Adarq.org

Blog Section => ADARQ & LanceSTS - Q&A => Topic started by: D4 on May 18, 2012, 03:17:15 pm

Title: Hyper-extended knee, rehab tips?
Post by: D4 on May 18, 2012, 03:17:15 pm
Hi Lance,

Have u had experience with athletes who hyper-extended their knees?  I hyper-extended my right knee, and my left one feels prone to that same injury right now.  The injury was minor but still, I can't do shit on it besides walk/very light jog, anything more intense I can feel pain.  It's getting better every day, as I'm resting it, taking ibuprofen.

From my own self-diagnosing, I believe it was caused by 2 things:

1) I got too heavy/fat from eating a LOT lately trying to get my lifting numbers up.  160lbs at 5'8" for an ecto doing intense plyo's and training single leg jump, I thought might be a bit much.  Do you agree?

2) I admit I made a stupid mistake, but past few months, I've basically just been doing full squats.  I think I created an imbalance between my hamstrings and quads.  So lately I've been doing leg curls and dead lifts (no squats cuz I can't squat with the knee like this).

I could be wrong, just my opinion on what caused it.  What do you think, and what do you recommend I do to recover from it?

Thanks.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 19, 2012, 12:39:45 am
Hi Lance,

Have u had experience with athletes who hyper-extended their knees?  I hyper-extended my right knee, and my left one feels prone to that same injury right now.  The injury was minor but still, I can't do shit on it besides walk/very light jog, anything more intense I can feel pain.  It's getting better every day, as I'm resting it, taking ibuprofen.

 Dont do any plyos or  jumps until its healed, takes time.



Quote
From my own self-diagnosing, I believe it was caused by 2 things:

1) I got too heavy/fat from eating a LOT lately trying to get my lifting numbers up.  160lbs at 5'8" for an ecto doing intense plyo's and training single leg jump, I thought might be a bit much.  Do you agree?

No, you havent been training your hamstrings, especially as a KNEE FLEXOR, and youve been doing a lot of knee extension exercises, while  jumping repetitively.


Quote
2) I admit I made a stupid mistake, but past few months, I've basically just been doing full squats.  I think I created an imbalance between my hamstrings and quads.  So lately I've been doing leg curls and dead lifts (no squats cuz I can't squat with the knee like this).

 Depending on how youre deadlifting, it can be simply another knee extension exercise. RDL's are a good idea here, and use a 2-1 ratio of knee flexion to extension for a while.


Quote
I could be wrong, just my opinion on what caused it.  What do you think, and what do you recommend I do to recover from it?

Thanks.

  Trying to improve a single leg  jump without training your hamstrings makes as much sense as trying to improve your bench press without training your triceps.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 19, 2012, 12:49:29 am
I see, thanks for the advice.  Would you rule against me at least doing single leg bounds with my left leg only?  My left leg is stronger at the hams.

I feel like on my dead lifts which I like doing, I am getting the bulk of the work on my hams and glutes, pretty much no quads, if so can I do reg deadlifts? Or should I fuck it and do rdls anyways?

So a 2:1 ratio of leg curls and deadlifts (or rdl) and squat sound good?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 19, 2012, 01:04:54 am
  Yea thats fine  just be really careful with that injured side, it could be a minor deal right now that you can turn into a major deal if you dont let it heal.  Look up the PCL and see if that sounds like the area youre feeling the pain as well.   Id keep the reps high on the leg curls at first, then cycle down into a more intense heavy range.  Keep tension on the muscle the whole time, dont relax throughout the whole set.  That will give you the most blood flow to help healing atm.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 19, 2012, 06:40:34 am
I looked up the PCL.  The weird thing is, before my injury this past Monday, I was feeling some awkwardness and minor pain in the back side of my knee.  Each day since Monday when I injured it, it got better and the pain was still at the PCL area, the backside.  Today however, when I accidentally shift too much weight onto my right knee, it hurts unlike the days before and I feel it on the outside of the knee.  Not sure, but isn't this the LCL area? 
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 20, 2012, 01:11:31 pm
 
  Where you felt the pain at the time of the injury will tell you more, swelling and compensation can show up in other areas.  If it doesnt improve with rest you need to go see the doc.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 20, 2012, 06:18:09 pm
Yeah the initial injury was definitely the PCL area.  IDK what I did on Friday, but it's going back to getting better by the day so that's good.  I'll rest it, and just do dead lifts and leg curls the way you said to do them, and see how it feels in a week.  If it doesn't improve, I'll check out a doctor.  Thanks for the advice.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 29, 2012, 03:33:30 pm
Hey Lance, it's been 2 weeks since the injury and since then I've only been doing dead lifts and leg curls.  I had to walk on my toes for my right leg to keep my knee bent so it doesn't extend, until this past Saturday I was finally able to walk normally.  It felt good, and didn't hurt when I extended it and put weight on it.  So today, I tried squatting, followed by dead lifts and leg curls.  First 2 warm up sets of squatting, I felt a little tingling in the back of my knee, but it wasn't pain at all, so I kept going and from the 3rd warm up set, it felt perfectly fine, no tingling, no nothing.  

Last time squatting was 3 weeks ago where I PR'd at 5 reps, 245lbs, today I did a pretty explosive single of 260, but failed a 275 single, so I don't think I lost much strength, if at all.  

Friday I would like to go and shoot around, play a little basketball (no pick up games) to test out my leg to see if I can play my league game on Saturday.  Would you approve of this? (Gonna have 1 more leg curling session during my upper body lifting day on Thursday)

Also, I don't know if this is important at all or whatever, but how come I had so much VMO activation/burn in my squats today?  I NEVER had this before?  Does it have anything to do with the squat break + p-chain only lifting I've been doing?

Anyways, thanks for all the rehab tips, it's been going great.

Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 30, 2012, 12:59:48 am

  You will have to use your own Judgement on playing, I would definitely do some light and low volume hops, skips, Jogging, etc. and test it out prior to stepping into a game.

  The vmo activity is very common after hamstring activation/strengthening at the knee end.  You can do it on spot if you contract the hamstrings at the bottom of the squat.  This works with psoas and glutes as well, pull down with the hip flexors actively as you descend into the squat and your glutes will fire much harder as well.   Your femur is likely tracking better now as well in knee dominant lifts.

 The thing to do now is, continue to get stronger in your compound lifts while CONTINUING to strengthen the rear side of your legs, at both ends.   Lots of guys missing the boat on this one, due to all the previous dogma with the "pchain".    Instead of looking at it like "im only training quads since they are most important", a smarter approach is "im going to strengthen the living fuck out of my hamstrings so that I can train my quads even harder, Jump all day long, and not get hurt".   

 
Title: Re: Hyper-extended knee, rehab tips?
Post by: Raptor on May 30, 2012, 08:49:27 am
Have you ever gotten into someone that is great at hamstring hip extensor activities and yet sucks at hamstring leg curling activities, Lance? I'm not sure if I have... I wonder if such a person exists
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 30, 2012, 03:16:51 pm
Have you ever gotten into someone that is great at hamstring hip extensor activities and yet sucks at hamstring leg curling activities, Lance? I'm not sure if I have... I wonder if such a person exists

 Not likely to see a huge difference as far as strength at either end, if theyre strong theyre strong.  Thats the reason I use the high rep range with the knee flexion, its not that theyre really weak in the area, its what the higher reps and time under tension do for the knee joint and soft tissues. 

  Most people have weak hamstrings, at either end period.  Athletes that already have very strong hamstrings are usually already very good athletically in my experience, whether that comes from genetics or training.   
Title: Re: Hyper-extended knee, rehab tips?
Post by: Raptor on May 30, 2012, 04:54:51 pm
What if a guy only does hamstring hip extensor strength training for a long period of time (say two years) and never does any leg curls or knee flexion hamstring activities. Can then a big gap appear in between these two "hamstring events"? Or the hamstring is just a muscle, it doesn't care how you train it?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 30, 2012, 10:33:21 pm
What if a guy only does hamstring hip extensor strength training for a long period of time (say two years) and never does any leg curls or knee flexion hamstring activities. Can then a big gap appear in between these two "hamstring events"? Or the hamstring is just a muscle, it doesn't care how you train it?


 I doubt that there would be a huge strength gap, but thats purely speculation since I have never done this with anyone.  I think there would still be potential knee pain issues if this guy was a jumping athlete like a track and field jumper.  Especially since you just described the prototype for a high level triple/long jumper (insanely strong hip extension in the hams), even  though they might not have achieved this through training.

 Train them as hip extensors to get stronger, train them as knee flexors with higher reps/tut for the hypoxic effects/healing/ blood flow, and cycle in some heavier work as well.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 30, 2012, 11:21:21 pm
Well... while walking around campus today, when I kind of took a small hop down a stair landing with the knee extended, I felt a little pain in my knee again.  It's significantly less severe than last week when it was still hurting, but still, it would be stupid to put this knee in a league game in as little as 3 days.  I'll shoot for next saturday for my return.

You say higher reps is better for healing the joint, but I also need to eventually do heavier weight for strength. 

Is 20 reps what you consider high reps?  Also I can just do both right?  3x8 heavier and then right after do 3x20 light...

Thanks.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 31, 2012, 12:03:33 am
Well... while walking around campus today, when I kind of took a small hop down a stair landing with the knee extended, I felt a little pain in my knee again.  It's significantly less severe than last week when it was still hurting, but still, it would be stupid to put this knee in a league game in as little as 3 days.  I'll shoot for next saturday for my return.

You say higher reps is better for healing the joint, but I also need to eventually do heavier weight for strength. 

Is 20 reps what you consider high reps?  Also I can just do both right?  3x8 heavier and then right after do 3x20 light...

Thanks.

2 Sets of 30 reps, 2-3 x a week,  progressing the weight from session to session works great for pre/rehab with pure knee flexion exercises.   You train your hamstrings as HIP EXTENSORS for strength for the majority of the time, and use the knee flexion exercises as I described, MOST of the time.

 Optimal scenario for you would  be to do something like ghr's, on a glute ham  bench, CORRECTLY, for 3-4 sets of 6-10 reps, followed  by high rep leg curls for 2 x 20-30 in one session.   In the next do rdls for 3-4 sets of 6-10 reps, followed  by another leg curling variation, preferably unilaterally for 2 x 20-30.

 Ghr's done correctly are a great exercise, done wrong theyre a waste of time and a good way to screw up recruitment patterns.

   
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 31, 2012, 12:42:42 am
I see, gotcha.  I don't have a GHR bench here though, so I'll just do RDL's once and dead lifts the other I guess.
Title: Re: Hyper-extended knee, rehab tips?
Post by: Raptor on May 31, 2012, 01:45:10 am
Why RDLs and not straight leg deadlifts?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 31, 2012, 02:16:50 am
Why RDLs and not straight leg deadlifts?

sldl requires coaching to make sure its done correctly, rdl is rather simple in comparison.  Youre right though, sldl is a wonderful exercise done CORRECTLY, and likely even more specific to performance in this case.
Title: Re: Hyper-extended knee, rehab tips?
Post by: Raptor on May 31, 2012, 08:26:32 am
Where do you think people fail form-wise on straight leg deadlifts?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 31, 2012, 10:22:52 am
 
  They turn it into a low  back  exercise  by  1.) Not pushing the hips to the rear on the eccentric and 2.) letting the  bar swing out away from them on the eccentric.  Those are the two main ones, of course some will find other ways to mess them up.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 31, 2012, 08:53:40 pm
I did 2x30 leg curls today with a moderate 60lbs, and I was able to get the 30 reps, but god damn, my hamstrings were HURTING for like 5 minutes after.  Like PAIN hurting.  Feels fine after but wth, never felt pain like that from lifting since my very first time ever touching a weight.

Also, a random question.  When sprinting, is the same knee flexion motion going on from what you do on a leg curl machine?  If so, I'm assuming a strong leg curl = faster sprints?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on May 31, 2012, 11:18:00 pm
I did 2x30 leg curls today with a moderate 60lbs, and I was able to get the 30 reps, but god damn, my hamstrings were HURTING for like 5 minutes after.  Like PAIN hurting.  Feels fine after but wth, never felt pain like that from lifting since my very first time ever touching a weight.

That pain is lactic acid, search lactic acid and tendon/ligament health if youre interested in the phenomena.  That painful  burning feeling is exactly what you want with these flushing sets.

Quote
Also, a random question.  When sprinting, is the same knee flexion motion going on from what you do on a leg curl machine?  If so, I'm assuming a strong leg curl = faster sprints?

 There are different ideas and camps on that one, and if one thinks there is active knee flexion in the manner you suggested its minimal rom..  but one thing you can put your house on is that it damn sure wont hurt to get them stronger.  The hamstrings have to  be insanely strong either way.

 If  you  believe they are purely hip extensors then they have to  be extremely strong at the knee end isometrically, if you subscribe to the idea that there is some active knee flexion causing forward movement, they have to  be extremely strong as well. Same thing with the single leg takeoff.   See the reverse hyper example on my  blog and clarification of what happens when the hamstrings arent up to par.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on May 31, 2012, 11:25:06 pm
I see.  Bottom line, get them fuckin strong either way.

Thanks.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on June 01, 2012, 12:32:56 am
I see.  Bottom line, get them fuckin strong either way.

 exactly.

Quote
Thanks.

 Youre welcome.  
Title: Re: Hyper-extended knee, rehab tips?
Post by: creativelyric on June 01, 2012, 12:33:26 am
Well... while walking around campus today, when I kind of took a small hop down a stair landing with the knee extended, I felt a little pain in my knee again.  It's significantly less severe than last week when it was still hurting, but still, it would be stupid to put this knee in a league game in as little as 3 days.  I'll shoot for next saturday for my return.

You say higher reps is better for healing the joint, but I also need to eventually do heavier weight for strength. 

Is 20 reps what you consider high reps?  Also I can just do both right?  3x8 heavier and then right after do 3x20 light...

Thanks.

2 Sets of 30 reps, 2-3 x a week,  progressing the weight from session to session works great for pre/rehab with pure knee flexion exercises.   You train your hamstrings as HIP EXTENSORS for strength for the majority of the time, and use the knee flexion exercises as I described, MOST of the time.

 Optimal scenario for you would  be to do something like ghr's, on a glute ham  bench, CORRECTLY, for 3-4 sets of 6-10 reps, followed  by high rep leg curls for 2 x 20-30 in one session.   In the next do rdls for 3-4 sets of 6-10 reps, followed  by another leg curling variation, preferably unilaterally for 2 x 20-30.

 Ghr's done correctly are a great exercise, done wrong theyre a waste of time and a good way to screw up recruitment patterns.

   

Cues for correct GHRs? I'm curious.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on June 01, 2012, 12:44:13 am

alex does great at really explaining how to initiate the movment, low abs= think  "knee raise into the pad"


http://www.youtube.com/watch?v=z4o699c2Zfs


korfist and wanna get fast

http://www.youtube.com/watch?v=yMo74H8qdz8


higher level progression

http://www.youtube.com/watch?v=5KdHKQjEkr8


this is far from what you typically see done on a ghr, and FAR more effective for performance.  Drive hip extension from the GLUTES, not the low back.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on June 01, 2012, 03:12:57 pm
Well it's been 2.5 weeks since my injury and every single day, my knee gets better except for this past Tuesday/Wednesday and I believe that it was the squatting.  I thought since I was able to pretty much extend my knee I can do some squats but not jump/plyo.  Of course I can't be 100% sure, but some pain came back immediately the day after squatting. 

What is a good way to test if my knee has healed then?  It seemed fine, no pain, able to bear weight when extended, etc.. I want to know when I can get back to knee extension exercises.

BTW, on today's deadlift session, I tried the touch n go method.  What's your thought on this vs resetting on each rep?  What I found today was, I was lifting much better this way doing a solid 3x5 @ 275lbs, and pretty much felt everything in my hamstrings (which should be good since that's my weak link) compared to when I usually reset, I feel it in my hamstrings + lower back, etc..
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on June 02, 2012, 10:38:23 pm


  Start squatting light and slowly progress the weight.  There is no fool proof test to guarantee youre ready to squat though.

 Touch and go deadlifts are fine as long as your form is held good.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on June 09, 2012, 06:06:51 pm
Hey Lance, just wanted to say thanks for the tips and rehab guide and stuff.  My knee seems to have healed.  I came back and played my league game today and posted a decent 10 pts, 6 ast, 5 rbs...

The 4 weeks of being injured and doing primarily dead lifts and leg curls, without squatting seems to have been a blessing in disguise.  I used  to be a little bit quad dominant, and now it could just be in my head, but I think I became more hip dominant now.  After my game, I was feeling sore in my glutes/hams which doesn't usually happen.  Also, even though I didn't play ball or do anything explosive for 4 weeks, I was as explosive as ever.  My ankles were collapsing though, I guess due to not having any stimulus for 4 weeks except minor calf raises.

Anyways, thanks.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on June 09, 2012, 06:58:37 pm
Hey Lance, just wanted to say thanks for the tips and rehab guide and stuff.  My knee seems to have healed.  I came back and played my league game today and posted a decent 10 pts, 6 ast, 5 rbs...

The 4 weeks of being injured and doing primarily dead lifts and leg curls, without squatting seems to have been a blessing in disguise.  I used  to be a little bit quad dominant, and now it could just be in my head, but I think I became more hip dominant now.  After my game, I was feeling sore in my glutes/hams which doesn't usually happen.  Also, even though I didn't play ball or do anything explosive for 4 weeks, I was as explosive as ever.  My ankles were collapsing though, I guess due to not having any stimulus for 4 weeks except minor calf raises.

Anyways, thanks.

You bet man, glad your knee is feeling better and youre noticing positive changes in your movement abilities.
Title: Re: Hyper-extended knee, rehab tips?
Post by: Raptor on June 09, 2012, 07:02:35 pm
Your explosiveness came from resting a bit more and not being overloaded with fatigue from the squats as well. I stopped squatting a few weeks ago and I feel great athleticism-wise.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on June 10, 2012, 07:50:30 pm
Your explosiveness came from resting a bit more and not being overloaded with fatigue from the squats as well. I stopped squatting a few weeks ago and I feel great athleticism-wise.

That probably contributes, but it's not the only reason, cause that doesn't explain the hip/hamstring fatigue from basketball which I usually never get.

Now that it's the day after, my VMO's are sore as well now, which I also never got after basketball before.  I would think all these are beneficial changes.
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on August 02, 2012, 06:14:26 pm
Hey Lance, just to be cautious I wanted to ask you about something.  My PCL area/back of knee pain has totally subsided for a good amount of time now.  I am squatting again, doing intense plyo's for the past 7 weeks now and everything is good.  Even my shin splints are gone. 

However, since like 1-2 weeks ago, when I put my knee in a certain angle sometimes, I feel like tightness and very slight pain in between the LCL and PCL on my left knee.  It's not the side of the knee, it's not the back, it's in the halfway point between the two.  Any idea what's going on?  For the first time yesterday, my right knee started feeling this too in the exact same corner/spot of my knee.  It seems very minor as I can play basketball and do plyo's still.

Another thing, after basketball yesterday it feels like my knee swelled up or something.  It feels like the area below my knee cap and above my OSD bump is stuffed with something.  It does look fatter than my right knee too.  I've never experienced this, what is this? 

Extra info:  These days I do play with a knee brace (the skinny straps that you put in the exact spot I mentioned where it feels stuffed up) because my OSD started hurting again on my left knee.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on August 02, 2012, 10:49:58 pm
Hey Lance, just to be cautious I wanted to ask you about something.  My PCL area/back of knee pain has totally subsided for a good amount of time now.  I am squatting again, doing intense plyo's for the past 7 weeks now and everything is good.  Even my shin splints are gone. 

However, since like 1-2 weeks ago, when I put my knee in a certain angle sometimes, I feel like tightness and very slight pain in between the LCL and PCL on my left knee.  It's not the side of the knee, it's not the back, it's in the halfway point between the two.  Any idea what's going on?  For the first time yesterday, my right knee started feeling this too in the exact same corner/spot of my knee.  It seems very minor as I can play basketball and do plyo's still.

Another thing, after basketball yesterday it feels like my knee swelled up or something.  It feels like the area below my knee cap and above my OSD bump is stuffed with something.  It does look fatter than my right knee too.  I've never experienced this, what is this? 

Extra info:  These days I do play with a knee brace (the skinny straps that you put in the exact spot I mentioned where it feels stuffed up) because my OSD started hurting again on my left knee.

 Sounds like inflammation from overuse, take a few days off from plyos and see how it goes.  Also if youre not already, take fish oil. 
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on August 24, 2012, 06:12:35 pm

However, since like 1-2 weeks ago, when I put my knee in a certain angle sometimes, I feel like tightness and very slight pain in between the LCL and PCL on my left knee.  It's not the side of the knee, it's not the back, it's in the halfway point between the two.  

Hey Lance, so this has not gone away and I tend to feel it most when I'm doing leg curls..  Do you think since it's been some time since my hyper-extension injury and it's completely healed and I did plenty of leg curls (high and low reps) since, I can stop doing leg curls now if I'm still training my hamstrings with SL box squats?
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on August 25, 2012, 01:12:00 am

However, since like 1-2 weeks ago, when I put my knee in a certain angle sometimes, I feel like tightness and very slight pain in between the LCL and PCL on my left knee.  It's not the side of the knee, it's not the back, it's in the halfway point between the two.  

Hey Lance, so this has not gone away and I tend to feel it most when I'm doing leg curls..  Do you think since it's been some time since my hyper-extension injury and it's completely healed and I did plenty of leg curls (high and low reps) since, I can stop doing leg curls now if I'm still training my hamstrings with SL box squats?

If leg curls are bothering it dont do them.  Is the pain at the end range of motion or the beginning?
Title: Re: Hyper-extended knee, rehab tips?
Post by: D4 on August 25, 2012, 01:02:42 pm
Mid to end range, when the leg is curled.

Like when I would practice the 40yd dash, in the starting position I get my left foot out in front and it's in a tense curled position so that bothered it too.  After about 2-3 sprints, and some stretching of that area (basically doing the legs straight, touch toes stretch but leaning my weight to the left) the pain would subside for the rest of the workout.
Title: Re: Hyper-extended knee, rehab tips?
Post by: LanceSTS on August 25, 2012, 05:20:07 pm

  Take a tennis ball or lacrosse ball and put it in between your upper calf/lower hamstring. Using your hands, pull your shin in hard against the ball and hold it there a few seconds.  Move it left and right and repeat for a few minutes.  See if that helps.