Building High-Performance Muscle™
Injuries and Rehab
 
Deadlifts & Squats Post ACL Reconstruction
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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

What's up guys. This is my first post here after around a year of lurking around the forum.

I have had a torn ACL/medial meniscus since I was 10 years old. I??m 21. Finally had the surgery 4 months ago. Hamstring tendon. Rehab has been tough but I've come far. My ROM is very good, lacking maybe 10-15 degrees flexion. No pain ever, only occasionally discomfort.

Both my physio and surgeon wants me to stay away from deadlifts and squats past 90°. Oh and use light weights, high reps 20 minimum.

First of all: How long should I stay away from deadlifts post ACL-surgery with a hamstring graft?

Second: I started doing deep squats (below parallel) a couple weeks ago and my quad and hamstrings already feels much stronger and a lot more explosive. OK great. I have two concerns however.

1) is it bad to do weighted squats 4 months post-op? I do 20 reps with good form. Heaviest I??ve gone so far is only 80 lbs.

2) will I be at risk of stretching my new ACL graft when doing deep squats? I disagree with my physio that say don??t go past 90. I have more ROM than that so why not go deeper and work out a bigger range of the muscles? Also going deep activates the hamstrings and glutes.

I??m asking these questions because I disagree with both my surgeon & physio on this subject and want outside input. I have also read numerous threads on misc workout forums where people say "screw your doctor, he's wrong" when it comes to squatting. I am gonna listen to what he says, but then again he's not sports oriented so I want outside opinions.

I am hoping that a PT will read and reply to this.

Thanks and peace out.

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iVoodoo
Level 5

Join date: Mar 2011
Location:
Posts: 429

Tough call man, tough call.
On one hand, the typical six month recovery period is extremely cautious in my opinion and experience,(I tore mine in 08') on the other hand, I'm not a doctor, and really am not qualified to evaluate you or your individual needs.

I was back to just about full speed (Sprints on flat ground, near maximal lifts, even shuttle runs) in about four months time.
I went at my pace, I rehabbed hard, it was pretty much my job to get better.
Saying that though, I was in constant contact with my physio, and never did anything that felt uncomfortable.

So, basically, go your own pace, but work with a physio that you find competent and accommodating.
I dumped a few physios before I found the one I wanted to work with.
He let me squat :)

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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

Haha yeah I had to dump one pt myself ;) But my current one is nice and knowledgeable. However she is 30-something year old and a mother so she doesn't share/understand my workout goals.


I have been doing what you say in regards to do things my own way and at my own pace and that has been working so far. What I'm worried is that deep squats will stretch my new ACL without me knowing about it.

My surgeon lets me lift weights, do squats and deadlifts, even surf and play hockey (no contact). He says do whatever you want, but progress slowly and listen to your knee. However he also said strict no running/jogging until 6 months. He's worried that running will stretch it being that the hamstring graft has a longer tension which increases the risk of laxity.

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iVoodoo
Level 5

Join date: Mar 2011
Location:
Posts: 429

If it hurts, don't do it, it's probably as simple as that.
:)

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BReddy
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Join date: Jun 2011
Location: California, USA
Posts: 110

mattis wrote:
What's up guys. This is my first post here after around a year of lurking around the forum.

I have had a torn ACL/medial meniscus since I was 10 years old. Iâ??m 21. Finally had the surgery 4 months ago. Hamstring tendon. Rehab has been tough but I've come far. My ROM is very good, lacking maybe 10-15 degrees flexion. No pain ever, only occasionally discomfort.

Both my physio and surgeon wants me to stay away from deadlifts and squats past 90?°. Oh and use light weights, high reps 20 minimum.

First of all: How long should I stay away from deadlifts post ACL-surgery with a hamstring graft?

Second: I started doing deep squats (below parallel) a couple weeks ago and my quad and hamstrings already feels much stronger and a lot more explosive. OK great. I have two concerns however.

1) is it bad to do weighted squats 4 months post-op? I do 20 reps with good form. Heaviest Iâ??ve gone so far is only 80 lbs.

2) will I be at risk of stretching my new ACL graft when doing deep squats? I disagree with my physio that say donâ??t go past 90. I have more ROM than that so why not go deeper and work out a bigger range of the muscles? Also going deep activates the hamstrings and glutes.

Iâ??m asking these questions because I disagree with both my surgeon & physio on this subject and want outside input. I have also read numerous threads on misc workout forums where people say "screw your doctor, he's wrong" when it comes to squatting. I am gonna listen to what he says, but then again he's not sports oriented so I want outside opinions.

I am hoping that a PT will read and reply to this.

Thanks and peace out.


I started doing deadlifts about 10 days after my ACL surgery. And I had a hamstring graft. I'm almost at 12 weeks right now. Albeit I went very light at first, just my bodyweight, but at four months you have nothing to worry about. Did the same thing with squatting (to 45 degrees though).

AFTER four months is about when it's ok to squat to full depth again. After 12 weeks the graft is essentially set in place. Some more remodeling may occur but the drilled bone is fully healed and set in place. Four months there really isn't anything to worry about.

High reps-20 minimum is retarded advice.

Next, waiting 6 months before you can run is unnecessary. Unless you are some bizarre case there is no way in hell it should take you that long. 6 months before you are full speed, cutting, jumping, yeah. 6 months before you can even jog in a straight line? No.

Finally, do all your running backwards and side to side before forward. Nobody ever mentions this but it is the way to go.

Your primary concern regarding your hamstring graft should be regaining your knee flexion strength. Stop worrying about squatting so much.

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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

Hi red thanks for replying.

Woah, deadlifts 10 days post-op? Thats crazy. even with bodyweight. I was on crutches for a month and my hamstring hurt like a bitch when I was walking around.

My surgeon's justification for wanting me to wait 6 months before running is that he wants my new ACL graft to last a lifetime, so to wait a month or two extra is a small price to pay to be on the safe side. But I don't jog anyways so it's not a biggie. I do walk a lot however, and its been all well and good. Some occasional morning stiffness/discomfort but nothing out of the ordinary.

I have been deadlifting/squatting the past two weeks and it's been great. I'm still a little scared about screwing my knee up again so I haven't gone super heavy. Currently doing 5/3/1 where I did 185 sumo deads and 135 squats this week. I haven't had any pain. Actually my knee has felt stronger this past week than it has since the surgery. It feels tighter and I have a bit less cliicking/popping when walking.

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olifter1
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Join date: Sep 2008
Location:
Posts: 105

mattis
How old is your MD? I'm not sure he has research to demonstrate ACL's lasting 59 years (you're 21 now and may live to be 80). At the 16 week mark you should be progressing to full function/sports if that is your goal. Keep working your range. Your PT, if qualified for sports medicine should be assessing your jumps, agility, landings, strength ratios, etc. BReddy is right and get your knee flexion/hamstring function going. Some anectdotal guidelines for full go on sports conditioning/progression:

Full knee flexion
knee flex/ext strength ratio: 75%
Quad strength: 79% of other side
Hop test: 80% of non-surgical side
No pain or swelling

My opinion would be to focus on single leg activities. You'll get a better idea of where you surgical side compares to the non-surgical side. Use mirrors with two leg activities to look for compensation patterns.

These are based on anectdotes/current guidelines in rehabilitation settings.

As always, consult with your physician. These statements are not supported by the FDA.

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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

If by MD you mean my surgeon, he is in his 50s. This guy is supposedly one of the best orthopedic surgeons in california. Hes operated on several pro skaters and other athletes like former 49ers wide receiver Jerry Rice.

I had my last PT session last week cause of insurance issues. If I get more sessions covered I?ll go to KStar @ SF crossfit. He knows his stuff so I really hope the billing issues get sorted out.

My PT did not have me do a lot of jumps etc. I will hopefully start playing ice hockey as I was really active in this sport in my teens.

Could you elaborate on those numbers you put up? How long post-Op are these numbers calculated from? 12 weeks?

I?m lacking some ROM and usually have some morning stiffness: Specially if its cold outside.

This is my current ROM. Little stiff right now. After leg workouts I can bend it a little further. My operated leg is in general a lot more stiff than my left. And I know that my right glute/hamstring is weaker than the left. But I don?t really notice this when squatting/deadlifting.

This is 19 weeks post surgery.



How would you say I'm doing at this stage?

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olifter1
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Join date: Sep 2008
Location:
Posts: 105

mattis,

Those numbers are arbitrary. Some take longer some shorter. Usually those are at the 16 week mark (with some wiggle room (+ or -).
Your range looks great for flexion. Hopefully you have full extension (can be difficult with a hamstring graft).

Remember you need to walk before your run. I wouldn't recommend sporting activities until you can perform full jumps with a stong single leg landing. Continue with balance activities, single leg, pliable surfaces/dynadisc/etc. Strength is king for all activities. Make it progressive. If you move too fast you may get increased swelling or symptoms. Listen to it.

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icwallac
Level 4

Join date: Jun 2008
Location: Texas, USA
Posts: 45

Your situation is tough to comment on from a PT standpoint. From the outside, there should be no reason you can't do deadlifts at 4 months unless you don't have the necessary ROM in both legs. However you mentioned a medial meniscus tear, as well, and it depends on if the physician performed a menisectomy or a meniscal repair. The 90 degree limitation they talked about is to limit loading of the menisci, not the ACL. Although 4 months still seems conservative. The biggest factor to look at is how you feel immediately and the day following the exercise. If there is increased swelling or medial joint pain then you should back off until the musculature can unload the joint enough to prevent that kind of response.

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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

@ icwallac
Thanks for responding. I had a meniscectomy and not a repair. He said it was a pretty complex tear. He removed 10-15%, which is very little.

I have been both squatting and deadlifting for three weeks now. Was a little nervous at first but I've had no pain or swelling. My knee actually feels better than ever! There is less clicking, less morning stiffness and it feels a lot more stable. I've also gained quite a lot of strength and muscle mass in only three weeks of training. It's just incredible how well my body has responded to my training efforts this month.

Oh and I went ice skating a couple days ago. Knee held up just fine!

I would say the strength is around 80-90% compared to my non-operated leg.

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icwallac
Level 4

Join date: Jun 2008
Location: Texas, USA
Posts: 45

What was your surgical date?

As long as the knee isn't swelling during or following the activity you are okay. Just be careful with progression because the medial femoral condyle and medial tibial facet bear the majority of the force during weight bearing. Pay attention to soreness and swelling post workout and that will help tell you if you are doing to much.

Also, be care about assuming how strong your involved leg is. Strength deficits are masked in bilateral lifts. Almost all ACL replacements demonstrate decreased strength and loading up to or longer than one year when measured by force plates regardless of how the person feels. Just keep that in mind. Revisions suck...

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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

icwallac
I replied to your post a couple days ago but I see that it did not go through for some reason.

My surgical date was October 31st, 2011.

I am cautious about progressing too fast. thats why I made this thread in the first place. Plus, I've gone through too much crap after the surgery to put myself at risk of retearing it. But thanks for reminding me :)

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TripleC223
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Join date: May 2010
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Posts: 58

Hey mattis, sounds like you are coming along pretty well. Just wanted to share my experience and offer a little advice.

I tore my ACL and meniscus playing basketball close to two years ago and had a hamstring graft and meniscus repair (Second ACL surgery for me, had the other on my other knee. I have torn both one time each, one with a patellar graft, the most recent a hamstring). I shared your same frustrations with my physical therapist taking things too slow. She was very knowledgeable and experienced, but it's hard to find a PT who isn't cautious with this injury. I don't think she understood the itch to get back in the weight room that most people on this forum would experience.

That said, my recovery was a bit different because of the meniscus repair. I was not allowed to do any kind of load-bearing past 90 degrees for several months for risk of tearing the meniscus repair. Stretching the ACL graft was never a concern my PT voiced. She was much more concerned with the meniscus. I did, however, start a running program at three months which is a pretty standard timeline.

I hammered away on the leg press in place of squats for the first three months (at first high reps, but then sets of 8 reps with heavier weight). I moved on to box squatting to parallel once I began running. I started out very light, but after about one month of box squatting I began back squatting to parallel. I started out with very light weight after I removed the box, but in about two months I worked my way back to 225 for sets of 4-5. As a reference, before the surgery I maxed out at around 300 back squat and 350 deadlift.

The biggest problem in returning to heavy squats and deadlifts was the asymmetry in strength and size between legs. My surgery leg took a little over one year to feel "equal" to my other leg. You'll find that when you start to load up your squat/deadlift, you can actively feel one leg working harder than the other as you reach the peak of the lift. You may be able to combat that for a while with lighter weight, but when the weights get heavy it's just natural that your stronger leg takes over.

What I did to balance things out was to start my workout with a heavy bilateral compound movement, be it back squat or deadlift. I would go heavy on that, maybe 4x5 or something similar with an appropriate weight. After that, I would do a unilateral push and pull movement with 1-2 extra sets on my recovering leg. It went something like this:

Back squat 4x5
Single-leg RDL 3x8 left leg, 5x8 right leg
Bulgarian split squat 3x8 left leg, 5x8 right leg

I used the same weight for each leg on the unilateral movements. This was part of a full-body routine that I did 3 times per week. I usually paired the unilaterals with an upper body exercise. Not only do the unilateral movements build up strength in each leg independently, it gives you a good way to gauge how you're progressing in your strength and balance.

On the off days (every other day, 3 times per week), I ran. That in itself is a different progression that you should check with your PT about. Too much running, and you'll know about it the next day. I should also say that I never went into a workout without warming up my knee. I always rode the exercise bike for 10-15 minutes before I lifted or ran. I also iced my knee after EVERY workout, be it running or lifting.

I started jump training at around six months using box jumps, broad jumps and single-leg box and broad jumps (x1 and x3).

At the one-year mark, I decided to max out my squat. I hit a new PR, getting up 345. Four weeks later, I maxed out my deadlift and pulled 415.

The best thing I can tell is probably something you've heard 100 times already: be patient. The first six months is so mentally taxing because you want to get back in the weight room and start throwing the weight around. Don't push it. The time between six months and one year after surgery is when your strength starts coming back. Once you have the training wheels taken off, you'll be amazed at how fast you're able to get back to where you were before the injury.

Good luck to you.


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mattis
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Join date: Feb 2012
Location: California, USA
Posts: 77

TripleC,
I am sorry for not responding to your post earlier. I simply did not notice that there was another post in this thread. Anywho, great post. Thank you.

I've started to load up the bar with some heavier weights. A couple weeks back I pulled a 295 deadlift (single rep, new PR for me) and yesterday I squatted 225 for seven reps. Also a new PR. I have not yet experienced what you are saying about the stronger leg "taking over".

One thing that I've noticed about myself is that I'm getting lazy with the rehab exercises. After a heavy squat/deadlift session I feel that those bodyweight rehab exercises will not be of any help to me. After pulling 300 pounds off the ground, how will balancing on a bosu ball with 15lbs dumbbells help me?

That being said, doing single-leg deadlifts etc. makes a lot more sense to me. I'll be sure to include those exercises you mentioned.

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