Knee Stability Problem

May 18, 2006

Dear Supertrainers,

I’m hoping somebody can shed some light on this. My wife has a long standing

knee problem. She was a competitive swimmer up through 2 years of college at

which point she hurt her knee and had reconstructive surgery. Until then she

had repeatedly injured her knee through swimming and field hockey, dislocating

it a few times but by the time she reached the doctor it had popped back into

place and the doctors claimed it was never dislocated in the first place. At

that time she had many Xrays, an MRI and CT scan, none of which, until the CT

scan, showed a problem. The CT finally convinced the doctor to operate.

Since the surgery (about 6 years ago) every now and then her knee will buckle

(sometimes going down stairs, sometimes walking) often causing her to fall,

twice down a flight of stairs, one of these falls caused a bulging disc in her

back, the other a concussion. The orthopedist has since Xrayed and claims

there is nothing wrong with the knee other than weak leg muscles. I have

started her (again) on a strength training program to build back up the

strength in her legs. She is able to do leg curls, extensions, machine squats

(Icarian super squat machine) and wall sits but not lunges or free weight

squats (too unstable). Her legs are pretty strong but the doctors keep saying

her bad leg is not strong enough. Also I have noticed that on her bad leg the

quadriceps muscle seems to be severely underdeveloped or missing from part of

her leg extending from the outside of her knee about 3 inches up. It looks

like a small depression in the muscle. The rest of the muscle seems ok but

overall the bad leg is smaller and weaker than the good leg. None of her

doctors have ever commented on this and we only just recently noticed it.

My questions are these:

What options does she have for “fixing” her knee, either surgical or

non-surgical, so that it does not cause her to collapse unexpectedly?

What is the problem with the part of her quad muscle above the knee?

Thanks in advance for any ideas you might have.

Jon Covin

Washington, DC

May 20, 2006

<<<Her legs are pretty strong but the doctors keep saying her bad leg

is not strong enough. Also I have noticed that on her bad leg the

quadriceps muscle seems to be severely underdeveloped or missing from

part of her leg extending from the outside of her knee about 3 inches

up. It looks like a small depression in the muscle. The rest of the

muscle seems ok but overall the bad leg is smaller and weaker than

the good leg. None of her doctors have ever commented on this and we

only just recently noticed it.

Thanks in advance for any ideas you might have.>>>

***Recently I helped one of my friends rehab from an ACL reconstruction; you may

find some of the ideas regarding the rehab outlined below helpful? Note that I

am not a physical therapist.

We used a number of the basic principles from PNF and used Dr Siff's

" statute of limitations " as a basis for the rehab:

1. Repeat the contractions with good form; the number of repetitions

determines the outcome – progression.

2. Tell the individual to focus on the area concerned – look at the

muscle; this may help to facilitate the muscle recruitment. + Visualisations or

sensitisations.

3. Use ice, strapping, heat, EMS, touch (stroke, brush, tap the muscle(s)) to

facilitate muscle recruitment.

4. Use spiral and diagonal patterns.

Some exercises we used included leg extensions using spiral and

diagonal patterns, band (+reverse) squat, terminal knee

extensions, step-ups, " siffie " squats and lunges (altering the size of the base

of support).

+++++++

TRAINING STATUTE OF LIMITATIONS

Mel C Siff PhD

>>>The principle of progressive gradual overload has been known and

applied for millenia, reputedly going back in recorded history to

Milo of Crotona in Italy who started lifting a calf as a child and

continued to do so until the animal and Milo both had matured into

fully grown adults. Research and practical experience has shown that

this principle is by no means linear, which means that, with

continued time of use, one can increase the load only to a gradually

diminishing extent - the so-called Law of

Diminishing Returns. One's strength tends to approach a limit, an

individual asymptote, which one never really reaches or exceeds.

However, factors such as age and motivation intervene and one's

progress begins to stagnate, cease, recede and decrease the way it

came. Later research indicated that progress appeared to be superior

and better sustained if the load was not progressively increased, but

cycled up and down in phases or waves, according to a principle known

as periodisation (details of which will be covered later in the

course).

Now, it is important to note that the principle of gradual

progressive overload (or gradual cyclical progressive overload) was

simply used to control the load or intensity of the training. We may

extend this principle to cover many more of the variables that are

involved in all sports training, according to a method that I

call " Training Statute of Limitations " . It is very easy to apply.

When you are training or rehabilitating someone, always begin with:

1. Limited load

2. Limited speed

3. Limited acceleration

4. Limited duration

5. Limited range

6. Limited complexity

7. Limited density (mean reps per minute)

Thus, one begins with each of these factors being limited so that

they are easy for the athlete to cope with and gradually you reduce

the limitations and increase each of these factors, not necessarily

in the above order at all, but in an order which suits the individual

at a given stage of fitness.

Some factors may have to be kept limited for longer than others, but

the same approach of gradual progressive cycled 'overload' applies,

with progress being monitored according to:

A. Perceived Rating of Effort (RPE) ....... done by the athlete

B. Rating of Technique (RT) ..................... done by the coach

Both of these ratings are most commonly judged on a scale from 1 to

10. If the rating in each case becomes unfavourable, the progression

is halted or decreased slightly, especially if the RT drops below

about 7 or 8 (where 10 is perfect technique). All changes in limited

factors are recorded in a daily diary, along with these two

subjective ratings, so that this information may be used to plan the

degree of gradual increase (or occasional decrease) in progression.

This same approach may be used for novices, athletes at a point of

stagnation or even with any clients undergoing rehabilitation after

serious illness or injury.<<<<

-------------

Carruthers

Wakefield, UK

June 21, 2006

Well you need to check her lower body stability. As we know there is no use of

maximal strength with the wrong coordination of the limbs.

So if you are strong but you got no coordination the force you can produce is

just misleaded. So you need to correct her firing patterns and motor abilities

to make her use the strength she has in the right way. Have you tried

wobbleboard 1-Leg Squats? You need an unstable surface to train the

coordiantion /procioception of her legs!

You mentioned that her knee is unstable in front movements(i.e. going down the

stairs) this is a hint that her ACL is injured or at least not protected by the

hamstrings. So what you need is a highly specialized leg programm. Another

point that is possible is a incorrect position of her hip/lower back region. If

she does not have a full lordosis she will lose stability in her legs too. The

body is a complex system and normally the problem never lies at the same place

where the problems occur. Check her ACL!

Kind Regards

Knebel PICP

Wuppertal, Germany

Jon Covin wrote:

<<I’m hoping somebody can shed some light on this. My wife has a long standing