How I Fix Knees

My approach to ACL and other knee injuries

Author

Zak Woodward
November 11, 2023

Helping people with knee injuries, particularly ACL injuries, has become the main focus on my coaching in recent years. I have helped over 60 athletes come back from various major knee injuries: ACL, MCL, and LCL tears, meniscus tears, or some combination all at once. 

To date I have not had a single athlete who has finished their entire recovery process with me re-injure their knee or injure the other one, a stat I am very proud of.

Not only that but, due to having unconventional methods and still being relatively unknown, I am rarely parents and athletes first choice after an injury. They tend to come to me after getting hurt for the second or third time, or after working with a handful of PT’s or specialists but still not making the progress they’re looking for. The 'Problem Children' as I lovingly call them.

A skiier I worked with, for example, was coming back from her ninth knee surgery (yes nine) when we started working together. Needless to say she had exhausted every other opportunity available to her and was still stuck in this endless cycle of pain and injury. After working together for less than 6 months she returned to skiing pain-free and remains that way to this day.

I tell you this not to brag but to offer proof that what we are doing is actually getting results.

Compare these results with current statistics on ACL return to sport (1):

  • Less than 50% of athletes return to pre-injury level of sport activity

  • Of those nearly 30% will re-injure their knee within the first 2 years

  • And another 20% will injure the other knee

That’s less than ¼ of all athletes who sustain an ACL injury returning to full sport activity without sustaining a second injury.

Those kind of numbers make me angry. When I look at that I think 'you're damn right I do things differently because if that's what 'normal' gets you these days I want nothing to do with it.'

If I had to sum up what we do differently in one sentence it would be:

'We challenge our athletes more, without pushing through pain, in ways that build the muscles and joints to levels greater than they were before they got hurt.'

Standard ACL Return to Sport Criteria is getting the injured leg within 90 - 95% strength of the non-injured leg and 85 - 90% symmetry in single leg hop testing (2). So not only is it acceptable to be less than 100%, but we are comparing that not to your pre-injury levels but to your non-injured leg which has spent the last 9 months also getting weaker due to not being used at maximal intensity.

I disagree.

I believe that every athlete should leave me stronger than they were before they got injured.

If you got injured at your previous best your previous 100% (especially if that was a non-contact injury) then that should be our minimum threshold we should be looking to reach and exceed if you want to come back as strong and as safe as possible.

You should be stronger, more athletic, more capable if you want to return to the field confident in your ability to both compete at a high level and stay healthy.

Declaring this goal from day 1 sets the tone for everything we are going to do together. We are going to have higher expectations for you than anyone you have worked with before… and that is going to push you to excel.

In order to do that we need to challenge our athletes, to push them, hard. This is possibly the biggest problem most athletes face with conventional rehab… it becomes too easy. They stopped being challenged and they stop progressing.

The caveat, however, and the other major issue athletes run into, is we do not want to push through pain. Pain is a signal that we are doing more damage than we can recover from, that we are actually setting ourselves backwards rather than moving forwards.

A mantra I repeat to my athletes is that training should be hard, not hurt.

We can also use this idea to our advantage. As long as we are not doing something that is painful, we can push you as much as possible and be confident all the work we're doing is pushing you forward towards your goal of getting back on the field.

So we want to challenge our athletes as much as possible. Push them to become even better than their previous best, all without pushing through pain.

The way we do that is with strength training that prioritizes key muscle groups that protect the knee as well as exercises that strengthen the joint itself (the internal structures like the tendons, ligaments, and connective tissue). This is how we can strengthen the knee from the outside and the inside to help our athletes become more athletic and more durable.

Progressing our athletes to freaskish levels on the nordic curl, for instance, is one way we are able to build exceptional hamstring strength in our athletes. This not only improves sprint speed but is crucial for ACL injury prevention and is an area that can still be lagging behind up to 2 years after surgery in some cases (3).

Another area of interest is the Vastus Medialis Oblique or VMO. This is the tear-drop shaped muscle on the inside of the quad that plays the biggest role in the stability of the knee. Unfortunately it is also the area that will often atrophy the most after surgery and tends to be the most challenging for athletes to rebuild post surgery. 

We use very specific exercises (like step ups and deep squats) to load and develop this muscle group as much as possible and is how we are able to get transformations like this:

Now in reality everything is important when it comes to Return to Sport after an ACL or other serious knee injury, all the pieces of the body work together as one unit so even if something small is off, it can throw off the whole system. These are just two areas we are particularly interested when it comes to protecting the knee specifically.

That's it.

That's my approach in a nutshell:

Challenge you as much as possible, without pushing through pain, to come back stronger than you were before getting hurt by strengthening the joint from the outside and the inside.

I have spent a long time giving out tips and tactics and highlighting different aspects of my training, but I wanted to put this out to explain why I'm doing certain things… what my thought process is.

My hope is that understanding this will make everything else I post and write about easier to understand. I also hope that this can give you ideas on how you can improve your own recovery or the recovery of people you work with: perhaps highlighting something you might have overlooked.

If you are looking for help with your own recovery check out my training application below. This is where we can start a conversation and see if you're a good fit for our 1-on-1 coaching program.

Feel free to reach out and connect with me on Instagram @zakwoodwardatp as well. I'm also starting to be a little more active on twitter and YouTube. If you have something specific you want me to cover let me know! 

Otherwise I will see you in next week's newsletter. Till then, bye! (peace)

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