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Old 10-14-2009, 09:00 PM   #41
Nick Hunter
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The knee hurts whenever it's weight bearing at around 75 degrees flexion now, valgus or not. I.E. Squatting down, stairs, getting in the car. I walk on my toes a lot to avoid valgus, especially around the house or up stairs. Otherwise my heels come straight off the floor. It's a strange gait. The knee gets about 15 degrees more flexion in a regular walking step, and all at once at the end of the step.

The ankles will be fixed with surgery.
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Old 10-15-2009, 03:06 PM   #42
Steven Low
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How bad is the atrophy in the quads? How about the hamstrings strength?
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Old 10-15-2009, 07:00 PM   #43
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I think the atrophy in the quad is significant. I think the firing is worse, though. I used the leg press the other day and woke up the next morning and my glute was sore but my quad wasn't. It's also hard to feel much of what IS there firing sometimes.
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Old 10-16-2009, 07:19 PM   #44
Nick Hunter
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Neutral Grip Lat Pulldown
50lb x12
100lb x10
120lb x10
125lb x10

Seated Incline Band Row
XYZ x15 (w/ 5s hold per)
XYZ x15 (w/ 10s hold at end)

Interval Cycling (20breaths slow, 30 breaths sprint)
4sets after warmup
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Old 10-16-2009, 07:38 PM   #45
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Maybe somebody can defeat or validate my logic here:

1. I have had crap ankle flexibility since before I started weight training. I have never had dorsiflexion that would allow my knees to pass over my toes in a squat because of ankle bone spurs.
2. I have at points been quite strong in the dead lift and wide-stance back squat. These were two lifts that did not require much ankle flexibility.
3. A wide-stance back squat and powerful dead lift, trained often, result in a well-developed posterior chain. Glutes and hamstrings. These exercises, trained at the exclusion of movements that directly target the quads, could create a hamstring-quadricep muscle imbalance.
4. This study shows that in the ACL insufficient knee the hamstring-quad ratio is typically higher due to a weakened quadriceps.

Theory: a much stronger pair of hamstrings than quads (when the ratio is typically reversed) could be the result of a life of motion dominated by posterior chain musculature. This ratio of forces on the knee could be contributing to my risk for ligament injuries, and my acute knee pain that is usually felt when my heels leave the ground and where quadriceps would usually dominate knee extension.

Developing ankle mobility (via surgery and PT) and focusing on training the quadriceps through any pain-free methods possible until they are AT LEAST AS strong as the hamstrings could be key in ridding me of knee pain and knee injuries.
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Old 10-16-2009, 08:20 PM   #46
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I am not sure why the study indicates what it does, and I am not sure why quad atrophy is more prevalent after ACL surgery either. I am going to look into this..

ACL injuries are usually the result of inwards tracking, quad dominance, limited ankle and hip flexibility.

Tight/strong hamstrings often protect the ACL in some aspects. For example, if there is anterior movement of the tibia relative to the femur (such as the anterior drawer test), the hamstrings can take over to prevent damage to the ACL.

I have personally never seen an injury in the clinic I work at.. though we've not had many ACL injuries.. of someone with an overdeveloped posterior chain having such an injury. Every single ACL case I've seen that wasn't really due to acute injury had a combination of pronating/flat feet, quad dominance, fairly weak hamstrings, and inward tracking knees.

I have extremely weak quad in my right leg due to my knee injury, and a strong posterior chain (30" vert, 9'+ broad, ~12s 100m) and I haven't had any problems so far. I'm focusing on rehabbing it. Need to keep up with my isometric quad sets because movement aggravates it in some respects.

Thus, I do not think a strong posterior chain relative to anterior chain based on my experience both observational and personal contributes to the preponderance of ACL tears. However, I do think weak quads can contribute to some instability leading to maltraction in the patellofemoral area (which would be your current problem).
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Last edited by Steven Low : 10-16-2009 at 08:25 PM.
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Old 10-16-2009, 08:27 PM   #47
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Bah, I thought I'd had a stroke of genius. Back to the thinking room.

Thanks, Steven!
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Old 11-02-2009, 07:18 PM   #48
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Two more weeks out. No change. This is now a full month without progress.

I'm thinking of finding another doctor for a second opinion.
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Old 12-03-2009, 11:26 AM   #49
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I got a new physio on Wednesday that I'll be seeing 3 times per week. I have a lot of confidence in him already.

His take:

My kneecap is mishandled and is tilted (x-ray shows this) laterally, which is irritating the cartilage of the patella and femur by rubbing its own little groove where it shouldn't. The pain comes from this repeated grinding.

My hamstrings and calves are ridiculously tight, and these two muscle enhance the amount of pressure or tension between the kneecap and the femoral groove.

My quadricep is weak from the surgery, and needs to be strengthened with alternate methods that do not irritate. The stronger it gets the better the pull will be on the patella.

My particular ACL graft came from the kneecap and patella tendon. The trauma from that also has a negative effect on my patellofemoral mechanics.
---

He is confident we can get everything all fixed up by loosening up the lateral areas on the knee and thigh, using better exercises to strengthen the quad, and getting the backs of my legs to approach normal flexibility. Worst case scenario he says is that my doctor may have to go back in and file down the patella or something. I should know if things are on track in the next month or so.
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Old 12-03-2009, 11:50 AM   #50
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I wrote this... for people like you:
http://www.eatmoveimprove.com/2009/1...-dysfunctions/

I suspected the kneecap thing was patellofemoral syndrome/chondromalacia patellae. I guess it's verified now.

With the above link you can do your own soft tissue work as well if you need to.

Utilize eccentric exercise for your quads!
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