I’m about 5 months removed from ACL reconstruction using a hamstring graft and am well ahead of schedule with my strength and endurance. However, my physical therapist tests my injured leg vs. my “good leg” (also tore that ACL in 2005) once per month and I’ve been lagging in hamstring strength in both legs. My hamstring strength in my non-surgery leg has been between 59-66% as strong as my quad strength in that leg while my surgery leg has been 52-54% in that regard. My PT says it should be between 60-80%, so I’d obviously like to build that way up in both legs so I don’t tear it again.
I’ve pretty much had the training wheels removed in my physical therapy for the past two months and have made decent gains in the weight room and running. I’ve been hammering my posterior chain, or so I thought, but my test results haven’t really budged. Main lifts I’ve been focusing on have been traditional squats, deadlifts, RDLs, GHRs, Bulgarian split squats and hamstring curls. I’ve also started some glute activation work based on an article I read on this site (“Dispelling the glute myth” I think it was).
I have been squatting twice per week and deadlifting once per week. I also started working some power cleans into the mix, though with very little weight. My question is, would it be wise to replace my squat days with deadlift days, or at least cut down the quad-heavy exercises while I try to build up my hamstring strength? I am just brainstorming here. I have been working a 2:1 or sometimes 3:1 squat-to-deadlift routine for the past 4-5 years on average. I just always assumed programs should be squat-heavy.
I don’t think it would be a bad idea to switch the focus of your lower body training from a squat focus to a deadlift focus, or at least posterior chain focus. I regularly will rotate a focus from a hip extension/posterior chain focus to a quad focus, but always have both in my training regardless of which is being “focused on”.
You may not need to switch to deadlift, but could instead alter the type/style of squat being used. For example, utilize a box squat/hip dominant squat technique rather than a quad dominant. It is quite common for the hamstring to lag a bit in strength after an ACL repair using the hamstring graft. You have to remember that it took some time for that hamstring to heal, so the hamstring itself will become inhibited/“shut down” not only due to ACL repair but also the graft that was taken from it.
The fact that your healthy leg is a bit off for the 3:2 quad to hamstring ratio shows you may need to refocus some of your training, and also may need to re-evaluate your technique as well. It may be a mobility issue at the ankle or hips, or even muscular imbalances/over-activation issues, that is causing the hamstring inhibition in the healthy leg.
Thanks LH. I lifted today and substituted box squats for my traditional squats. I have never done box squats, so I read up on them beforehand. I read some of Dave Tate’s stuff. Sitting back is easy, and I eventually got the hang of lifting your hips first. I can definitely feel the difference with these. I’ll continue to box squat twice per week and deadlift once per week. I’ll probably keep my exercises at 2:1 with posterior chain vs. quad focus for a while.
Another thing you can do is put a resistance band around your knees when you squat. It forces you to push your legs out and activates your gluteus medius more throughout the motion…a key player for long term prevention of anterior knee pain.
My question for you is… how did they test your hamstring strength? You can be very strong in the hamstrings in deadlifts and such and absolutely suck when it comes to a leg curl or a manual muscle test for knee flexion… which is how most therapists are going to grade your strength. Flexion is pretty meaningless functionally… so you might not even have a problem.
[quote]edwardhuntington wrote:
Flexion is pretty meaningless functionally… so you might not even have a problem.[/quote]
I am going to have to disagree with this statement. For the deadlift, active knee flexion is useless, but in all around knee function and athletic activity, knee flexion is very important. When it comes to ACL repaired knees, hamstring strength, especially distally at the insertion on the tibia, is very important. Among other things (including gluteal strength to avoid a valgus knee position, proper ankle and hip mobility, etc), distal hamstring strength can help prevent and resist anterior tibial translation, which is what the ACL’s purpose is as well. Decreased/insufficient strength of the distal hamstring = increased load on the ACL when an anterior translation of the tibia occurs during activity.
Now I am not advocating performing huge amounts of isolated knee flexion/hamstring curls as prevention work for ACL injuries, but you can’t ignore that function of the knee as well. With proper exercises like glute ham raises, sprinting (when appropriate for ACL repaired knees), swiss ball curls, slide board curls, etc, you can incorporate hip extension with knee flexion strength and develop proper motor patterns at both ends of the hamstring. If you develop strength at the hamstring into hip extension, it will help develop all around strength of the hamstring which may help with knee flexion, but you can’t just ignore the motion. Obviously, the glutes and hamstrings work synergistically for hip extension and proper glute function is a huge priority for healthy knees. But if there is a weakness associated with knee flexion, you can’t ignore it.
Also, for all around knee health and injury prevention, you don’t want weak hamstrings in the knee flexion action. Weak hamstrings in the knee flexion action can result in the IT Band taking up the slack in that motion and becoming over dominant. That can lead to other issues, including IT Band friction syndrome and other pathologies up and down the chain due to stresses placed on the lateral knee and fibular head and tightness in the hip due to a tight IT band leading to a tight TFL.