The other day, Bill and I were having a discussion at IFAST about training clients after knee surgery.
If you read a lot of the research out there, it leads us to believe the following:
1 – If you’ve had an ACL tear, even with surgery and rehab, you could be at increased risk for arthritic changes (especially if you’re a female).
2 – If you’ve had a partial meniscectomy, you’re at an increased risk for arthritic changes. There’s a lot of debate going on about this one, but they’ll generally tell you that 20% is the magic number – more than 20%, wear and tear goes up. Less than 20% removal, it’s not as big of a deal.
But here are my thoughts on the topic (in case you were interested!)
There are two things that people aren’t talking about enough these days.
First and foremost, not enough people are talking about mechanics and alignment. Secondly, we still don’t have enough people talking about strength.
Let’s look at both, and how improving your mechanics and your strength can help keep your knees healthy for as long as possible.
Improving Knee Mechanics
Many of the people who injure their knees and require surgery come to IFAST post-operatively with obvious alignment issues. If someone had a partial lateral meniscectomy, would it surprise you to see them with this kind of alignment?
It becomes a chicken or the egg phenomenon – did they injure their knee because of their alignment? Or did they injure their knee, and then the compensations became apparent later on?
Rather than simply guessing, the only thing we can safely do is address the mechanical issue at hand.
If the pictured client above came to me, the first thing I would do is address their biomechanics, and work to improve their alignment.
Strengthening the hips and reducing their knee valgus would take stress off that lateral compartment, reducing wear and tear. The hips are crucial to keeping the knees healthy over the long haul.
It’s like a car – if you drive around with the alignment off for months on end, you’re going to unevenly wear down the tires on your car. Your body is no different.
So addressing the mechanics is starting point. The next step is to strengthen the surrounding structures.
Strength and Knee Stability
When someone has a partial meniscectomy (a minor surgery where they take out pieces of your meniscus), they also reduce passive stability at the knee.
If you look at the picture above, the meniscus does two things:
1 – Acts as a shock absorber/cushion for the knee, helping to dissipate and distribute force, and
2 – Conforms to the femur to increase total knee stability.
Imagine taking out the entire meniscus – how would the femur and tibia would fit together? What do you think happens when we take away that stability?
It would be a loose, sloppy fit.
So worse case scenario, how can we get some of that stability back? How can we improve stability in the absence of passive stability that our meniscus gives us?
You’ve got it folks – you strengthen your active stabilizers, such as your quads, calves, and hamstrings (or just about anything else that crosses over the knee!).
Strength training increases stability and helps to compress the joint. Without that stability, you have a loose, sloppy joint, that’s really going to be subject to increased wear and tear.
(Side Note: Keep in mind that this is a slippery slope. Obviously, compression can be a good thing with regards to stability. But, ridiculously heavy training can [most likely] further accelerate wear-and-tear due to the loads involved.)
At the end of the day, we may not have control over what has happened from a surgical perspective in the past. BUT, we do have control over what we do from this day forward. Addressing our biomechanics and strengthening our knees are two fantastic ways to keep us healthy and feeling good for years to come.
PS – I would be remiss if I didn’t at least mention my Bulletproof Knees manual here; I cover alignment, biomechanics, and strength training in there, and at $99 it’s about 1/3rd of what you’d pay for a customized program. The feedback I’ve gotten has been fantastic, so if you’re suffering from knee issues you owe it to yourself to pick up a copy.