how to deal with scar tissue formed after ACL injury

[friedell]

Hello Mark, ive been reading your post conserning injuries in the stickies.

As you know from my original post I had an ACL injury. The acl injury was a partial tear.

This makes squatting uncomfortble and sometimes painful due either to

1 scar tissue which puts pressure on my kneecap
2 from possible poor traction of the kneecap according to my surgeon.

However the only way to know for sure is to operate which i dont want as rehab is long and theres no guarantee of success.

Would the rehab method that you advised for muscle belly injuries be applicable in my case. Could it help with the scar tissue that has formed or is it too late to address it now.

[Mark Rippetoe]

I don't think that a lot of scar tissue forms on a healing ACL, but perhaps someone with surgical credentials will correct me if I'm wrong. I have no idea what your surgeon means by "poor traction" of the patella. I have no ACL in my right knee and I just squatted 315 x 5 x 2 with no trouble at all. The injury rehab in the sticky -- one more time -- is for vascular muscle bellies and other structures that can heal rapidly due to a blood supply, not a ligament. This injury is just trained through conservatively until it feels better.

I think most of your problem is squat technique. Post a video.

[Chickdiver]

had an ACL reconstruction 8.5 years ago (allograft). My injured knee is very healthy, and 99% of the time I can't tell any difference between it and the uninjured knee. A few things I have learned (both from my surgeon and via experience) along the way:

-my knee is happiest when I am lifting regularly
-my knee loves squats
- you need to keep the supporting muscles strong- that would be the hamstrings and quads (this from my surgeon)
-climbing stairs (or the "stairmaster") is good rehab for the knee (also from my surgeon)
- don't do things that require you to plant your foot and pivot
-don't run long distances- sprints once or twice a week are OK

How long ago was your injury? I had a complete tear with an allograft (cadaver tissue) reconstruction. I was diving and hauling SCUBA gear around at 6 weeks post op, and really back to normal in 6 months. A year out I couldn't tell the difference in stability or strength between the injured and uninjured knees.

As a little anecdotal aside- my father, who is 60, was a defensive tackle in college, and is a lifelong lifter. In 1970 he completely *fucked up* a knee- unhappy triad tear (ACL, MCL and PCL) as well as severe meniscal tearing. At that time they couldn't repair the ligament tears like they can now, so they went in and sort of "reinforced" the knee, at the same time they removed 90% of his medial meniscus. He has continued to lift and is pain free and his knee is stable- which is proof enough for me that keeping strong is the answer.

[ZEvenEsh]

I have had ACL plus 2 mensicus surgeries on same knee.

My R knee feels pretty damn good, and my rehab went best when I STOPPED listening to Doctors & listened to my own body.

My last surgery, June 1, 2009 was a mensicus but my recovery was awesome.

I trained legs very hard up to 36 hrs prior to surgery.

I began dragging the sled 36 hrs AFTER surgery.

I stayed on my crutches for 1 minute Basically from the wheel chair to the car and then ditched them.

Lots of icing.

I performed barbell zercher squats and box squats often.

KB Swings, band leg curls, sled work, 45 degree back extensions and eventually glute ham raises.

I learned that an active body is a healthy body.

Lunges became a staple as well.

Simple stuff, like sled drags and swings were done almost daily.

When my ACL was super tight post surgery, I perform KB goblet squats and double KB squats not just for leg strength, but to force the flexibility back.

In a nut shell, I was very aggressive with my rehab.

I am NOT a Doctor, so of course, use your common sense and do what YOU feel is best for you.

I just described my own experience and found that anytime an athlete comes here after a knee surgery, their rehab is best suited for someone with no desire to become a bad ass and only makes them feel like a pussy.

I can't say enough good things about the ease of sled work and how it really helped w/prehab & rehab.

Hope this helps a bit

--Z--

[Dastardly]

Your surgeon was probably talking about patella 'tracking' not traction.

This is a therapists favourite thing to blame for everything.

I tore some ligament in my knee back in march when I was just starting to get into squatting. the first couple weeks were unbearable, massively swollen leg. Sciatic nerve pain running from toes all the way up spine.

I had to wait till mid june to get a scan, and more weeks to get results which were that they couldnt find any tears (they had probably healed sufficiently by then).

With all this waiting and lack of treatment I had to figure out my own rehab. Logic suggested that building strength in legs would be good. So I continued to squat regularly and found it helped a lot in reducing stiffness and pain.

In another month or so I got to see a therapist who concluded that I probably had intitially done some tearing but it was mostly fixed now. The only thing they suggested was silly partial leg extensions as a supposed method to fix patella tracking.

I had a lot of muscle on my outer/lateral thighs but comparatively little on the inner/medial side. Which she said pulled my patella sideways ruining tracking which would be likely to add to patella pain an inhibit recovery.

I didnt do her silly weak exercises but came up with some of my own after reading bits from Mike Roberstons (writer of bulletproof knees) and eric cressey on the net. I found a bunch of single leg excercises that I was able to do for high reps that worked the medial thigh at least as hard as the lateral.

Things like VMO Dips/Terminal Knee extensions with band resistance.

http://running.competitor.com/2009/0...e-vmo-dip_2064
IMG]http://www.tmuscle.com/img/photos/06-101-training/image005.jpg[/IMG]

Using this method I was rapidly able to fix the imbalance and correct patella tracking. I saw the therapist a couple times mroe but there was no more advice or help they could offer me. Fixing knee tracking through weak silly exercises seemed to be the only tick up her sleeve.

the hamstring on the offending leg, was more tight than the other one. She kept telling me to stretch it. An I did vigorously nearly everyday this year. But it is still tighter, sore, and hurts at the knee insertion when tension is applied.

I still get some pain/stiffness in knee, but mostly only occurs when not squatting regularly. But what is most concerning is the 'crunchy' sinuous rough sound when bending my knee into an acute angle. So I am deathly scared of deep front or high bar back squats which I had been keen on learning.

If I bend my knee into this angle a few times (where it makes the loud crunchy sound) a dull soreness begins and gets stronger as I do more. The roughness must be scar tissue or displaced ligament/cartilage (what else could it be?)

So I guess I am in a similar position to yourself.

I have been stalling heavily on my squat. So have been thinking of implementing Rip/starr's rehab protocol myself as I have to deload anyway and high reps would probably do me some good.

I am a little dissapointed to hear from Rip that it wont really work for ligament type injuries. But am still considering it as I still have a soreness running along right hamstring, and am pondering if high reps of deep squat(acute bend) of right knee may help re-work/position the rough scar tissue in my right knee. but I know its going to be very very painful.

[Mark Rippetoe]

I didnt do her silly weak exercises but came up with some of my own after reading bits from Mike Roberstons (writer of bulletproof knees) and eric cressey on the net. I found a bunch of single leg excercises that I was able to do for high reps that worked the medial thigh at least as hard as the lateral.

Things like VMO Dips/Terminal Knee extensions with band resistance.

http://running.competitor.com/2009/0...e-vmo-dip_2064
IMG]http://www.tmuscle.com/img/photos/06-101-training/image005.jpg[/IMG]

Using this method I was rapidly able to fix the imbalance and correct patella tracking. I saw the therapist a couple times mroe but there was no more advice or help they could offer me. Fixing knee tracking through weak silly exercises seemed to be the only tick up her sleeve.

You refer to her exercises as "silly", and rightly so, but you then show us a horribly silly exercise and a silly analysis from a skinny guy with two extra neck vertebrae and claim that this fixed your knees. You didn't happen to be squatting during this time of healing, did you?

[Dastardly]

Sorry, I probably sound like a really arrogant know it all.

I was just incredibly frustrated waiting months for a scan, then more months for brief visits to a therapist who offerred very little help or advice.

I was very worried about what id done to my knee, and was incapacitated for a good while with a swollen leg and fragile painful knee. I had no idea what id done to it inside and had to wait over 3 months for results of the scan after which I didnt actually get to see doctor/consultant. They just wrote a very brief letter to my GP.

After so long, limping around with a swollen leg I had to come up with my own rehab just to cope. I read up as much as I could and began slowly working it as mobility came back. Which eventually became light barbell squatting as I was just getting into the idea of training when it happened.

I found that each time I squatted, although it was sore. Afterwards pain & stiffness was reduced for a day or two. So I kept at it regularly.

When I finally got to see therapist and all she suggested was sitting on the edge of a bed and extending leg. I was dissapointed & frustrated. I even humoured her by trying it for a while but eventually came to terms that it was kind of pointless. I decided to work on her suggestion of 'fixing tracking' almost to prove that it was not the issue.

I used exercises that I could do for high reps that created a lot of 'pump' around the VM/knee area the the single leg partial squats (similar to the guy on the box but with resistance band)

Combined with careful DB lunges with larger weights. As they seemed to work quads more evenly than barbell squats were doing.

I was going with the best information I could find, Mike Robertson seemed to be the most respected guy out there for knee rehab and I was using what I could find of his theory/exercises even though I didnt really know what was wrong inside my knee.

I was able to fix patella tracking very quickly doing this, therapist was impressed. But was then stuck in terms of advising me about what more to do to fix the pain, stiffness, grinding/crunching in my knee. I dissapointingly accepted it was a dead end and kept squatting hoping it would eventually heal/smoothen out but it still hasnt.

Ive finally got a chance to see someone at the hospital in a couple of weeks and really hope theyll finally be able to properly explain the situation inside my knee and perhaps have a method of 'fixing' it.

[Mark Rippetoe]

You seem to be stuck in your "patellar tracking" think. The squat is not about the quads, but rather about all the muscles that move the hips and knees. If you want to depend on hospital staff to fix your knee and physical therapy to restore your squat strength, that's fine of course, but I promise that you will be disappointed. I'd bet that a video of your squat would reveal some problems that could be easily fixed.

[Dastardly]

Like I said, I only focused on the whole tracking thing to appease the therapist and eliminate it as a cause for my lasting knee problems. I know/feel it is something far more significant going on inside.

But as you asked about squatting videos, id be silly not to take this opportunity for some advice from you.

I posted a thread here about some difficulties id been having getting obvious hip drive/up-tilted hips during the squat.

http://startingstrength.com/resource...ad.php?t=14031

If you have the time id appreciate if you could check it out.

[Mark Rippetoe]

These aren't the best squats I've ever seen, but I see nothing here that would hurt your knees. You seem to feel responsible to your therapist. In this country the therapist I hire is responsible to me. And I don't think you've read the book. Cressey's and Robertson's, yes, but probably not mine.