Testimonial: Bulletproof Knees

Back in town and back in action next week. For now, here's a testimonial I received the other day.

Mike,

Thanks to your BPK program along with some serious ART, I'm happy to inform you that I've avoided meniscus surgery and my knee is at least 70-80% better! My ART practitioner freed up some of the scar tissue that I had on the front of my knee and behind it, bringing me close to pre-pain levels. While there is still some pain, I'm going to resume my ART treatments in a few months to really hammer away at the remainder of the problem, but in the mean time I will continue foam rolling and mobility work outlined in your BPK manual and M2 DVD.

Seriously Mike - thank you. I thought my dreams of being a competitive athlete were over before they even got started, but now that I'm relatively pain free I'm going to continue pushing towards my goals.

All the best,
Roger Lawson

New Stuff from MR

I've got a ton of programs to write today, so I'm going to keep this brief. Here's some new material from moi that you might not have seen yet.

Bulletproof Your Knees - An Interview with Inga Yandell (located on pages 66 and 67)

This interview is geared toward a more lay population, with an emphasis on women's knee health.

Foundational Fat Loss - Published at FigureAthlete.com

A bare-bones, stripped down fat loss article. Don't expect anything revolutionary, just some of the basic rules and principles that need to be applied to get the ball rolling.

I hope everyone is having a great week. Enjoy!

Stay strong
MR

Q&A: Knee issues

Mike-

I've written you before, but this time I'm nervous and need some advice. I have an MRI scheduled for Monday, and have been told I most likely have a torn meniscus (left knee, medial meniscus) and possibly a partial tear of the ACL.

I know the exact moment I noticed a problem, but there was no trauma or pain to speak of. I was playing a volleyball tournament on 9/28, had played 3 matches and was finishing my dynamic warmup for the 4th match. The only thing I did different was a hamstring stretch with my foot elevated on a wall (slightly above hip height) - kind of dumb and pointless, but in any case...I went to walk onto the court and my left foot was almost being pulled out to the side as I brought it forward in my gait. I was reticent to do hitting lines because I felt like I would collapse after a jump. The feeling subsided and I played the rest of the match, having absolutely no problems. Later that night into the next day, my knee was swollen and stiff.

I finally was able to be seen by the orthopedist last Thursday. He did the test (I forget the name) for the ACL, and found a great deal of laxity in both knees, but the left did not "lock" at the end range of motion. He was surprised that I had never injured or had surgery on my knee - I think he didn't believe me. Of course, I broke my elbow and had a doctor twist it all over the place and tell me it was fine, so I'm not sure what my pain tolerance is.

My questions are two-fold (and I'm going to buy Bulletproof Knees right away, to be sure!!) - any advice on questions to ask the orthopedist about my ACL/meniscus to ensure I'm getting the whole story, and is it possible to forgo ACL surgery (if it's indeed torn) and just work on strengthening the leg? The degree of laxity in both knees (which I think I've had all my life) has opened up the possiblity that my ACL wasn't doing a whole heck of a lot - and the right one still isn't. My main sport is volleyball, playing competitively once a week and a couple tournaments a month, attending nationals and playing beach doubles in the summer.

Any other advice or suggestions you could give me would be much appreciated. If Bulletproof Knees would have most of what I'm looking for, I'll start there.

Thanks for your time - and counsel!

First off, thanks for your question!

When going to your ortho, here are the following questions I would want to know:

- What's the degree of the ACL tear? A full-thickeness tear (Grade 3) would need surgery; anything below (1 or 2) can be treated conservatively in most cases.

- What is the location and size of the meniscus tear? I would then ask you, is there any feeling of locking and/or giving way? Does it cause pain or a decrease in function?

Here are some thoughts, FWIW.

If you don't have a Grade 3 tear, then you'll most likely be able to avoid an ACL reconstruction. That, in and of itself, is good news. I would definitely be taking some time off from volleyball, though, and when you return you may want to wear a brace for a period of time until you're comfortable again with explosive tri-planar movements. As you may remember, this is what Dallas Clark did for the Colts a few years ago - they thought he had torn his ACL, when it fact it wasn't a full-thickness tear. A few weeks of conservative therapy and he was back on the field.

Now I'm all for conservative therapy, but if you DO have a Grade 3 tear surgery is probably your best option. Those that go without a reconstruction are more likely to have rapid onset of osteoarthritis, so even though surgery/rehab would suck, it should give you a better long-term outcome.

What you do with the meniscus tear will then be contigent upon the severity of the ACL tear. If the meniscus tear is asymptomatic and you don't need ACL surgery, you can probably leave it alone - more and more docs are trying to leave these kinds of tears as is. If it is causing you issues though (whether it's pain or mechanical) you may need to get it scoped. I've discussed the difference between partial meniscectomies and meniscus repairs before on the blog, so be sure to check it out here.

I hope that gives you a little ammo when meeting with your ortho this week. Keep in mind that my bias is always to stray away from surgery if at all possible, but in some cases it is warranted and will provide the best outcome.

Good luck and keep me posted!

Stay strong
MR

Do work son!

Ok, the title has absolutely nothing to do with the post, but that's what happens when you spend too much time in your gym!

Here are 5 knee health tips I gave to Eric Cressey for his recent newsletter. If you aren't signed up, why not? My man is wicked smart and he's always got great content in his newsletter. Enjoy!

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5 Keys to Bulletproofing Your Knees

1. VMO specific work is currently poo-poo in the strength and conditioning industry. While I agree that we need to focus on strengthening the hip abductors/external rotators (especially glute max and posterior glute med), current literature leads us to believe that there’s more to the VMO than we might have expected.

Several studies in the past two years have indicated that there is a definite change in fiber pennation between the vastus medialis longus (VML) and the vastus medialis obliquus (VMO). Beyond that, while your other quad muscles like rectus femoris and vastus lateralis only have one motor point, the entire vastus medialis actually has THREE motor points!

We may not totally understand the VMO yet, but I’m not willing to write off its importance with regards to knee health.

2. When looking at the body as a functional unit, we can’t overlook the core with regards to knee health. More specifically, we know the rectus abdominus and external obliques work to keep us in pelvic neutral and out of anterior pelvic tilt. Lack of strength in these core muscles increases anterior pelvic tilt, which drives internal rotation of the hip and valgus of the knee. Getting and keeping these muscles strong could go a long way to preventing knee injuries, especially in female athletes.

3. Are accelerated ACL rehab programs what we need? I’m not so sure, and I think making young athletes follow the accelerated programs the pros use may do more harm than good.

Unlike the pros that are getting paid to play, we need to focus on the long-term outcomes of our young athletes, not simply getting them back on the field ASAP. Many have done an excellent job of rehabbing patients and getting them back on the field quickly, and quantifying strength and power production/absorption is critical.

Many of the leading PT’s and orthos, however, are moving back to a slightly more conservative approach to allow the graft itself more time to heal. The properties of a tendon graft slowly take on the properties of a ligament over time; this is called ligamentization. However, ligamentous changes can still be seen as late as 12-18 months post-surgery.

[Note from EC: so, if you have a patellar tendon graft for a new ACL, you might not really have what you want until 1-1.5 years post-surgery. Tendons and ligaments have different qualities.]

4. To piggy-back on the previous point, another factor that isn’t examined as often as it should is long-term outcomes of ACL rehabbed clients. Sure it’s great to get them back on the field in 6, 9 or 12 months, but what are the long-term ramifications?

We know that females who have suffered ACL tears are much more likely to develop early osteoarthritis. If we can improve long-term outcomes by keeping them out a little longer, isn’t that worth it? As a PT or strength coach, it’s our job to help clients/athletes make the best decision for their long-term health, especially if they are too young to understand the long-term repercussions of their decision.

5. When an athlete tears their ACL, proprioceptive deficits are seen as quickly as 24 hours post-injury. What’s really intriguing, however, is that we often see this same deficit carried over to the healthy knee as well! Even after reconstruction this deficit can be seen for up to six years.

To counteract this, don’t forget to include basic proprioceptive training (barefoot warm-ups, single-leg stance work, etc.), and train that “off” leg in the interim.

If you like this tips and want more, be sure to check out my Bulletproof Knees manual.

Stay strong

MR

The "strained" right knee?

Lots of knee related content this week. My good buddy Eric Cressey sent me the following link today regarding a knee injury to Washington Wizards forward Antawn Jamison. Please observe:

http://sports.espn.go.com/nba/recap?gameId=281007006&campaign=rss&source=ESPNHeadlines

While I don't expect pro-level teams to divulge what's going on with all their athletes, let's be clear that there's a significant difference between a strain and a sprain.

From the Mayo Clinic website:

Sprain - A sprain is a stretching or tearing of ligaments. Ligaments are tough bands of fibrous tissue that connect one bone to another. Common locations for sprains are your ankles and knees.

Strain - A strain is a stretching or tearing of muscle or tendon. People commonly call strains "pulled" muscles. Hamstring and back injuries are among the most common strains.

Now I don't know about you, but when I see someone's knee buckle like that, it's pretty rare that it's a simple "strain." The exception would be if someone blew their quad tendon, which he doesn't appear to have done.

Instead, when buckling occurs it typically occurs due to ligament damage - possibly a torn ACL, MCL, etc. I'm no sports medicine doc, but I'd be surprised if this was a simple muscle pull and that he's out a week or so. (For his sake, however, I hope I'm wrong - he's a helluva player.)

So as I stated up front I don't expect teams to divulge all their insider secrets, but at the very least the reporting of injuries leaves a lot to be desired for an anatomy geek such as myself.

Stay strong

MR

If you want to learn more about knee injures and how to prevent them, check out my knee manual.

Q&A: Hip Flexor Stretches

Mike,


I finally saved up enough money to get the Bulletproof Knees Manual and DVD and I'm excited about starting b/c I've been dealing w/ knee issues now for 6 months.


I have anterior knee pain (likely chondromalacia patella) and all the hip flexor stretches you describe are in a half kneeling position. This aggravates my pain b/c my patella is being compressed into the ground and I've tried using a towel and a pad but it's still aggravating.


Do you have any suggestions for effective hip flexor stretches where I don't have to be in half kneeling position?


Thanks a lot,

Nolan


Nolan -

That's a great question; here's a stretch you can use to get at those hip flexors without putting you in the half-kneeling/split-stance position.

You'll need to lay on either a massage table, bed, or something of a similar height. Pull one knee to your chest, while allowing the opposite leg to hang down over the table. Make sure to keep your stomach tight, and it may help to think about using your glute to "pull" your hip down.

I hope this helps - good luck with the program!

Stay strong

MR

How do you train minus two knee ligaments?

For those of you who follow professional football you've no doubt heard about Shawne Merriman; he's quite possibly one of the most dynamic defensive players in the league. (Just understand that it pains me to say that considering he plays for the Chargers, but I digress).

In case you've missed it, Shawne had off-season surgery to repair torn cartilage in his knee, but hadn't felt good in camp. He recently had 4 surgeons evaluate him and tell him that he needs reconstructive surgery because he has torn the PCL and LCL ligaments in his knee. Obviously, this would effectively end his season.

However, no one said that young men think about the long-term; Shawn has gone against the docs recommendations and decided against surgery even though he risks a "career-ending injury." So how could he possibly play in this state? Let's take a quick step back to examine how we create stability around our joints.

In your joints, you have what are called active and passive stabilizers. The passive stabilizers include cartilage structures (menisci in your knee, labrum in your shoulder, etc.), ligaments, and joint capsules. They are passive in nature because they don't contract and relax like muscles do. In essence, they just kind of keep things in place.

In contrast, your muscles are active stabilizers - you can use them to contract and improve stability around a joint. In the case of your knee the primary active stabilizers include the hamstrings, adductors, gluteals, and quadriceps.

So what happens when you tear two of the four ligaments in your knee? First off, you become very unstable - you've essentially lost half of your passive stability. If you asked for my opinion, I would tell you that he's assinine for trying to play. I have an infininte amount of respect for playing through the pain and giving yourself to your team, but I definitely worry about the long-term ramifications of doing so. With that being said, however, what could he do from a training standpoint to make it through the season?

The answer, my friends, is to get his active stabilizers as strong as possible. The stronger he gets his glutes and hamstrings to help him declerate, the better off he'll be. He still may not make it through the season, but it will at least give him a fighting chance. Another option would be a serious sized brace to help re-create some of the lost stability. Now keep in mind we don't know the severity of his tears, but I would assume you're looking at least grade 2 (partial thickness) if not grade 3 (full thickness) tears if all 4 docs want him to have surgery.

If you're interested in learning more about the anatomy and function of your knees, along with how to keep them healthy, be sure to pick up a copy of my Bulletproof Knees manual. Your knees will thank you.

Stay strong

MR

BTW - Can I give myself a virtual high-five for coming up with an entire blog post that consists of one single thought? Gooooooooooooooooo me!

'Tis the season...

...for knee injuries.

If you're a football fan like me, you love and hate this time of year. The pre-season is winding down, and it's time for us to enjoy the best time of the sporting year - football season.

Unfortunately, it's a double-edged sword - we've waited for 6 months for our favorite teams to take the field, and quite often, our whole season can go down in flames with one key injury.

And you know what I'm talking about - when we're talking football, we're talking knee injuries. In the past month or so we've lost Peyton Manning (surgically removed bursa sac), Shawn Merriman (torn PCL and LCL), Jason Taylor ("sprained" knee) and Osi Umenyiora (torn lateral mensicus) for various lengths of time. Some will be back this year - others won't. Last year the Colts lost three starters to season long knee injuries (Booger McFarland - torn patellar tendon, Rob Morris - torn ACL, Marvin Harrison - ruptured bursa sac).

Football is hard to prepare for physically when compared to other sports. In basketball, soccer, and volleyball you typically see non-contact injuries. Essentially, these people have weak or faulty active stabilization patterns - typically the glutes and hamstrings are either inhibited or flat out weak, and smooth deceleration of jumps and cuts isn't possible. When you lack active stability, your body is forced to rely on the next source - passive stabilizers like menisci, tendons and ligaments. Obviously, if you can get stronger and improve activation patterns, you go a long way to staying healthier.

In contrast, football players are exposed to both non-contact AND contact based injuries. As I mention in my Bulletproof Knees manual (and the lecture as well), you could have the most orthopedically healthy knee known to man, but if you get caught in the wrong position, or hit with enough force in the right area, your knee is probably going to go.

So if it were up to you, which option would you choose?

1 - You figure there's nothing you can do to protect your knees, so instead of playing you curl up in the fetal position on a remote corner of the sideline? Or
2 - Take as many steps possible to reduce, and possibly even prevent, a major knee injury?

If you're a competitive footballer, whether at the Pop Warner or Pro Bowl level, you owe it to yourself to check out Bulletproof Knees - it may be the only thing between you and a knee injury.

Stay strong
MR

Thinking Long Term...

So this blog post is going to essentially be my "newsletter" for the week - I hope you enjoy it!

Last week, Bill Hartman and I were having a discussion in between clients at the gym. Essentially, we were talking about the long-term health/repercussions of playing sports at an elite level. I was reading an article about Greg Oden, quite possibly one of the most talented basketball players to come out of Indiana. In case you've been living under a rock the past year, Greg had microfracture knee surgery in the off-season last year and missed his entire rookie year.

As we were discussing things, I started thinking about the long-term effects of the microfracture procedure, and knee surgeries in general. If you're unfamiliar with it, here's the jist of what they do: When hyaline cartilage wears down (or is removed) you essentially have a bone-on-bone contact area. This bone-on-bone isn't good as it wears down the joint surfaces, and as you move plant and cut, lift heavy things, etc., it leads to the progression of osteoarthritic changes in the knee. Certain forces are more injurious or damaging to the knee, but to prevent this bone-on-bone doctors will go in and drill directly into the bony areas. The goal of a microfracture procedure is to make the bone bleed out; the ensuing hole is filled in/covered with fibrocartilage. Unfortunately, while hyaline cartilage (i.e. your meniscus) is very resilient, fibrocartilage isn't nearly as resilient.

If you follow the NBA, you know that quite a few big name players have undergone the microfracture procedue - Jason Kidd, Chris Webber, Greg Oden, Amare Stoudemire, Zach Randolph, Anfernee "Penny" Hardaway, etc. As well, if you followed their careers post-surgery, the results were very different. Kidd and Stoudemire returned with great success, while many of the others (most notably Hardaway and Webber) were robbed of their trademark explosiveness and had their careers cut short.

So what does all this have to do with you? That's a great question - and after my long-winded preface, here's what I want you to remember: Always think about the long-term. What effects do the things you're doing right now have on your future health and well-being?

Now please understand I'm not trying to sway you one way or the other. I remember a while back being in Dr. Klootwyk's office (he's the knee surgeon for the Colts), and there was an autographed picture of a Colts player with this message inscribed:

"Doc - Thanks for fixing the money maker!"

My goal isn't to sway you one way or the other - if your goal is to squat a 1000 pounds or rush for 1,500 yards in the NFL, great! Just understand the long-term effects that might have on your body. I can tell you this: If I had to choose between being set financially for life at the age of 26 or 27 and possibly having a knee replacement later on in life, I can tell you which one I would choose without a doubt!

I think sometimes we fail to appreciate the health and well-being of our bodies; my goal is to have a strong, healthy, and resilient body for many years to come. Having had a knee surgery myself, I understand what I am capable of, and the repercussions that certain things have on my body.

That's also why I created my Bulletproof Knees manual - I wanted to figure out the things that I could do to stay healthy and strong as long as possible. I've had a lot of questions lately from young people whose knees are beat to hell, and that's part of the reason I'm typing this right now. If you take the steps to get yourself healthy RIGHT NOW and stay that way, you'll be so much better over the long haul, regardless of your long-term goals.

Stay strong and have a great week!

MR

Q&A: Patellar Tendonitis

Hi Mike,


I've been reading your articles on T-Nation, purchased Magnificent Mobility/Inside-Out and am beginning to incorporate both into training and non-training periods.



I have recently been diagnosed with patellar tendonitis in the right knee and was wondering if you could give any recommendations as to how to treat this. Should I be looking into your "Bulletproof Knees" book, or should something like Magnificent Mobility be sufficient (over time)?



Thanks for your time.
James

Thanks for contacting me James. I'm glad you're finding the products useful, and hopefully this post will help you get that knee 100% again.

First of all, you should know that true tendonitis is pretty rare - and if it is what you have, then high-dose NSAID's for a couple of days should clear it right up. What you probably have it patellar tendinosis.

While I think Bulletproof Knees would help, it's more of a post-rehab protocol. If you do in fact have patellar tendinosis, current research seems to indicate that eccentric decline squats seem to help clear it up pretty well. I would meet with a qualified PT, or at the very least do a thorough search on Pubmed to help you figure out the best protocol.

As I recall (and it's been a while since I read through the research, so don't hold me to this!), two to three sets of 15 repetitions on at least a 15 degree decline worked quite well over the course of several weeks. You have to perform these twice a day, and it's probably going to be pretty uncomfortable in the beginning.

The bigger question is - why did this happen in the first place? In my humble opinion, people who develop patellar tendinosis tend to be in a greater degree of anterior pelvic tilt on that side when compared to the unaffected side. What does this mean from a training perspective?

- You need more rectus/external oblique work on that side.

- You probably lack glute activation/strength on that side.

- One or more of your hip flexors on that side are either short/stiff.

So once you've cleaned up the tendinosis, work to iron out the side-to-side imbalances that most likely created it initially. This is where Bulletproof Knees would be the most beneficial - to help you get back to 100% after you've dealt with the pathology.

Good luck!

MR

Q&A - Bulletproof Knees

MR, I am doing the Sample Phase I Workout.

You list Static Stretching and Activation as number 2 in the Program, but in other parts of the same chapter you recommend stretching after one finishes the rest of the routines, or doing stretching before bedtime. Should I do the described stretching before number 3, Dynamic Flexibility Drills, do them after, or do stretching at two different points (before Flexibility AND another set before bed)?

I am rehabilitating a reconstructed left knee (surgery done in 1978). Can you recommend a good TFL/IT band stretch - I cannot find one in your manual. Because of said injured knee, I use the Tummiello piriformis stretch, since performing the one you give in the manual's stretching section causes me pain in the anterior left knee.

Thanks to you, I finally have a comprehensive program to get both of my wheels back on track. Keep up the good work. Larry

I can see were this would be confusing, Larry. There are various times when static stretching can be beneficial within the Bulletproof Knees program. Let me explain.

Pre-workout, we include what's called "Acute Corrective Strategies" to help re-groove better movement patterns in the muscles. For instance we would stretch your hip flexors, and then follow that up with an activation drill to enhance neural drive to the glutes. In this case, we're very specific in the stretches that we would perform.

After you've included the "acute corrective" drills to optimize neural drive to the glutes, you'd move in to your dynamic flexibility drills. Just as an aside, you can do this either before or after your dynamic flex, it's really more of a preference than a physiological law.

Now at the end of your day, that would be the optimal time to go through an extensive static stretching routine. This is where we would stretch all the muscle groups that we outline within the appendix of the manual. Most people have a very poor stretch tolerance, so this should help quite a bit.

As for your question regarding the TFL/IT Band, the IT band itself is very hard to stretch since it's not muscle tissue - it doesn't have the same physical properties. To stretch the TFL, try kneeling on a pad or pillow, activating the glutes and posteriorly tilting the pelvis. If you have a tight TLF on one side, you should get a nice stretch here. If nothing else, cue yourself to stay tight, tall, and drive the hips forward.

I hope this helps and keep me posted on your progres!

Best
MR

Q&A 4/29

Hi Mike,

I've just finished reading the Bulletproof Knees manual and I thought it was a fantastic read! It's definitely a resource I'll be using to help myself and anyone I know with knee problems (and hopefully prevent some people even having them!)

I do have a few questions from reading the manual I was hoping you would be able to help with:

1) On the double and single leg jump progressions, is it a good progression to go from wearing trainers to barefoot? I know there has been a shift towards doing warm ups and where possible train barefoot, I just wasn't sure whether it would be too much on the joints or not.

MR: While warm-ups and such are great choices for barefoot training, I really don't advocate taking this over into ballistic/high shock absorption movements like jumps and sprints. Most people's feet are far too weak to effectively absorb the shock, and while their knees might feel great they'll end up with some sort of lower extremity injury. Not good!

2) You mention that if someone suffers from compression or tracking issues they shouldn't wear the knee sleeves. Could you expand on why this is? If someone does suffer, are there any alternatives to wearing knee sleeves?

MR: People that have compression/tracking issues generally like the warmth a knee sleeve provides, but if they're too tight they only create more compression/tracking issues at the patello-femoral joint.

It's not so much that it's contraindicated, but I would definitely make sure they are loose and not furthering altering the normal biomechanics of the knee.

3) I like the idea of using the credit card to remove fluid, when you are scraping the card up the leg, do you just go around the whole knee or if you have a specific area that aches, just scrape over that area?

MR: I will actually start at the lower exremity, work my way up to the knee, and the all the way up into the thigh. If your leg is elevated and straight so that your foot is above your hip, think about working from the upper most to lower most portions.

4) Final question :-). I don't currently have any bands to be able to do the band stomps. I am currently looking to get some ironwoody ones, do you think they would be ok to do the band stomps with?

Thank you very much for your help!

Regards,

Jon

MR: I don't have any experience with the Iron Woody bands; every band I've ever purchased has been of the Topper(?) variety which can be purchased at Elite Fitness Systems (www.elitefts.com).

Thanks for the questions and good luck!

MR

Q&A

Mike-

I got to your site a bit circuitously via stronglifts.com. Your “Bulletproof Knees” intrigues me greatly as I own a reconstructed ACL in my left knee and I am a sponge for good info.

I have two questions (if I may):

1) I started the stronglifts 5x5 program about four weeks ago and have been progressing slowly as I am “new” to free weights. I added Bulgarian split squats to my routine as a means of developing the posterior chain. I have no issues going past parallel with either a front of low back squat. I have no pain. I think my technique is solid (feedback from a PT on site where I work out).

My problem/issue is that I have developed a bit of swelling above the knee to the outside of each knee, with the “good” knee carrying a bit more fluid than the left oddly enough. Nothing excessive but noticeable when I fire the quads, you can see a bit of a bulge. Does this sound like an overuse issue due to the additional BSS routine or something I should go see my orthopod about? Empty bar on the BSS and I am currently squatting 140lbs front and back….like I said, just getting started.

2) Plantar Faciitis in left heel…barefoot or shoes? Is there a connection between the aftermath of the ACL issues and the plantar facilities issues? There is a good deal of size difference between the left and right leg, top to bottom. (Many years wearing a brace before the re-construction and poor maintenance during that time…I’m getting religion late in life.).

Oh, I’m 53, 175lbs and an avid squash player who can’t get off the court even when his body tells him to until it breaks down (very stubborn).

Thanks for reading and if the short answer is to “buy the book” or “go see your Doc” that’s cool. Just wanted to get a gauge as to the type of info I can expect with the book.

#1 - It's hard to say exactly why your knee is swelling without watching you perform the exercises at hand. If you haven't been training all that heavy, it could just me an instance of doing too much, too soon. If the knees aren't ready for it, a natural response is swelling until your body acclimates to the loading.

Now, one suggest I would make is that BSS's aren't an optimal choice if you're looking for posterior chain development. I would prefer a PC dominant movement like RDL's, deadlifts, etc. If you want a unilateral PC dominant exercise, single-leg RDL's would be a good option as well.

#2 - With regards to the plantar fascitis, it could be a result of the surrounding tissues "stiffening" to protect the knee joint. I would get some aggressive soft-tissue work done (ART, deep tissue massage, foam rolling) on the gastroc/soleus, Achilles tendon and plantar fascia. You may even be tight up into your hamstrings, so you'll have to explore a little. Some old fashioned static stretching may help as well. If your quads aren't firing as expected, loosening up the posterior knee musculature should help.

And when in doubt, buy the book ;)

Stay strong
MR

Testimonial - Knee health advice

A young gentleman by the name of Antoine wrote me a few weeks ago with serious knee pain. I gave him some advice to try and help him out; here's the e-mail I got from him two days ago. Enjoy!

Stay strong
MR

Here is some follow-up after a month or so:

I've been doing the eccentric, single-leg squats on a decline board for a few weeks as you suggested. It doesn't hurt but it is a bit uncomfortable. This being said, I can now do, without any weight, squats and lunges pain free.

I recently tried light deadlifts and front squats (ATG) and it seems to be fine.

So..... this stuff works!

I'll now add some glutes exercises (SLDL, hip abduction, step-up, etc)

Thanks again!
Antoine

If you're interested, be sure to check out my Bulletproof Knees DVD and manual to help with your long-term approach to knee health.

Developing your philosophy

Right now I’ve basically completed all the “content” for my Australian seminars. What I’ve done is create four PowerPoint’s that will serve as the course material. Here are the topics:

- Introduction and 21st Century Core Training
- Optimizing Upper Extremity Biomechanics
- Bulletproof Knees
- Program Design

My goal is to give all the attendees an idea of my training philosophy and the art/science behind it.

I would suggest that anyone who wants to become a better coach go through this at some point in time. As clear as I thought my philosophies were, it gives you a new level of clarity when you have to write everything out and explain it coherently to an audience. Why do you prefer certain exercises? Why do you include certain modalities? What are your core thoughts on training for the various parts of the body?

Many people on the ‘net are more than willing to poke holes in your philosophy, while they don’t even have a philosophy themselves! It may sound easy at first, but when you really try to sort out each and every step of your training program, it gives you new found perspective. Quite often we make corrections and do things on the fly, without a lot of regard as to “why” they work.

In my estimation, being able to explain the “how’s” AND the “why’s” is an integral part of your learning curve. If you can’t communicate your thoughts to others (be they seminar attendees or clients/athletes), good luck getting them to buy into your methods.

Stay strong
MR

An Interview with Robert Dos Remedios

All -

Here's the link to a recent interview I did with strength coach Robert Dos Remedios:

http://coachdos.activeboard.com/forum.spark?forumID=112122&p=3&topicID=14448968

You have to sign-up for the board, but I think the interview will be worth it.

Mike Robertson

Get Your Glutes Firing

This is another area that not nearly enough of us are addressing, as most who have patello-femoral pain are only worried about isolating the vastus medialis obliquus (VMO).

In research by Ireland et al. (1), they found that athletes with patello-femoral pain had significantly decreased strength in both hip abduction and hip external rotation. How much is significant? These subjects were 26% weaker in hip abduction and 36% weaker in hip external rotation!

Now that we know what movements to train, what muscles are most affected? Specifically, we're talking about getting your gluteus maximus and posterior fibers of the gluteus medius firing. So before we do low-body work, we should be getting some activation work in to make sure those muscles are stimulated and ready to go. X-Band walks are perfect here.

You'll see in the video that the set-up is a little funky, so hopefully seeing it will make it easier than me trying to explain it! Big things to focus on here include turning the toes out slightly and bracing the core throughout. This will prevent you from using the "Weeble-Wooble" substitution pattern that typically occurs in hip abduction movements. Stay tight, tall, and use those glutes and you should be just fine.

In maintenance phases (where I'm focusing on max strength), I may only do one set before training. In phases where motor control and recruitment are the priority (for instance, in the early off-season or a transition phase), I may perform three or even four sets of these exercises before training.

Read More

Mike Robertson

Addressing the Lordotic Posture

I have a lordotic posture and unable to achieve pelvic neutral with tight hip flexors and active back extensors, core strength is good, could I utilize any exercises from Magnificent Mobility, Inside-Out, and Building The Efficient Athlete to help the above?

Magnificent Mobility
Pull-back butt kicks
Glute bridges
Mini-band walks
Warrior Lunges
Walking Spidermen
Squat-to-Stand
Etc.

Mike, checked out the lovely Blood on the Barbell program, as a raw beginner,what are your best basic exercises needed to gain adequate strength base or would one need to have a coach learn perhaps all the exercise assessments or maybe all the structural balance listed from BTEA in order to interprate a similar program for beginners?

It's great to have a coach/trainer evaluate you in the beginning, but you still need a basic strength base to see progress. Unless you have a specific pathology that needs to be addressed, stick to the basics (squat, bench, deadlifts, push-ups, lunges, pull-ups, etc.) and you should see plenty of progress.

what exercises should a trainer teach me to get wet with as a beginner?

See above

Basically, of alot changes happened over time such as staying away from sit ups but sticking with reverse crunches that puts people off, please can you tell me if curl ups,toes to sky variations (reverse curls),thin tummies,hip extensions, wide grip bench presses are any good exercise now?

I'm not familiar with all those exercises - just remember that while there are good and bad exercises, you need to qualify the exercise to the individual, not vice versa. What's great for one person and their goals is terrible for another.

Stay strong
MR

Everything Starts with Efficiency. Click to Get Started.

My Thoughts: Personal Trainers

While at the gym the other day, I had some mixed emotions while watching one of the “trainers” take a client through a workout. Let’s examine both the pros and cons:

Pros

I have a lot of respect for anyone who does this for a living, especially if they got into it for the right reasons. Most trainers are going to work long hours, get paid an average (but not outstanding wage), and probably be in and out of the industry in a few years. It’s definitely not the easiest job in the world.

As well, people often think of all the glitz and glory of working with highly functioning people or strictly elite athletes. I hate to tell you, but it’s not always all that glamorous, especially when starting out. In the beginning, you take whomever you can whenever you can to make ends meet. You don’t have the ability to pick and choose who you want to train. Especially if you have other people underneath you within the business, it’s not just about you making money – you are responsible for your other coaches and their lifestyle as well.

It’s easy to criticize trainers if you’re not in the industry, or if this isn’t your sole means of employment. But making a living as a trainer? Well, let’s just say it’s not the easiest thing in the world.

Cons

While I can appreciate the hard work and dedication these people put in, there are certain things that just flat out piss me off. First off, I’m pretty sure one of the guys had little or no training experience, let alone a certification. The “training session” consisted of weighted lunges (she didn’t need any extra weight, believe me), ab machine crunches, and a host of other poorly chosen exercises. So while the exercise selection sucked, the coaching wasn’t any better. The people who lose in this equation are the people paying for the sessions, and the good trainers out there who get a black eye from being associated with this trainer.

Now, couple this with a total lack of professionalism when it comes to attire. A polo shirt is fine, but take the time to at least tuck it in. It’s no wonder why people think trainers are total idiots; if you look the part, people will assume it to be true.

If we want this profession to be elevated to a higher level (whether it’s strength coaching, training, therapy, whatever), not only do we need to act the part but we need to look the part as well. Get your education up to par. Read articles and books. Listen to high quality CD’s and DVD’s. Attend seminars. You get the point.

But once you have the education and the know-how, take the time to look the part as well. Shaving from time to time, dressing appropriately, and keeping yourself in shape all help to raise the bar.

If we want to be paid like professionals, it’s time to look and act the part!

Mike Robertson

Meniscus Repair or Partial Meniscectomy

Mike,
I just wanted to let you know how much I have enjoyed the program Bulletproof Knees. I feel more confident now dealing with the many clients and the ever present knee pain. Of course that's after the MRI and the all clear from their Doctors.

However, I do have a question for you concerning meniscus repair. I have two clients who have had the surgery and were told not only no squatting or step-ups, but not even the basic quad stretch. On page 61 you made it clear about this. I would appreciate any additional comments.

Again thanks for all your work, I also have your shoulder program, great information. Thanks for your help.

Sincerely,
Ken Dunn NSCA, USPTA

The biggest issue here is the terminology, as there’s a huge difference between a MENSICUS REPAIR and a PARTIAL MENISCECTOMY. Here’s a quick anatomy lesson, for those interested.

The meniscus is a hugely important portion of your knee. Not only is it your primary means of shock absorption, but is also aids in distributing force evenly across the knees and aids in proprioception at the knee joint. A few decades ago (before we understood the importance of the meniscus), it was quite common for doctors to yank the whole thing when it was torn! As you can imagine, the post-surgical results were less than optimal and quality of life rapidly declined in most cases.

Now, on to the types of surgery. Only the outer 1/3rd of the meniscus is vascular, or receives blood. Therefore, this is the only portion of the knee which can actually heal itself. Tears that are in the outer 1/3rd of the meniscus, and which are relatively new, are typically the best candidates for a MENISCAL REPAIR. In this case the surgeon will go in and actually suture the torn pieces together, and then cast/stabilize the knee so that it can’t be moved for several weeks. The biggest pro of this procedure is the fact that, if successful, you’ll have all your meniscus in the future. The biggest con here is that the rehabilitation is much more lengthy, often taking up to 6 months to get someone back to full speed.

In contrast, for older injuries or in tears that occur within in the inner 2/3rd’s of the meniscus, a partial meniscectomy is generally performed. In this case the surgeon will go in and remove the torn segments, and then attempt to smooth out the remaining portions of the meniscus. The pro here is that you can typically bounce back very quickly; once you’ve removed swelling/inflammation at the joint you can typically crank up your training pretty quickly. On the down side, you lose some of the shock-absorbing capacity at the joint, leaving you at increased risk of long-term knee issues such as arthritis.

So understanding the type of surgery here is critical – if your surgeon performed a mensical repair, then that client will not be prepared to train for several weeks after surgery. If they only performed a partial meniscectomy, then let swelling, inflammation, and performance dictate what they can/can’t do. Hopefully the physical therapist that worked with them post-surgery has focused on regaining adequate flexion/extension of the knee – if not, that’s a whole ‘nother blog post!

Mike Robertson

The Most Comprehensive Resource Ever Created for Eliminating Knee Pain.