…….from a very excellent strength & conditioning coach that I know well and greatly respect his work…………

I have a good relationship with a very well known knee/shoulder guy in the area. He sends me tons of patients, sometimes I feel they need someone more qualified but the Doctor loves us and says we get better results than most PTs………….

…………We get lots of Post rehab ACL people, usually 3-6 months post op after PT. I am told by him that they need quad strength but cant squat or lunge………….What should my main focus be?

…………In these specific cases is the leg extension, which he says is a good choice, the right option?

…………Also as I am sure they are weak in the Post Chain how should I structure the program in terms of balance? More quad work, even, more post chain?

1. To start this off, this physician is an idiot.

I’m sure it’s an article unto itself, but why there is any assumption that a surgeon is also expert at rehabilitation is just bizarre. They may very well be expert, but to assume that doctors or surgeons know more or better than PTs and trainers is just ludicrous.

So if these folks are directed by Dr. Dumbass to not squat or lunge, then how are they going to get in and out of a car, a chair, take a dump, go up and down the stairs, pick something up off the ground? Need I go on? I mean even walking is a model of lunging when there is double stance.

2. My experience is that doctors don’t give a rat’s ass about patients’ ultimate success, but rather their immediate happiness. Immediate in the case of ACL surgery is about 9 months. I don’t think most surgeons care about anything past 9-12 months even, and anything not right after that point, the surgeon is out of the picture, and the athlete or parents chalk it up to some form “I guess this is the best it’s gonna be as good as it’s gonna be. I had surgery.”

I think f your kids come back with a strong quad, and their parents are happy, I don’t think this buffoon doctor is going to care if you did with squats, lunges, or rubbing your tummy and patting your head at the same time.

3. If squats and lunges are out, how about Deadlifts, 1-leg deadlifts, and spit squats? Those are technically not squats or lunges, are they?

4. The quad “weakness” is a reaction to the knee pain/surgery. This arthogenic inhibition was not the problem before the surgery. I think there is fair agreement among those that are not retarded that the ACL is jeopardized by limited stability in the frontal and transverse plane, not the sagittal plane. While I don’t think this is suggested by your idiot doctor, the posterior chain that controls the valgus collapse should be the primary focus, not the quad.

Perhaps this study will demonstrate that stupid “intensive” rehab does nothing to your little quad problem?

Quad girth or isolated extension strength is meaningless when you can bury a 1-leg squat or have great form in the 5-Hop Test. These are 2 measures that have very positive correlation in outcome studies at least 2 years ago when I wrote my DPT project on the latest evidence on tests in Outcome studies in the literature.

I will suggest that I will and have used version of Russian e-stim at any point in the training process where tone is below minimum standard. I am not very educated on its nuances, but it appears the Compex devices are very worth looking into.

5. If you never isolate knee extension, I think you will be fine. In fact, one of the more successful interventions to increase isolated quad performance is manual therapy through the proximal hip flexor attachments @ ASIS and AIIS. The quad is in “safe mode” even though the surgery is healed. The quad is still trying to protect the knee, and the right type of manual therapy can release that tone. Quad contour will change immediately.

6. If you insist on isolating knee extension, the best option, which is not completely isolation, is the standing TKE. You can use a band or a cable machine. I have used sets of 25 for this movement in conjunction with an anterior core and/or WBV training. But this is probably just keeping as much of the bath water as possible without puking. This clearly can not be a go to move or something “quad strengthening” is based upon.