Q an A (ACL injury)

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Q: Tony, the fitness coordinator where I work just asked me to take another client, but she has a left knee injury (ACL). She wants to go on a fat loss program. I don’t want to risk injuring her just doing bodyweight squats and lunges because she has mentioned tome that both movements hurt her knee. My experience is still limited, and I have only dealt with clients with healthy joints. I would like to help this person, but I do not know exactly how to go at it. Any advice you could give me would be great.

A: It’s not surprising that it was/is an ACL injury. Research has shown that women are upwards of SIX times more likely to experience an ACL injury compared to their male counterparts. Research has also shown that for some reason, women kinda like Brad Pitt. Never heard of him. In any case, there are a multitude of reasons as to why women are more predisposed to ACL injuries. For one, most (not all) are weaker than a baby’s fart. Secondly, it comes down to simple biomechanics. Women have wider hips and narrow knees compared to men (also called the Q-angle) which places them at risk for injury.

That being said, you can still do TON of lower body work with her. Focus your attention on the posterior chain specifically (hamstrings and glutes). The ACL is the primary restraint of posterior translation of the tibia (conversely, the PCL restrains anterior translation), so anything “we” can do to strengthen the posterior chain will benefit women immensely in this regard.

Exercises to do:

1. Rack Pulls (or partial deadlifts). Start from knee height to groove the pattern. Once they master that, you can move on to other deadlift variations.

2. Pull-Throughs (the perfect cure for anyone who suffers from flat tush syndrome).

3. SHELC (Supine Hip Extension w/ Leg Curl) on a SWISS ball.

4. Glute Ham Raises

5. Reverse Lunges/Walking Lunges (long stride). Key Point: the longer the stride, the more emphasis you place on the hamstrings.

6. Work on squat technique. 99 out of 100 times, if someone says that squatting hurts them, they’re performing it wrong. If a doctor tells someone not to squat, 99 out of 100 times, I want to drop kick him or her across the head. Everyone uses a toilet with no pain……that’s squatting. Teach her to squat with her hips/hamstrings and NOT her quads. She should break with her hips on the descent and not her knees. Have her squat down to a 14-16 inch box and see what happens. The important thing is to have her do it in a pain free ROM. From there you can have her do bodyweight squats and gradually load her (goblet squats, front squats, etc.). Additionally, you may find some use with adding in some isometric holds. Something to think about.

7. As far as conditioning, if you have access to a sled that would be perfect since it’s pretty much ALL concentric action (no eccentric). So there should be no pain what-so-ever doing those. I wouldn’t have her do sprints quite yet (I am sure her running mechanics need work anyways), but maybe something along the lines of the ellipitcal would be a better option for the time being.

8. Buy “Bulletproof Knees” by Mike Robertson. As a trainer, any resource you can use to deal with acute or chronic knee issues with clients, the better of you’re going to be. Mike’s manual is one of the best. It’s simple, precise, and you won’t feel bogged down by a bunch of medical mumbo-jumbo. Mike gives you a solid plan of attack to deal with just about any knee issue you may come across. And lets be honest, being in this profession, it’s going to happen. Think of it as an investment (in yourself) and not an expense.

In a nutshell, you can still train her lower body. For the love of all that is holy, just steer clear of the usual suspects (leg press, leg extensions, leg curls, etc). Those are probably what got her in this mess in the first place.

Tony Gentilcore

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