Trouble regaining symmetrical use of legs during squats after knee injury

[stuffedsuperdud]

Hi everyone,
Last march I injured my left a knee and couldn't put weight on it for several weeks. (Torn MCL, possible meniscus injury but no conclusive diagnosis, no surgery needed after all.) The quad atrophied pretty badly in the process and I developed some patellofemoral pain in the meantime from the atrophy occurring unevenly and the IT band tightening up badly. I started to squat as soon as the swelling died down and I regained most of my range of motion. I also had lots of aggressive patellar mobilization and myofascial release work done which helped with the patella tracking issues.

Initially I had a heck of a time standing up correctly with just bodyweight as my hips would side my center of mass over to the good leg. Slowly though I added weight, making sure to maintain perfect form. Full disclosure: sometimes, Set 3 Rep 4-5 or so would get away from me and I'd shift to the good leg. Oddly enough, I noticed that when front squatting, my body did not naturally shift and it was much easier to maintain symmetry, so I alternated between front and back and figured by the time I LP'ed my way back to my old weights everything will be peachy.

Well, last week I squatted 335 for 3x5, very close to where I had been when I was injured. I am standing up symmetrically but the good leg was still noticeably more tired than the bad at the end, and the DOMS the next day was much worse on its side too; left leg was barely sore. The bad leg is also noticeably less hypertrophied still, and a bit of patellofemoral pain and crepitus remains and is extra noticeable when standing up from a dead stop at the bottom position, e.g. from a pause squat or a snatch. I don't know if this pain is very subtly making me shift my weight unevenly.

Doctors are at their wits end and they don't lift and don't really care anyway since I can do everyday tasks with no problem and pass their various tests for knee injuries. Anyone here have any idea what else I can do to correct this?

Biological stats: 5'9" 28 y/o 220lbs
Recently squatted 335x5x3 and deadlifted about 360x5x1, both near where I was when I got hurt.

Sorry for the essay; just trying to be as detailed as possible. Thanks for any insight. Let me know if anything needs clarifying.

[Tom Campitelli]

Did you suffer any nerve damage in this injury? If so, it may be like this for a while, or perhaps for good. It sounds like you are doing things correctly. A cue that may help you while squatting is to put more weight into the injured leg. You are about 10 months out from this injury, correct? I feel like this may just take you a while and things may never be quite perfect, although they will probably continue to improve slowly as you work on it. Seeing a video of your squat would be of use. I wish I had something more helpful to say than, "Good work so far. Things may continue to be a little lopsided even with diligent effort." The level of function that you have already attained vastly exceeds the average patient after a similar injury, which is one reason why your doctors probably don't have many helpful things to say.

We'll see if some others have input or experiences.

[Aljoscha Liebe]

I had a surgery on my left ankle in may this year and still have trouble with coming symmetrical out of the hole of the squat, because I use the right leg too much (which makes the right constantly tight and achy). Would also be interested on any input here. Could some additional single leg work like pistols be of help here?

[stuffedsuperdud]

Thanks for the optimism, Tom. I doubt I have nerve injury. Doctors didn't notice any sort of nerve dysfunction, + the accident wasn't particularly severe. I was just standing up with a wobbly snatch that I should have dumped and the knee caved inwards and rotated a bit from a partially bent position with the foot planted. Recipe for injury, yes, but no high-speed collisions or anything that might have made for a dramatic drinking story. (I got pretty sick of saying, "I was standing up with my last warmup..." after a while). It's also a troublesome knee that has a history of minor sprains going back to 2001. Like you said, it might just be something I'll have to deal with and let it work itself out. I was hoping that someone would know about some sort of magical Bulgarian one-legged kettlebell squat exercise but I guess that's too much to ask.

For anyone else who might be in a similar boat, I did notice one thing. Squats and ART work (Some physical therapists are good! You just need to do what I did and find a clinic that works with actual high-level athletes) helped me slowly come back, but the most unexpected thing for my rehab so far has actually been the Prowler. I wasn't feeling well one day and decided to give the thing a push instead of lift, and the next day, the crepitus and pain were noticeably improved. I tried it again a few days later and experienced another improvement. Been making incremental improvements since. No idea why this was the case; my guess it it forces the joint to work concentrically alone across its entire ROM at the exact speed it wants to? But that's just speculation. If anyone else has any hypotheses or wants to be data point #2, keep me posted.

[veryhrm]

I had ACL replacement surgery (patellar tendon graft) on my knee years ago (years before i was doing SS). Between the injury and recovery from surgery my leg was also significantly atrophied. It took over a year (don't remember exactly) to get back to full strength. The size took even longer. Some puffiness persisted for several years (i have no idea if from the surgery or from the original injury. Squats seemed to help that too (or maybe just coincidence)). So i wouldn't get worked up about it at 9 months, just do your best to keep the motion even so you don't ingrain strange movement patterns and don't progress the weight if you absolutely can't get it w/o shifting.

I had a surgery on my left ankle in may this year and still have trouble with coming symmetrical out of the hole of the squat, because I use the right leg too much (which makes the right constantly tight and achy). Would also be interested on any input here. Could some additional single leg work like pistols be of help here?

Don't think i've ever seen Rip recommend such. My recommendation is you should work on ROM. w/ various joint injuries i've had i noticed that if you don't work the ROM gradually beyond the comfort zone it won't return by itself (i know that's not real news). So work that so that the squat isn't challenging it / causing pain. Doing specific strength work for it i think would be unhelpful after the initial rehab phase (which you're well beyond it sounds like).

[Tom Campitelli]

Would also be interested on any input here. Could some additional single leg work like pistols be of help here?

Veryhrm is correct here. Pistols can be tough on the knees. They also demand spinal flexion in most cases. Unilateral exercise may or may not have its uses, but learning to push evenly bilaterally is a skill that requires practice after an injury like this. The only way to do that is through using both feet and being conscious of how you are producing force.

[kessg]

To add to the discussion:

I have a leg length discrepancy, and once I became aware of it, I also noticed that I put more weight on my longer leg as I stand. So now, whenever I'm standing (waiting in line, waiting for a microwave to finish heating, etc), I just try to stand on one leg - my shorter one. Don't know if it's helping or not, but it can also improve balance, core stability -- so can't hurt.