Jim Smith

I’m 53 years old, 5-9 and 242. I tore my right medial collateral ligament playing football my sophomore year in high school. In those days, they cut what looks like a softball seam in the side of your knee and used a metal staple to reattach the ligament, cutting out lots of your cartilage to make it fit. Then a cast for a long time, I believe 8-12 weeks. Then some minor physical therapy, mainly some light leg extensions and some range of motion work. Bottom line, I never rehabbed it properly, played two more years of high school and a year of college, plus one season of wrestling. The knee hurt some but held up remarkably well under the circumstances. However, by the time I was 35, I had considerable pain—never much of the kind you describe where it hurts just sitting there—usually more during and after exercise or activity. When it started hurting every day when I took my first steps, I went to see an orthopedic specialist. Turns out not only did I have a very loose MCL (both that doctor and another excellent specialist I saw about 8 years ago couldn’t help chuckling when they saw how far they could bend my lower leg out to the side), I had also somewhere along the line badly torn my ACL (which meant doctors can also have a lot of fun seeing how far they can pull my lower leg forward too). The doctor and I argued for several minutes about whether or not I was favoring that leg when I went up steps and so forth. I said I didn’t but he proved that I did. The pain was from the resulting arthritis. It was a tough visit, including facing up to the fact that I was a candidate for knee replacement, though at the time too young for it. But information is power, and I came away with the knowledge that I would either have to find ways to strengthen the touchy knee or lose it.

I should say that the recovery is far from total. I feel some pain in my knee every single day, and I cannot run or jump rope for more than 30 seconds without flaring up the pain later that day. But I compete in deadlifting and squat in my training, can walk up to 8-10 miles and feel normal the next day, and I can use an elliptical trainer for 40 or more minutes. There is hope for a normal life, and a beyond normal though not elite training life.

Here are some things I wish I would have known sooner:

The exercise that got me started on strengthening the quad was a high rep one-legged bodyweight squat done off two cinder blocks positioned inside my dip bars. Paul Anderson did a similar exercise, but he only held onto one vertical pipe for balance. I set up as if doing dips, but just used the one leg to take as much of the weight as it could. This was the only way I could find to start light enough. I found these worked best with a set of high rep one-leg leg extensions, 20-30 reps for some pre-exhaust. These supersets not only strengthened my leg, they also somehow worked as pain relievers. My knee felt better after doing them. I now do box pistols with similar results, but they would have been too difficult to start with.
Proper squat form, along with what several other posts mentioned—going heel-less or barefoot, got me back into squatting. I had my feet too narrow and was also letting my knees travel too far forward. Now squats are almost never a problem. I really like using chains and bands, now, too, because they are lighter at the bottom. But I am still careful not to squat more than twice per week, usually once.
It’s not just the muscles that shut down when your knee experiences pain, injury or surgery. The proprioceptors stop working as well. Rehab now includes work on bosu balls and inflatable balance disks. I’ve got a couple of those disks, and they help my knee relearn how to balance on the one leg.
A few years ago, I got a state of the art Breg brace, specially fitted. I don’t wear it all the time when I train, and I never wear it when I hike, but it really helps on the elliptical, when I’m doing pistols, and when I’m using kettlebells.
I wear a neoprene sleeve for warmth all the time when I train, and I always start with 10 minutes on the elliptical, even when I’m not working legs that day. Many times the sleeve and warm-up make whatever pain I’ve been feeling that day go away.

It boils down to unilateral work, including balance work, starting with below bodyweight if necessary, slow progression, excellent form when a movement involves your legs, some tender loving care, and knowing your limits. Add in the regime in Smitty’s post, keep taking the anti-imflammatories, and keep a positive attitude.

David Burk