Welcome to Dan Riley's latest installment of Texans Fitness Corner. The response continues to be overwhelming. We will continue to post selected answers to your questions throughout the year. Join in by shooting over an e-mail to fitness@houstontexans.com.
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*NOTE: Before engaging in any new physical activity, always consult your physician.*
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I am a 51-year-old high school football coach. I am in need of one, and possibly two knee replacements. I've prolonged the inevitable long enough. My coaching has deteriorated this past season because I find it impossible to stand for 2-3 hours at a crack. My question is what kinds of strength training can a person do for legs after knee replacement?
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-- Greg, Milwaukee Washington High School
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Wow! Both knees? Yikes! That's a bad deal. I can empathize with your situation. I've had knee surgery and elbow surgery. I can attribute my problems to the accumulation of things I have done for many years.
I don't know what caused your joint problems but I truly believe the increased exposure by today's athletes, to activities incorporating significant impact forces, will result in many more joint problems later on in life.
I've learned that most young athletes are more resilient and durable than older athletes. They recover quicker, complain less about physical problems, and are more apt to shrug off the aches and pains associated with training and competition.
During my tenure in the NFL I've observed the accumulative affects of physical trauma on the articulating surfaces. Joint degradation of our athletes must be a concern for all coaches. I constantly urge coaches to select physical activities on and off the field judiciously. Prudent care must be taken to eliminate activities that are potentially harmful today, and/or, 10 to 20 years from now.
There is a physical risk taken to play the game of football and many other sports. I'm not talking about a catastrophic episode, I'm referring to the normal wear and tear expected of playing any sport. The longer the sport is played, the greater the wear and tear.
Check out the older players on NBA or NFL teams. After a game many have their knees wrapped in ice and slowly hobble out of the locker room. The young players are bouncing around the locker room making plans to go out for the evening.
My concern is not just for the professional athlete who begins to experience joint complications before their careers are over. My concern is also for the high school and/or college athlete and the joint problems they may experience, as they grow older. These problems may be attributed to a variety of activities performed during their athletic career. Some of these activities may be unavoidable.
Mark Schlereth, former Washington Redskin, made the following statement regarding injuries, "If I'm going to be hurt, I want it to be on the playing field, not in the weight room or out on the track." Some consideration must be given to the potential negative impact an activity may have when the athlete's playing days are over. It's my responsibility to eliminate unnecessary activities that are avoidable.
I have modified and eliminated some things in our program because of my concern for future negative consequences. For example, I have eliminated negative only exercise from our program. It is a lifting technique capable of generating significant strength gains rapidly. The athlete only lowers the weight. Very heavy weights can be used.
I eliminated the use of negative only exercise because of my concern for the long-term potential damage to joints. It is a very productive training technique I used for many years. Regardless of how productive negative only exercise is, I can't in good conscience ask players to do something that may cause gradual joint damage. The complications would occur long after their playing days are over.
I have helped rehabilitate athletes with knee reconstruction surgeries, but have never trained anyone with a knee replacement. I know some people that have had the knee replacement procedure done and it was a complete success. I don't think you'll be setting any age group squat records, but you should enjoy a pain free and active lifestyle.
Permanent atrophy can occur if you wait too long to regain lost strength. However, if you begin rehab too early, or become too aggressive, physical setbacks will happen and delay your recovery.
Initially you must rely upon the advice of your doctor and physical therapist. To regain all lost strength you may have to become a little more aggressive on your own. Some rehab specialists are satisfied when their patient is pain free, has developed full range of motion, and has regained modest strength in the affected muscles.
I consider the rehabilitation process complete when the athlete:
- Is pain free.
- Reestablishes full range of motion of the joint and muscles involved.
- Regains pre-injury strength of all muscles affected.
- Develops the necessary level of skills, abilities, and level of conditioning, to safely participate in a game or practice.
You need not worry about being able to practice or play in a game, but you should expect to experience items 1-3 listed above.
We keep accurate records of each exercise performed by our players. They perform exercises with both legs simultaneously and also perform these exercises with each leg individually. We use these numbers for comparison during the rehab process.
The rehabilitation process is not complete until strength levels return to the same "best effort" on every exercise prior to the injury. We use the strength of the unaffected leg as a barometer to gauge the progress of the injured leg.
Rely upon the advice of your doctor and therapist throughout your rehabilitation. Constantly ask questions and/or make suggestions. It is your knee.
Once you are pain free and have full range of motion I would suggest you and your therapist/trainer consider some of the following:
- Initially select weights that are extremely conservative (very light) and gradually add resistance each workout.
- Keep accurate records of everything:
a. the exercises performed
b. the amount of weight lifted
c. the order of exercise
d. seat settings
e. range of motion (if a range limiter is used to limit range of motion)
f. use a stopwatch to monitor exercise speed when performing slow reps
- Select only a few basic exercises to begin with; if there is soreness or joint aggravation on the next day, it will make it easier to identify the problem and eliminate it. When you are sure none of the exercises being performed, is irritating the knee, continue to add a new movement until you are performing exercises for every major muscle involved.
- During the early phases of rehabilitation perform strength training exercises five days/week. The amount of weight used in the early phases of rehab is very light allowing full recovery by the next day. This will expedite strength increases. Continue this process until …
a. the gains stop or drop off radically from one workout to the next.
b. you experience muscular soreness for no apparent reason.
c. your leg muscles feel lethargic and fatigued going into a workout.
- If you experience any of the above begin a three-day a week protocol until you again experience any of the problems listed above (a-c). At this point decrease your leg training permanently to twice a week (example: Monday - Thursday).
- During the early phases of rehabilitation I use slow rep training exclusively on all exercises affecting the knee joint. Using a stopwatch, we sound off with an 8 second cadence (for 8 reps). The player in a very smooth and controlled manner takes 8 seconds to raise the weight.
The advantage of slow rep training:
a. A lighter weight than normal is used, which decreases joint shearing.
b. Significant strength gains can be generated in a very safe manner.
- After modest strength gains are obtained I begin using our normal lifting techniques. Raise the weight in a smooth and controlled manner, pause in the muscles contracted position, and emphasize the lowering of the weight. We use 12 reps as a rule.
- In the early phases of rehab perform the leg press, leg curl, leg extension, and calf exercises, with each leg separately. Continue with this training regimen until you have generated modest strength gains.
- Once you have generated modest strength gains in the affected leg, begin alternating workouts. On Day 1, perform exercises using each leg separately. This will force each leg to perform all of the work and receive full benefits. On Day 2, perform each exercise using both legs together. Initially the non-injured leg will attempt to perform more of the work. You will have to make a conscientious effort to force the injured leg to work equally.
- Perform both multi-joint exercises (example: leg press) and isolation exercises. The leg press is an exercise that indirectly strengthens each muscle that crosses the hip and knee joint. Isolation exercises are needed to target each major muscle group.
- Below is a sample leg routine I have used with our players.
a. leg press - hips & legs
b. leg curl - hamstrings
c. hip extension - gluteals
d. leg press - hips & legs
e. leg extension - quadriceps
f. leg press - hips & legs
g. adduction - adductors (groin)
h. abduction - gluteus minimus (outer hip)
i. hip flexion - hip flexors
j. straight-legged calves - gastrocnemius
k. bent-legged calves - soleus
The situation may vary each time I help to rehabilitate an athlete. I am fortunate that I can rely upon the advice of our head trainer, Kevin Bastin. He coordinates the entire rehab protocol. Kevin and his staff supervise the early phases of rehab.
Some athletes are further along than others when Kevin turns them over to me. The athlete is usually pain free with full range of motion and has no restrictions. At this point our goal is to incorporate all of the exercises listed above. Our goal is to regain all lost strength when compared to our athlete's preinjury best efforts.
In all rehabs there are periods of adjustment to accommodate what is best for the injured player. You must be prepared to pay close attention to how you feel and make adjustments accordingly. It is essential that you keep accurate records and most important…be patient.
I wish you the best of luck with your surgery and a safe and complete rehabilitation.
Go Texans! God Bless America.
