An Abridged Synopsis
Injuries can be a real hindrance to gains, especially when they’re serious in nature. Not only can they affect your physical capabilities – they can take a huge toll on your mental state also. If you’ve been following my work for some time, you may remember that a year ago, I suffered a nearly unheard of injury myself during a game of basketball. A bilateral patellar tendon rupture left me immobilized for months, and called for reconstructive surgery to both of my knees; a very invasive procedure that took one hour per knee. It was over a month and a half post-surgery before I took my first unassisted steps without crutches or braces to support me. The surgeons gave me a timeline of nearly 2 years to return to “full strength and function”, noting that since this was an injury to both knees simultaneously, I couldn’t really do much to expedite the recovery process (I had no “good” leg to rely on!). At this point – almost exactly one year later – I can’t complain at my progress thus far, with all things considered. Which brings me to an important segue:
Cutting through the Internet Glitz
Let’s forget about my shamelessly egregious article title. Like I was sure to mention in the original article: I’m not really trying to inspire. Nor am I taking to the interwebs to gloat about some record-breaking progress I made as a rehab hero who’s sent the doctors’ recommendations to hell. I’ll preface all of this by saying that despite the numbers or videos I post on the internet that show progressive milestones of achievement, I’m nowhere near “back to normal”, and that’s the truth. Sure, I can “do” most things, but each impressive feat I recorded has happened after a notably long warm up, and the actual feat itself involves a serious physical and mental grind – even when it looks smooth as butter on camera.
That’s the funny thing about the internet, and it may make you reconsider many of the impressive motivational training videos you find online; Chances are, many of those same feats are performed strictly for the purpose of being fawned over on YouTube, and not a true part of an actual workout. It’s worth some thought before you jump headfirst into a Zercher squat max workout or a deadlift ladder challenge.
In my case, there are irrefutable truths that I’ve had to get used to. Regardless of what I can get myself to do while in the gym, some things remain constant:
- Mornings are very stiff.
- Warm-ups take longer. Way longer.
- Going from 0-100 in day-to-day life isn’t going to happen for the time being. No breaking into a cold run to catch the bus or train.
As stellar as progress has been, I suspect these things will take much longer than the prescribed 2 years to truly be ‘solved’. And that’s fine. Today, if I want my lower body to function athletically, I have to take the time to get it ready. Right now, I’m focused on that process of becoming ready (my warm ups) taking less and less time as the months go on.
My point of this subheading is to keep you aware that beyond that video or photo update, usually comes a world of not-quite-as-triumphant truth that paints a much more accurate picture of any major rehab story.
Sounds like a downer to kick things off, but it’s actually not the case. My year-end follow up at the hospital will be sure to impress the surgeons who worked on my knees. I’m only highlighting that though I’m doing great, things are just different now – and for that adjective to go away, it’ll take much more time.
Now that you’re aware, here’s what I’ve been doing.
The Rehab Story
Beside about 6 sessions of formal physiotherapy and hydrotherapy in the first 4 months, I’ve done my own rehab for this injury, which, from how I feel, hasn’t hurt me. I’ve been determined to make strides in a progressive way, and in this process I’ve learned movement variations that work best for me. I’ve supplemented my progress with sessions of massage therapy and occasional chiropractic treatment. I also purchased an electronic muscle stimulation kit that consists of electrodes I would place on my quads daily to help activate the dormant muscle tissue.
The chiro sessions involve ART and acupuncture, which do well to break up adhesions and scar tissue. Because of my history of back issues, these sessions were quite important in the earlier stages of rehab, when I didn’t have quite as much range of motion available at the knee joints.
Once I was able to walk on my own without braces or crutches, I headed to the gym. There, the first thing I was focused on was creating more range of motion, and getting my quads and hips to “let go” of my knees as best they could, so I could achieve greater flexion. It’s astounding how much muscle tightness can affect the integrity of a joint, and refer itself to other load bearing areas. I couldn’t yet deep squat, or grab my own heels, so it was very difficult finding a way to really stretch my quads and gently put my knees into a deeper-than-comfortable flexion. A lunge-position stretch, spiderman walk-style was fairly effective, but arduous to get into and out of. I found a solution by using the high handles of a loaded trap bar. This allowed me to place my weight on the handles, and drive the knees forward over my toes with less than my body weight over my feet. I found it to be much more real-world effective than doing a prone or supine stretch and helped create more range of motion for me in a hurry.
The Bodyweight Staples
As you could imagine, it didn’t take much for me to be feeling the agony of a difficult workout, and basic bodyweight ‘task’ exercises were a task indeed. Simple movements like Peterson step ups – even from a box 6 inches high, regular step ups, very modified lunges, and kneel-to-stands were often more than enough to be a full workout in and of themselves. They challenged my muscular endurance, single-leg stability, and eccentric control. For the first while, I used a dowel to support myself before finally moving to unassisted. These never exited my regime, and I made sure I found minimum one movement per workout under this umbrella to include. Things like walking up or down stairs slowly became more within the realms of possibility, though still a labored task.
The next tool may have been the biggest help to my recovery process and capabilities, out of anything I write here. The leg press and other open-chain pressing machines allowed gravity to push me into a flexion far deeper than I’d have been able to duplicate standing or passively stretching. Placing the muscles into a loaded stretch while the surrounding muscles had the chance to co-contract was incredible – even if the weight I was relegated to was hardly more than the empty machine cradle. I followed the rule I follow all the time: Don’t increase load until you’ve exploited other aspects of progression – in this case, adding range of motion and increasing reps. In order to hit the quads harder, I played around with foot position by going lower on the platform and using a duck footed stance. I also often pressed more through the balls of my feet, even allowing the heels to raise up off the platform in deep flexion. I would rarely count reps. Remember – I was going for a specific goal, so “breaking the rules” played its part.
I set targets for my squats, starting from a high box, and working my way down as I got stronger over time. Squatting to a 24 inch box was humbling, since I was in excruciating pain and I was barely going down at all. Because of my quad weakness, and because I simply didn’t trust my eccentric control or stretch reflex just yet, I did all of my squats to a box target. Once I was able to hit the 12 inch box with a mild front load, I gave my first attempts at bodyweight free squats.
Front Squats FTW
It can be confirmed now that my new go-to squat variation, probably for life, is and will be the front squat. I’m glad that before the injury I was very proficient at them thanks to frequent practice. Spending time Olympic lifting helped that cause also. My first attempts at front squats were with a fixed bar so light that I couldn’t even use a standard clean grip on the bar. By the time I graduated to an empty Olympic bar, I felt like a powerlifter. I made a focal point of controlling my eccentric reps and coming to a pause at the bottom of each rep for 3 reasons: 1) Fear. I didn’t trust that I could descend quickly without my kneecaps shooting across the room. 2) Training effect. I knew the most strength gains would come from how I approached the negative portion of my reps. Using control and killing and transfer of forces was the golden ticket. 3) Stiffness. Early on, I physically couldn’t descend beyond a certain speed in a squat pattern. It was almost as though the knees wouldn’t “allow” it. Looking back, that was a protective mechanism I could get behind.
Interestingly, between leg curls and leg extensions, the thing that got in the way of my knees progressing was actually the curls. One would think extensions would aggravate the tendons, but 9 times out of 10, they felt great. I used (and continue to use) them often. Prone hamstring curls would gum up the junction between my lower and upper leg on the back side, lighting up a small stabilizing muscle called the popliteus. As a by-product of this, the Sartorius, a long inner thigh muscle would get very tight from overcompensation. The end result would be a swollen knee capsule with plenty of articular fluid restricting the joint. I’d feel a “grabbing” sensation on every step, and it compromised my stride. After a number of episodes of this lasting a few days at a time, I opted to avoid hamstring curls and RDL’s for some time. It didn’t seem the junction was ready.
Just like my commitment to the front squat, the trap bar became my new number 1 choice for deadlifting variations. I could widen out my stance a touch, and keep a more vertical torso compared to a straight bar. Plus, I wanted more quad activation, and the setup a trap bar deadlift promotes did just that. I was cautious with volume, and constantly practiced sets of 3-5 until I reached a weight that was appropriate for a single set of 10 reps. Early on, I could hardly lift anything, and I had to go high-handle, from an elevated surface.
I wish those were 25’s. They’re not.
On Knee Wraps, Supplements, Drugs, and Other Miscellany
First things first: The healing process is a trend – not a linear continuum between bad and good. In English, that means that as you generally get better, stronger, and healthier, there are going to be “good knee days” and bad ones. And there’s nothing you can do about it. Some days, you wake up, and you’re just plain stiff. And that feeling doesn’t go away later, either. These are the days where it’s crystal clear that you shouldn’t push it. You can’t expect to get the most out of an injured and surgically repaired limb (or two) every single time you step into the gym. Show some maturity and stay within your means. On my bad knee days – which still occur, albeit less frequently, I’m sure to wear tensor bandages on the knees to compress any unwarranted swelling and for a little biofeedback. Also, bearing “heavy” loads in the gym, for now, usually calls for knee wraps. Slowly but surely, I’ve been weaning myself off of them here and there.
Partially due to negligence, and partially due to stubbornness, I didn’t use anything consistently in the form of supplements to expedite my healing process. I tried to eat cleaner for good nutirents, and to maintain a lighter body weight (which is generally working), and resolved to remain methodical with my training. The hydromorphone pills and extra strength Tylenol are still nearly full containers sitting in my medicine cabinet, since I stopped using either the second week out of hospital.
I also found boxing as a great way to challenge multi-planar movement in a gentle way. Since lateral lunges or Cossack squats would be too difficult for me, I gloved up and hit and moved around the heavy bag.
If you’re used to following my work and training, you’ll know that for the last few years, I haven’t been a ‘numbers’ guy. But for sake of reference, now, at the 1 year anniversary of my double reconstructive knee surgery, I’ve hit a 330 pound deadlift for 10 reps, a 265 pound full range front squat for 2 reps, and a 24 inch box jump for sets of 5 reps. I can perform loaded rear leg elevated split squats, can jog on flat ground for close to 20 strides, and can jump rope for rounds of a minute at a time.
To be clear, all of the above is hard, even after a lengthy, thorough warmup. Extremely. But it’s now possible to be accomplished, whereas before, it was just a daydream.
It’s still a tall order to think about sprinting or dunking a basketball again, but it’s much more of a realistic thought to consider compared to before. Many coaches or practitioners reading this are probably ready to unleash a litany of how many “important” stretches, nutritional and supplement strategies, drills or exercises I didn’t include in my process. Chances are, I tried many of them. Believe me, there are dozens of things I left out of this write-up. I chose to discuss the ones I felt were most important to share. Moreover, after about a dozen years of good training, you come to learn what your body responds well to, and what it doesn’t, fairly quickly after trying. Above all, I’ll reiterate something: These are the things that worked for me, but what matters most is consistency with the vehicles you do decide to employ.
And when all else fails, grow a playoff beard. It’ll get you through the plateaus.