Hi Doctor,
My friend had MCLR years ago, and he still has pain in the patellar tendon, it never healed completely. And when he goes back to playing soccer, the pain increases and stops him from training in the gym.
What is the best advice I can give him?
I had ACLR 7 months ago and I have the same symptoms, but it never stops me from squatting as once I’m warmed up the pain disappears. The only issue I have is I can’t play soccer for longer than 30mn as my hamstrings’ tendons start feeling super tight plus the pain in the patellar tendon and my knee feels locked and gets swollen.
Knowing I gained back full strength and beyond on the DL and Squat, what would the best thing for me to do?
Also, is the knee rehab template good for our cases?
Thank you so much for your time
Siham
Hey Siham, what was used as the return to sport criteria for you and ACLR? What type of graft were you? At 7 months, unless you had performed a strength test on an isokinetic dynamometer and had a limb symmetry index of greater than 80% (your surgical leg is 80% as strong as your nonsurgical) then I’m not overly surprised if you have some residual knee pain. At this point the graft is still remodeling and it is common to have strength deficits unless you had a good rehab program (still occur with good rehab, just less frequent). What are you using to measure having gained by full strength?
All that to say, both yours and your friends presentation would likely benefit from the knee rehab template. But specific to you, you’re still in the return to sport phase of rehab and some of this is still about you getting back in soccer shape.
Hi Derek,
Thank you for your response.
The doctor cleared me to join team practice after 4 months, I don’t know what criteria he based this on but at that time I for sure wasn’t able to play. So, I started doing basic drills moving with the ball in small surfaces, before moving to kicking a month later then joining team practice. At first, I had no issue playing soccer for an hour, but then these symptoms started showing up in the next sessions.
It’s the patellar tendon graft. I did 4 months of rehab, and also worked with a strength coach for 6 months. The rehab consisted of gaining back the ROM and strength doing goblet squats, side walks, lunges, etc plus balance and proprioception work on unstable surfaces, then we moved to jumping on obstacles and jump squats. Concerning the strength program, I started it 2 months post op, first doing leg press and rack pulls, then once I started leg pressing my bodyweight, we moved to goblet squats and then low bar squats. As for the rack-pulls, we kept increasing the ROM until I started doing DL again. Before the ACLR, my top squat set of 5 was at 40 kilos and now it’s at 70 kilos, and my top DL set was at 100 kilos for 2 reps, now I’m at 110 kilos for 3 reps, this is why I said that I gained back my strength, maybe this is not enough and there’s much more to this.
I also can’t go down the stairs normally, I have to crush the descent a little bit because I can’t keep in balance over my knee, the stairs are what hurt my tendons the most.
Thanks for the thorough response. This actually helps out A LOT in discussing this. It is not uncommon to have some residual swelling with a BTB (patellar graft) as essentially you can think of this as a surgical induced tendinopathy. Sometimes your strength comes back for the primary lifts (which is certainly sounds like yours did) but you can have a deficit side to side. Most of the time this can be parsed out with a fancy test but for the sake of this situation it sounds like this is still the case. What are you doing single leg in your training now for strength? A proxy we can use to determine if there is a side to side deficit is a single leg press and a single leg knee extension. Find RPE 8 for a set of 8 on your surgical leg and compare it to your non surgical leg i.e. if 200# is 8 on your surgical leg and 4 on your non surgical, odds are there is still a deficit we need to work on. This can also get into some specificity of training in that soccer tends to emphasize a lot of deceleration and change of direction. If there hasn’t been a lot of eccentric emphasis sometimes those components lag. If playing sports were just a factor of strength power lifters would be great soccer players.
The going down stairs normal complaint also leads me to suspect you may still have some deficits in your quadriceps. This could be a good place to look at the knee template as a means of addressing those symptoms. Out of curiosity, what do you weigh?
Thank you so much for your guidance.
I never did any single leg strength training only the ones I mentionned… Not even in my rehab.
I had planned to focus on hypertrophy this month so I purchased the 7 week gpp hypertrophy program, maybe I should change the plan and focus on gaining back the strength on my surgical leg?
If I decide to go with the knee rehab template, would you advise me to get it now or wait for the new rehab templates to be out?
My current weight is 57 Kg.
A little update: I PRed my DL yesterday, 1 RM at 127 Kg
I would give the side to side strength test on a single leg exercise a go. If there is a pretty good discrepancy, you may be better served addressing this first. You could likely do this with the hypertrophy template subbing in some single leg exercises. This would let you run the template but also allow some more focal work to bring up any deficit you continue to have side to side.
Thank you doctor, I actually did the test yesterday and there was a really big difference especially on the leg extension machine, really huge one. RPE 8 on the surgical leg and I would say much less than RPE 4 on the other one… On the leg press however it was more of an RPE 5/6