Tuesday, July 1, 2008

Training Around Knee Pain

I get many pre-knee surgery and post-knee rehab clients. For the most part these people come to me in order to still get a training effect around the existing injury. The things we first look at are:

1. Eliminating knee dominant exercises that present ANY discomfort. Many times this is all of them.

2. Performing mostly hip dominant patterns. Deadlifting, bridging, etc. We will replace all knee dominant exercises for hip dominant. Basically overdosing on hip dominant exercises. The deadlifting pattern is of the most importance to learn, as it sets the patterning for squatting.

3. Restoring ankle and hip mobility. This is usually what caused the injury in the first place. If the ankle isn’t moving right and the hip is lacking mobility, guess what makes up the movement? Yes, the knee.

4. Waking up the foot musculature to produce stability thus making the ankle maintain the new found mobility. We do this by teaching the client proper foot positioning and including barefoot warm-ups.

5. In extreme cases where the client really cant use the leg at all, we will work the good leg only. This is called a “cross transfer”. The injured leg will actually get some of the benefits of the working leg even though the injured leg is not being exercised. This is because the body cannot completely separate itself.

On the road to recovery we look at:

1. Progressing to a single leg unsupported pain free squat. We use a progression of split squats, split squat back foot elevated, and finally single leg squatting with emphasis on progressive range of motion.

2. We also want the client to eccentrically decelerate in a dynamic environment. We use Mike Boyle’s plyometric progression for this. This is used in the later stages of recovery.

So, just because you have an existing injury or pain, this should not be an excuse to not train. There are many ways to train around all sorts of injuries. These are some that I use for knees.