Tommy Conway - Physiotherapist
So after having a third knee surgery in February, it was about time I sorted my lower limbs out and decided to dedicate the next few months to fix all my ailments. It has been an interesting injury and wasn't easy to get better but was very rewarding in what I am learning from it. This brings me onto the heading of the Blog “ Are you feeling what you are meant to feel?”.
After traveling to Nebraska in December to complete the PRC exam, one point kept sticking in my head “can your clients feel what you want them to feel?”. So you give them single leg deadlift, single leg squat and all they feel is the calf. Well they are a hamstring and quad exercise and your client is just getting the calf, so they are not feeling what they are meant to feel, hmmm what’s going on?. This was also the case with me post operation as I was doing lunges walking forward my left (unaffected and 3 cm bigger in quad bulk) was burning whilst my right (operated leg) was asleep and felt I could lunge forever on it. Over the next two days I would have left leg DOMS but no right leg DOMS. I have seen this more and more with knee injuries and post-surgery, the operated leg does not fatigue when it should if anything it's feeling stronger.
So what’s going on?
Mostly after surgeries, the issue within the joint is resolved but the pattern or position that the joint was in pre-op is not resolved and we have to figure that out first. So where to start? Let's start with stance.
Stance is the most underrated exercise that we use. It really is one of the most important things when rehabbing clients. When treating a young GAA player post patella tendon (Right knee) rupture who has significant atrophy of the Quadriceps and VMO in particular. His surgeon was obsessed with getting that VMO back and he had spent months doing knee extensions but it didn’t grow. When asked the question “ what do you feel when doing the knee extensions?” he replied “ the tendon”. So we spent an hour going through an assessment and then exercises for the VMO and quad but it was all tendon, I through the kitchen sink at it but no good. I had failed but decided to give it another go next week and work on it together. When he was leaving and his mother was paying he was standing at the desk and put his left foot in front of his right, he had about 15 degrees right knee bend two hands on the reception desk and I was watching from my room (with two doors open its a clean view to reception) and there it was winking at me the VMO - he was in right stance and that's what I missed. We should always get stance first because it's the first thing you lose.
Breaking down stance:
What to look for in stance and all exercises
Which way is the
1: Sternum: Thorax is 50% bodyweight you need to own that first
2: Zipper: It will tell you which way your pelvis is going
3: Shoulder height - it will dictate how well you can hip hike.
Stance reposition 1:
Stance reposition 2: Use a book as it will allow for a hip hike
NOTE: These positions are where I feel the muscles recruiting more and also fit the mold of PRI patterns. What alters these patterns is a pathology.
Let's break down the lunge for instance - Right foot forward lunge with left leg trailing, whats going on at the quads?. Right quad is concentric shortening whilst the left leg is eccentrically lengthening and loading. If you lunge with the right leg and feel left quad you need to figure out how to get that left quad to let go or you will never load the right side properly. This is so important for field sports athletes as this position mirrors running mechanics and change of direction. For example, if when playing the left quad that has being been holding you up during your 3 - 9-month rehab is taken away (slips, stuck in the ground) you have a right quad trying to slow down a knee that does not know how to without help from its left quad friend.
Right quad loading Lunge position:
Right lunge with right side rotation of t spine = left rotation of pelvis
Zipper to left rib cage to the right
Right Lunge with rotation and counterweight
Counterweight will mean sternum turns right
Left shoulder lower
Right Lunge with counterweight + right intercostal lengthening
counterweight will mean sternum turns right
Left shoulder lower + right intercostal stretch
The wall Squat:
A staple of most knee rehab programmes and I use to loathe it but I have recently started using it again. The reason I use to loathe it is because I couldn't get people to “feel what they were meant to feel”. So here is some simple fixes of the wall squat.
Left quad wall squat
Zipper left using foam roller
Left quad wall squat + Loaded
Left shoulder lower
Left quad wall squat on book + loaded
Left shoulder lower
Left hip hike
Thanks for reading and next week I am breaking down fixes for a single leg deadlift and glute bridge