"Bulletproof Knees" Applicable Information for Pre/Rehab

[grprahl]

The purpose of the Bulletproof Knees Manual by Mike Robertson is to help rehab and correct issues that cause knee pain. After reading it last night, I feel that much of the general information parallels information that is spread throughout this board regarding pre and rehabilitation, soft tissue work, etc. For many of you this information is probably obvious, but probably not for everyone.

Instead of treating symptoms and taking a "physical therapist-like" approach, which aims for general rehab goals like walking without a limp, etc, we should shoot for a more exacting approach for full rehabilitation. Oftentimes this means fixing mechanical and/or neurological issues far from the area that was injured. In the example of knees, a quad-dominant lifting program, combined with the fact that many Americans spend a significant portion of the day sitting, can shorten and tighten anterior muscles like the quads and hip flexors. Not only does this put extra stress on the knees, but it causes anterior pelvic tilt, which puts the hamstrings in an overly stretched position. This makes in mechanically harder for the glutes to work properly, transfering much work directly to the hamstrings, which are already weakened from their overlengthened positioning. This causes a couple problems. For one, injuries such as hamstring pulls and ACL tears occur more readily (the hamstrings are designed to absorb force that decreases the load on the ACL during certain movements. when they are weakened from poor biomechanics, this ability is compromised, causing the ACL to take the full brunt of the shock). Secondly, athletes with anterior pelvic tilt often complain of "tight hamstrings" and as a result, will stretch the hamstrings. In fact, the real area they should be focusing on lengthening is the hip flexors and quads to help correct the pelvic tilt.

Some joints are designed to be stabile, while others are designed to be mobile. With increased stability we have decreased mobility, an dvice versa. This idea was initially presented by Gray Cook, I believe. The ankle and hip are mobile joints, while the knee is a more stable joint. The scapulare are a mix between the two. If you have a lack of mobility in the hip and ankle, injuries in the stable joints are more common because they are forced to become more mobile than they were designed. This example can be applied to upper body joints as well.

Robertson lays out a general plan for reaching full capacity: 1. Soft tissue length and quality 2. Mobility 3. Strength Training

According to Robertson, soft tissue lengthening is best utilized by dynamic stretching pre-workout, eccentric quasi-isometric (EQI) exercises post-workout, and static stretches at night. EQI exercises are where we put the body in an active isometric position near the end of our range of motion. As the body gets tired, it sags down even further, increasing the stretch while still under tension. German hang holds and weighted pike stretch sound familiar, anyone? I know Slizzardman has talked about these to me before. There are many great benefits to this type of active stretching post-workout.

For soft-tissue quality, foam rolling, ART, deep tissue massage, and Self-instrumented massage (SIM) are all mentioned. He has a nice chart showing which modality treats which tissues best. Foam rolling can be done almost every day if needed. ART can be done one to three days per week in a “remodeling†phase, or biweekly or monthly for “tune-upsâ€. Deep tissue massage is a necessity at least once a month. Sometimes massage schools give cheap massages from students required to complete a certain amount of hours before graduation. SIM, also known as IASTM, Graston Technique, Starr Technique, etc, are where we use tools to amplify adhesions in the tissue, making them easier to identify and work on. He recommends no more than one to two (5-10 min) sessions a week, as this is a very invasive, yet powerful, technique. I will add that Graston was the only thing that brought my pulled hamstring to full pain-free activity even when ART didn’t. It can be self-performed using baby oil and a tool such as the handle of a butter knife. As with any soft tissue work, you should have a sound knowledge of your anatomy/physiology before attempting the work on yourself.

One more useful thing he noted involved strengthening. When initially rehabbing an injury, he believes it best to focus on uni-lateral exercises to enforce proper muscle recruiting. In bilateral exercises it’s too easy for the body to avoid the injured area, using a different set of muscles to get through the movement, only furthering the strength imbalance. Also, it can be of great help to use activation exercises prior to the strength work to activate proper firing patterns. Examples of this would be glute bridges to activate the glutes before performing an exercise that combines the whole posterior chain.

[Seiji]

Sounds bulletproof to me

[Erik Sjolin]

Sounds bulletproof to me

Ba-dum tiss.