5) Keep your hamstrings very strong, and don't do "quadriceps extensions", ever. Closed-chain only. Squats, lunges, and creative variants thereof.

Yes to strong quads, no to quad extensions are evil. Used within the proper range of motion, with the machine adjusted correctly for leg size, and with low to medium weights, quad extensions are a good way to target muscles that will atrophy after surgery. Combined with hamstring curls, plus the others mentioned, these open chain exercises have a valid place in routines. Around 6 months post-op, after all the PT, they can be useful getting the muscles back. Lunges the way a lot of people do them are arguably worse on the knees even though they are closed-chain. Some of the silly "funcitonal" stuff people do on a Bosu belong in a Richard Simmons video--useful for rehab, dumb for training.

Boracus, heel hooking isn't a problem at all for at least one friend who had the hamstring graft. YMMV.

I have had two ACL surgeries since 2002. The first was a patella tendon (Check Spelling) and the second a hamstring graft. Most Docs wont even suggest a Patella graft anymore due to the pain assoscated with the knee long term. I have total recovery in my knees as far as sports and climbing goes, but have loads of pain and arthritis in the knee where they took my patella. You will have a weak hamstring if you use a hamstring graft but with proper and diligent rehab you can fix that; you cant fix the damage to the front of the knee with the patella graft. My hamstring is as strong as ever, the only problem I have with it is that sometimes it strains a little easy if I don't stretch well.

Good luck with surgery...as long as you do what you are suppose to your recovery will be fine!

About seven months after surgery I slipped on some gravel and tore the hamstring that the graft was taken from, so don't rush your recovery. I would say it took me about a year to be comfortable to climb on.

My son, 17 years old and interested in extreme sports, tore his ACL, MCL and meniscus in January and had surgery that month at Steadman-Hawkins. Since he can't ski this summer, he is looking for a new sport and would like to try a NOLS course that includes rock climbing.

When you talk about quads "coming back"...the context here is a rockclimber, not a bodybuilder. Extensions can certainly "build up" the quads, and make the legs appear more symmetrical. I'm sure you are aware, though, that doing extensions DOES NOT appreciably improve the ability to perform a squat lift.

Doing extensions improves...your ability to do extensions. My focus as a PT, is improving FUNCTION.

Doing squats improves your ability to high-step, heel-hook, drop-knee, hike uphill to the crag with a pack, downclimb, and probably several other things.

It's interesting you are concerned about people doing lunges "the way a lot of people do them", yet you are seemingly unconcerned about applying a similar standard to extensions. Any exercise can be done "wrong".

Also, when you say a Bosu, or "functional exercises", are "silly", but that they are "useful for rehab"...well, the context here IS rehab, from ACL repair.

For pre-surgery strengthening of muscles that atrophy severely, extensions are useful. As post-PT (IOW after you have done your job) exercise, again extensions can be very helpful at strengthening muscles that have atrophied. I'm talking about the time before and after an ACL victim works with you (2 months before surgery and starting around 6 months after).

As you probably know, "functional training" has been quite the fad in the past decade. They stole a bunch of ideas from you PT types and then applied them to non-injured people. What works great in your application is now proving lousy for sport conditioning. The studies coming out in the past couple of years show that training combining instability/balance challenges/multi-planar movement are not as effective as the hypesters want people to believe. Making the muscles strong, no matter what the exercise, and then working on sport specific movement is most productive.

In that context, extensions are just as valid part of a training program as squats. It isn't an either/or, it's another tool in the quiver but a lot of the claims are made about extensions being bad. Personally, having had operations on both knees, I think just about all lunges are worse for training and especially rehab.

Laurie, ditto the comments about road cycling as a better option than rockclimbing. Plus, depending on the NOLS course in question, carrying a heavy pack off-trail could be a very bad thing for a knee. Boating itself is great but all the walking around on slick rock can also be less than knee-friendly.

Anterior/posterior tibiofemoral shear forces(Wilk):

Knee extension(OKC): 100-45 degrees load PCL ligament until 40-0 degrees which is ACL load
Knee flexion (OKC): 0-40 degrees ACL load
Squat and leg press (CKC): peak PCL load at knee flexion 90 degrees, no load on ACL.

quad extensions will make your quads bigger, but they won't help you squat significantly more, or help you run a faster 40 time, or jump higher. They will improve your ability to perform quad extensions.

Actually I'm talking about leg rehab after the ACL rehab. PTs quit when there is still a lot of work to be done getting back into shape. It isn't as simple as open chain versus closed chain. In particular the higher compressive forces of back squats is rough on the meniscus so it isn't a great choice (http://tinyurl.com/dhq4zl). Leg presses also fall into that category and there people can do all sorts of weird angles. Yes there is a shear force in extensions and curls but that is why low to moderate loads and specific ranges (Wiilk used extreme examples that aren't relevant) are recommended.



And this is where you are simply wrong. OK you'd be right if they only did extensions and nothing else but that isn't the way it works. Combined with other exercises, they can help you get stronger faster and without injury.

And this is where you are simply wrong. OK you'd be right if they only did extensions and nothing else but that isn't the way it works. Combined with other exercises, they can help you get stronger faster and without injury.

In particular the higher compressive forces of back squats is rough on the meniscus so it isn't a great choice.

OAHM is totally right on this one.

If you want to get back faster, then use all the tools in the shed and don't limit your options.

You seem to fallen into that trap too of mono-think and over-hyped functional training to the exclusion of everything else.

and I have never, ever implied do just open

In particular the higher compressive forces of back squats is rough on the meniscus so it isn't a great choice

The way studies are conducted, they never compare an AB routine to A and B, only A versus B (they are also limited in time frame due to cost).

OAHM when i said Wilks used extreme examples to prove his point, I was specifically referring to taking the knee past 90 to 100 and past 15 to 0. It's those extremes where the majority of the shear occurs yet most of the muscle activation is between 80 and 20.

For the lurkers...

...And if you want to prevent another ACL repair, focus on strengthening the hamstrings.

The reality is that anyone will get stronger faster by doing a combination of closed and open chain exercises instead of just closed

Trying to train motor skills at the same time as strength is dumb since you won't get optimal results for either.

You seem to fallen into that trap too of mono-think and over-hyped functional training to the exclusion of everything else.