Last week, Dr. Anthony Falco discussed the role of the meniscus in the knee and when you should consider getting surgery to repair a meniscus tear. This week, I will discuss some things you should implement into your training program following knee surgery and how you can further progress after you have completed working with your physical therapist following surgery. Following any knee surgery it is imperative to build back adequate muscle mass in the quadriceps, re-establish proper landing mechanics and force absorption of ground forces during high power activities and solidify sprinting mechanics.
 
 
Eccentric focused exercises are your best friends
 
            After knee surgery it is common to experience atrophy (diminished muscle mass) of the quadriceps of the repaired leg. While your physical therapist more than likely focused on building back lost mass, it is imperative to continue this focus once you have moved on to strength and speed training.
 
            While I have no problem with seated leg extensions early on in the rehabilitation process, I believe other alternatives should be utilized in strength training protocol. Essentially, seated leg extensions limit activity of the hamstring while the quadriceps is contracting. This never really happens in sports. So, I prefer the terminal knee extension (TKE), as a quadriceps building exercise that allows the hamstring to work in addition to the quadriceps. Basically, anchor a band and place it around your knee. Slightly flex your knee forward before pulling it back into extension and contracting your quadriceps. While many other quadriceps dominant movements can be performed to build muscle mass (lunges, split squats etc.), here are my general hypertrophy guidelines to follow:
 

• Eccentric Tension
  • The eccentric (think moving back to flexed position in the knee extensions) portion of the range of motion of any exercise is the number one area to build muscle mass as it is responsible for the most torn muscle fibers (main contributing factor to hypertrophy).
• High Repetitions
  • Repetitions in the 12-15 range are perfect to build muscle mass. Go any higher and you will begin instead working on muscular endurance.
• Adequate Time Under Tension
  • Time under tension is basically the total amount of time a muscle spends in a contracted state (sum total of the time spent in all areas of the range of motion). Aim for 30-50 seconds of time under tension to build muscle mass

 
Absorbing forces, re-conditioning tendons and ligaments and sprinting technique
 
            While building mass back in the quadriceps you should also focus on re-introducing your tendons and ligaments to power movements such as jumping and sprinting. It is important not to jump right in to high intensity jumps and sprints as your body may not be ready to handle the demand places on the knee and surrounding areas.
 
Extensive Plyometrics
 
                  Extensive plyometrics are lower intensity jumps that are essentially “hypertrophy for jumping.” Meaning, they rid of use of the stretch shortening cycle (reactive stretch reflex of the ligaments and tendons involved in maximum intensity jumping and sprinting). We accomplish this by implementing pauses or performing short rhythmic jumps. The main goal is to re-condition the tendons and ligaments and prepare them to handle higher intensities. Also, it teaches them how to behave again so performance is maximized later on. During these exercises the focus should be on sound and clean landing mechanics. Here is what you should look for:
 

• Absorbing ground forces with the “entire foot.”
  • Many knee injuries occur due to inability to absorb ground forces with the entirety of the foot. Failing to do so can shift pressure anteriorly (forward) and leave the ACL susceptible to injury. Cue your athlete to land on the ground, box etc. by maintaining contact with the entire bottom of their foot.
• Arm use
  • The arms are a neglected portion of power development and jumping effectiveness. Proper use of the arms can help load timing. Ensure that the athlete lowers their arms into their lower half load.
• Proper External Hip Rotation (Avoiding Valgus)
  • Aim to avoid “knock knees,” (knees moving inward upon pre-loading, load, or landing. If this cannot be done it may be best to take a step back and sure up the posterior chain.
• Land in proper squat position
  • This is an easy cue to use to help landing mechanics. We want to maintain proper spine alignment upon landing and avoid further damage to our back.

 
Low Intensity Sprinting Start Types
 
            Lastly, it is extremely important to reaffirm good sprinting technique while not exposing an athlete to sprinting variations that produce too much power. That is, low start types (push-up, mountain climber, etc.) or start types that involve excess power building via medicine ball throws.
 

• Falling Starts
  • Start type where good acceleration angle is drilled via a forward fall (without flexing at the knees or hips).
  • Considered the most basic of starting types due to the more upright positioning of the body as it moves into the sprint.
  • Use this before you progress into more advanced types that place the athlete at a lower angle. A lower angle is conducive to higher power output.

 
             Overall, it is important to progress through movements with a plan once an athlete has moved through a full rehabilitation program and can begin training!
 
            
Gerry DeFilippo

          Last week, Dr. Anthony Falco discussed the basics of heart rate training and how to properly calculate your resting heart rate and maximum heart rate. Once you determine these numbers you can properly utilize heart rate monitors to enhance your training. In athletes, this can be tremendously useful, as it will allow them to better determine if their aerobic training is focused on recovery, maintenance, or aerobic improvement. For the sake of this article, we will be focusing on aerobic improvement. To improve an athlete’s aerobic capacity you must understand the percentage of maximum heart rate needed to reach the improvement threshold and also how to use exercises which best work towards achieving that same goal.
 
Proper Heart Rate Percentage For Aerobic Improvement
 
            In the past I discussed using the aerobic capacity system to help aide in recovery for athletes. For recovery, it is best to work in a 60-75% range of the athlete’s max heart rate.  However, the range for aerobic improvement goes as high as 85-90% of the max heart rate.  Basically, apply Dr. Falco’s formula for your maximum heart to these percentages and you can find the best threshold for an athlete to work in to improve aerobic capacity. For example:
 

• 18 year old athlete
  • Max Heart Rate (220-age)= 202
  • For 85-90% Threshold:
    • 171-181 beats per minute

 
How To Construct A Proper Movement Pattern Aerobic Program
 
            As I previously mentioned, the movement patterns are great to use for aerobic improvement for a number of reasons. In addition to helping improve an athlete’s working capacity, you can also use this as extra time to drill home proper form with the main movements. However, it is extremely important to note that an athlete must show proficiency in these movements prior to using them, as it is never ideal to learn a new skill or movement in a fatigued state. For example, an athlete who cannot perform a proper bodyweight squat should not be allowed to use this movement in an aerobic circuit as they will be susceptible to not only injury, but can further program their nervous system to perform the movement incorrectly.
 

• Guidelines For a Movement Pattern Aerobic Program
  • I like to use intervals of 30 seconds of work and 30 seconds of rest as a basic starting point for my athletes. You can adjust intensity of the working sets by gauging the heart rate of the first few sets and determining if it falls in the necessary range you calculated
  • Basic Movement Patterns
    • Push: Push-up
    • Pull: Pull-up
    • Squat: Bodyweight Squat
    • Hinge: Kettle Bell Swing
    • Lunge: Bodyweight Reverse Lunges
  • NOTE: You can use the above template for your aerobic conditioning, but it is essential that you perform these movements with either bodyweight or with extremely light loads. The goal is not to build strength or power during the aerobic conditioning.

 
The most important thing to remember here is that you can find success with a multitude of different methods. Once you have determined your proper heart rate the main goal is simply stay in that zone and maximize your aerobic capacity. Movement pattern circuits are simply a great alternative to use because they can further solidify the proper form and technique of the most important qualities and movements for an athlete. 

​Gerry DeFilippo

           The start of a new year is often a time when people will start a new fitness or health goal. One important factor that aids in meeting goals is having a way to measure progress. Heart rate can be a simple metric to help measure progress of a fitness program and can serve as an indicator of cardiovascular health.

            Tracking heart rate can be as simple as finding your pulse in your neck (carotid artery) or wrist (the radial artery) and using a stopwatch. Count the number of beats for one full minute or count the number of beats in 10 seconds and multiply by 6 for an estimate. The old fashioned way works great but today fitness trackers, fitbits, heart rate monitors, even apps on our phones can help measure our heart rate.

Here are 3 ways that heart rate can be utilized to keep you on track for your fitness goals:

1 - Measure heart rate recovery 1, 2
-Heart rate recovery is defined as how long it takes your heart rate to return to baseline following a bout of exercise. This is a measure of how well your nervous system regulates your heart.
-Perform a baseline workout - walk for 20 minutes, run 2 miles, take a spin class. Pick something that can be repeated after a few months of training.
-Following exercise rest quietly for 1 minute and then take your heart rate and take it again each minute until it returns to your resting heart rate.
-At one minute heart rate should decrease by 12 beats per minute or greater.

2 - Calculate your target training zone.
    Here is a link with a calculator for target heart rate:
    http://www.ottawarun.com/heartrate.htm

As an example:
A 40 year old with a resting heart rate of 70 beats per minute wants to train between 70 and 80% of his max heart rate.
    220-40 = 180 (max HR)
    180 (max HR) - 70 (resting HR)= 110
    110 x .7 = 77 + 70 = 147
    110 x .8 = 88 + 70 = 158
    Target training zone using = 147 to 158 beats per minute.

This calculation is based on age and resting heart rate to determine an appropriate training zone to improve aerobic capacity. This method known as the “Karvonen Formula” is a simple estimate that is correlated to VO2 max which is considered the gold standard measurement of aerobic capacity.

The American Heart Association makes recommendations for amount of exercise. For moderate intensity 50-70% of max heart rate and vigorous intensity 70-85%. Keep track of the amount of time you spend exercising in the target zone!

If you have any previous heart conditions or issues consult with your doctor or physical therapist before starting any new exercise program. If you have questions or want to learn more about how to start a new exercise program we can help with that too! If we can help you conquer any barriers that prevent you from reaching your fitness and health goals come see us!

Check in next week and Gerry from Challenger Strength will share is insight on how he helps his athletes and clients improve their cardiovascular fitness.

Sources:

1 - Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery
immediately after exercise as a predictor of mortality. N Engl J Med. 1999 Oct
28;341(18):1351-7.

2 - Jolly MA, Brennan DM, Cho L. Impact of exercise on heart rate recovery.
Circulation. 2011 Oct 4;124(14):1520-6. doi: 10.1161/CIRCULATIONAHA.110.005009.
Epub 2011 Sep 26.

3-https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887?pg= 2

Infographic: http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.Wk0Syt-nGM8

Dr. Anthony Falco

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