorrect patellar tracking.
I've posed this question to a number of different trainers, and I'd like to add one additional exercise for the VMOs that was recommended and has really helped me (credit goes to Craig Ballantyne specifically for this one): Peterson step-ups on a low block. When you do it with your right leg on the block, you point your toes to the 1 o'clock position and when you do it with your left, to the 11 o'clock position.
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