Training to Stabilise the Knee

[G-Man]

Hi Mark,

Congratulations on a great book (SS2E), I have owned it for a few years and it has been helpful and influential. It's hard to find a book founded on common sense and hard truths in fitness literature.

I have previously dislocated both knees. If the stories and recoveries are important then read on (please!) but if only the current condition is important skip to R4.

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L1&2: First was my left knee at age 17. Whilst I was pivoting my hips back to straddle a high fence my leg collapsed and I had to figure out what happened and belt the patella back in. Then I had a partial dislocation 6 months after whilst twisting in Squash, I continued playing the game and since then it has been fine.

R1 @ Age 19: The right knee happened whilst wrestling. I pushed my knee into the ground whilst twisting my leg open (ball and heel of foot and calf against ground) and it came out. It was rather brutal, I feel that I basically pulled it out with my unbalanced quads and with some help from the ground and since then it has clicked and grinded whilst bending the knee (not so bad extending it). Like the first it required beating back in.

R2 @ Age 21: The second time happened as a I lost balance as I rolled my left ankle. It went back in as I straightened my leg. Fun fun!

R3 @ Age 22: The third time was the worst of all, whilst running backwards to catch a football I placed my right foot in some mud and the foot went away from me opening gait(?) and rotating the foot outwards. Same old recipe but I was running and hence put a lot of load through the right leg I was landing on. I felt as if the upper leg was resonably still, while the lower leg was bent out to the right from the knee whilst I fell to the ground.

Despite the event being the most painful experience I have ever had, I have had a great deal of pain in the recovery. Crutches for over a month and then a walking stick for some time because I couldn't put weight on it without pain. I think the specialist said the pain was from a huge amount of swelling and a partial meniscus tearing.

I got back to cycling, bosu ball body weight squats, weighted deadlifts and attempted to do 1 legged squats to help work on stability.

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R4 @ Age 24: I simply turned around quickly to my left (pivoting on the right leg, hence opening my stance) as I was trying to turn 180' quickly, at the 90' point i just fell on my face. Patella went straight back in. Pain free injury, swelling ached though!

The left knee is A ok. The right patella is obviously quite loose, the joint is grindy, clicky and occasionally painful after impact exercises like running and tennis. However its ok. Not surgery material I'm told.

I'm 25 now and pretty unhappy being reasonably sedentary. This is because of a justified fear of reoccurrence.

I'm told after the last dislocation+recovery I resolved the problem of activation of the VMO, ie. it activates as intended with knee extension, it may not have done that well before. I also believe I have good adductor and hip stability. However I don't have great 1 leg balance.

I have done some novice strength training before for short durations.
120% of BW Bench Press 1RM
205% of BW Deadlift 1RM
unsure of Squat 1RM, I have 2 repped 100% of BW before.

QUESTIONS
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1. Do I have business in the gym, or should I have good 1 leg balance before squatting.
2. Is it fair to say that if I do starting strengths 2E idea of increasing load slowly but weekly I should develop a more stable knee?
3. I am worried that the underdeveloped VMO will maintain proportion in the quads (and maintain knee instability) or the other quads will increase further out of proportion. Is this unfounded?


Again, thanks for the book, I hope you have time to answer my questions, I would appreciate it a great deal.

[Mark Rippetoe]

Notice that every time you dislocated you were in rotation of some sort. Note that squats, presses, deadlifts, benches, and power cleans do not involve rotation.

1. You don't squat with one leg, so you don't need one-leg balance to squat. This is good, because even clumsy people can squat.

2. That is fair, since the knee receives the same increasing stress the muscles do, and will be forced to adapt.

3. Unless the underdeveloped VMO has received nerve-supply damage, it will have no choice but to contract with the other muscles, since the motor neurons will carry the signal to it. If your form is balanced, symmetrical, and technically correct, the weaker VMO will adapt to the relatively heavier stress imposed by getting stronger until it adapts to the greater stress it receives and becomes proportional to the other muscles in the quads and to the other leg. At this point it will be balanced.