Importance of Movement Progressions for Post Surgery Knee Recovery

Today I have a great post for you on what to do post knee injury to help your knee recover.

Enjoy!

– Rick

Movement Progressions, What are They?

And why you should know how to use them to help yourself or your clients recover after knee injuries.

Before you finish this article I want to share with you how important movement progressions can be in recovering from injuries and returning back to competing sports or excelling at exercise. But first, I want to share with you why this information is so important.

Before I get to that, here is a sneak peak into what I do:

I first saw Rick speak about a year ago in Las Vegas. I liked where his head was at with regards to the exercise industry and decided to keep a close eye on his programs and information. It was a good thing I did because something rather lousy was about to happen to me.

You see, like a lot of fitness professionals whose goal is optimal performance, I like to cross train in several different sports. This keeps me on my feet (or so I thought) and makes me a more well rounded coach. This time, however, I was mistaken…

I had decided to join an “adult” gymnastics class with a friend of mine. I put the quotations around the word adult because the next youngest person there was the ripe old age of 16. I was having trouble during one part of the warm-up where were being instructed to do a punch 360 to a dive roll. I couldn’t smooth out the motion and make it flow as one movement. As I geared up for my last pass of this particular warm-up drill I centered my thoughts and said to myself, “I’m gonna punch so hard that there’s no way I can miss this movement.” And punch hard I did.

As I landed from my 360 to punch for my dive roll I felt instant and terrible pain. I tumbled to the ground and realized something bad had just happened. Long story short, my movement mistake cost me a partial tear in my LCL and MCL, a damaged Meniscus, a torn Quad and an ACL that officially said Bye Bye!

I knew instantly that it was a long road ahead to get back to where I was.

Now, I need to interject that this isn’t the first knee injury I had. In fact I jacked the other knee up 8 years before in a car vs. bike accident (I was on the bike). The good news, however, is since I had already gone through a knee injury before, I knew what had to be done to make it better. I already knew the mistakes I had made and what progressions I should be doing. The knowledge that the first injury gave me would only be increased by my journey towards recovering from the more recent injury.

So what are these movement progressions that I keep talking about?

The simplest way to describe a movement progression is to think about the way a baby goes from being born to being able to walk.

At first the baby spends most of its time in a reclined position. As babies begin to gain control over their core muscles they are able to then roll over onto their stomachs and hold their head up, and eventually this ‘tummy time” turns into pushing up and crawling, followed by lifting the body in the air and holding a standing position with support. Once they are confident in holding a standing position with support they start their new journey of learning to move on 2 legs.

Now as simplified as this may seem, if we miss any step along the way, we most likely won’t end up being as functionally (I hate that word) developed as someone who goes through all the steps.

Simply put, you need to earn the right to do the next movement by developing the necessary mobility and stability to properly perform the preceding movement.

Would you start a new client out on a one leg squat?

How about a rehab client?

I don’t think so.

So let’s get you to the meat of this article so you can understand the exact movement progressions I originally used on myself, and then went on to use on dozens of my clients to get rid of knee pain and return to optimal performance.

Before I jump into the actual movements here are 3 rules you need to follow in order to maximize the results you will get from using movement progressions in your training.

3 Movement Progression Rules

Rule #1 – Do not worry about reps, sets, or any other workout parameter that someone gives you. Instead focus on how the movement feels. Focus on mastering the movement so you have complete control every step of the way. Do not consider moving on to the next progression until you could send Rick or myself a video (please don’t actually send a video) that we would give you the thumbs up for.

Rule #2 – Be patient. In order to be able to return to competitive sports or just killing it in the gym you need to be patient. One of the biggest lessons I learned from knee injury #1 was to take my time. Whenever I tried to move to the next skill too fast I woke up inflamed and in pain. Being patient is the only way to get back to your old abilities and beyond.

Rule #3 – Seek help. If you aren’t sure whether you are doing things right or not, seek help. Purchase products that will help you, hire coaches that know how to help you, and don’t settle for your garden-variety trainer or physical therapist. If you’re not feeling better or seeing performance results in 5 sessions then fire them and find someone who can help. It took me years to accept help but now I realize the importance of it. I hire coaches for everything from business to rock climbing. Seek help and you will cut your road to recovery in half!

All right, let’s start out with the absolute basics. The first few things I see on people who are coming off a knee injury or even worse, a knee surgery, are they lack terminal knee extension and flexion, their glute has turned off, and their gait is out of whack from walking with a brace on. Here’s how I like to approach this issue.

First, their physical therapist or other qualified practitioner should be the one responsible for getting their range of motion back. Please don’t lay your hands on your personal training clients pretending to be a therapist. If they are not getting terminal extension and flexion, you should refer them to a physical therapist that you know can help them achieve these end ranges of motion.

Problem #1 – Connecting with Gluteus Maximus

Second, you need to re-establish their connection to their glute muscle.

My favorite way it to have your client or yourself (if you are the one rehabbing) reactivate their glute is to lay prone, bend both knees so the bottoms of your feet are facing the ceiling, and then lift one leg at a time attempting to use just your glute muscle and not your back and hamstrings. This should be a small range of motion and if held for time should yield a mean butt burn rather then a set of pumped spinal erectors or cramping hamstrings.

Once you have established a connection with that muscle again, it’s time to move to a standing position.

There are 4 drills that I like to use in a standing position in order to get someone to stabilize their knee through the hip. The first two are the basic drills, the third drill should be done when mastering the first two, and the fourth drill should follow mastery of the third drill.

Drill #1

Start by facing a wall with your toes about 2 feet from the wall.

Place a pad on the wall about hip height and lift one leg with the knee bent to parallel and place that knee on the pillow.

Keep your spine neutral and your pelvis parallel to the floor and the wall. Press your knee into the wall using your glute muscle. In this position, which emulates a triple extension found in most sports, you should feel the glute muscle firing hard.

You may need someone to test your glute or give it a series of light pokes in order to make sure it is firing rather than your calf and hamstring. Hold for a time and think of perfecting the feel of the movement rather then following a set time limit.

Drill #2

The second glute drill starts by turning 90 degrees from the wall and bringing your feet underneath your hips and crossing your arms.

From there descend into a ¼ squat making sure you feel the weight in your heel, and either side of the ball of your foot. Lastly, lift the foot closest to the wall off the ground by curling your hamstring and proceed to push your knee, the side of your thigh, your hip and your shoulders into the wall, while still maintaining a neutral spine.

Hold for a time and feel the burn! You know you have it right when you feel the muscles of your hip and glute burning. You know you’re not quite doing it right when you feel your leg muscles burning out or your knee is bothering you.

Once you ‘vemastered the above 2 drills it’s time to move to the standing glute activation holds. These positions should emulate the 2 moves we already practiced without the use of a wall to provide proprioceptive feedback. For the top position, stand on one leg with your thigh around parallel, and complete the extension of your hips by firing your glute. For the ¼ squat drill, assume the same position as when your side was against the wall, and again feel the burn in those glute muscles.

Finally, once you have mastered the 2 static standing positions, make them one move by SLOWLY moving from the extended position into the flexed position. Again the first muscle to say hello should be the muscles of your hip and butt. If your knee hurts or your quad and foot burn, go back to the preceding steps and take your time to master them.

Once you have mastered these glute drills and you are feeling confident in your stability, here is a progression to practice to get you back to sports performance and beyond! Please do not rush through the basic steps, but rather make sure you have really mastered the basic foundation. Without going into great detail about the execution of each exercise, here is a list of the exact 11 movement progressions I use with my clients and myself.

1) Hip Stability And Glute Activation Drills (as we already discussed)
2) Assisted Box Squat (progress by increasing range of motion)
3) Box Squat (progress by increasing range of motion)
4) Bodyweight Squat
5) Goblet Squat
6) Double Kettlebell or Barbell Front Squat
7) One Leg Assisted Box Squat (progress by increasing range of motion)
8) One Leg Box Squat (progress by increasing range of motion)
9) One Leg Bodyweight Squat
10) One Leg Goblet Squat
11) One Leg Double Kettlebell or Barbell Front Squat

Here is a picture highlighting the 10-step movement progression sequence after mastering the hip stability and glute activation drills outlined above.

Problem #2 Check

Lastly, when someone comes off a knee injury they are much more likely to do what I call the peg leg walk. Instead of bending their hip and knee, they hike their pelvis using their core muscles and walk like they have a peg leg. Now, oftentimes the drills highlighted —  especially the foundational glute drills — help to fix this issue.

However, there are times when you need to dig a little deeper. The first place I look at is to make sure you or they have proper core function. Now, I learned a lot about how the core works from watching the lectures in Muscle Imbalances Revealed and you should, too. So, instead of going into great detail about the various movement progressions that you can use for the core, why don’t you check out Rick’s Muscle Imbalances Revealed so you can learn directly from the real experts. Watch those videos and you will know everything you need to fix the core.

Problem # 3 Check

So, here are the takeaways from learning to use proper movement progressions for post knee injury. Focus on movement first, be patient, seek help if necessary, make sure your PT is competent and helps to return your full range of motion, follow and master the foundational glute activation and hip stability drills, follow the lower body exercise movement progression outlined above, and buy Muscle Imbalances Revealed. No more excuses, let’s get that knee pain free!!

About the Author – Tyler Bramlett

Tyler Bramlett is a Personal Fitness Consultant and Boot Camp owner located in Santa Cruz, California. Plus he runs an active blog called Garage Warrior. His focus is on improving movement quality and skill to help people become stronger, more flexible, more coordinated, and injury proof. His certifications include RCK, CK-FMS, USAW L1 and CrossFit L1. Over the last decade he has spent countless hours and dollars seeking out and learning from many noted experts in the fitness industry including world renowned strongman Dennis Rogers, top physical therapist Grey Cook, originator of the kettlebell movement Pavel Tsatsouline, former Cirque Du Soliel Athlete Jean-Luc Martin, and many more.

If you would like to check out Tyler’s Warrior Warm Up, click here.

Rick Kaselj, MS