Sometimes we, as physical therapists and strength coaches, get too wrapped up in the latest, greatest exercise or treatment approach (e.g., Graston, PRI, SFMA) and forget that strengthening weak muscles still matters. By strengthening weak muscles, I mean continuing basic, isolated, non-functional exercises like the leg curl.
Two weeks ago, a high level soccer player–who had ACL Reconstruction 18 months ago–came to me with anterior knee pain that prohibits her from playing soccer. Take a look at these testing results as performed at her previous physical therapy clinic:
What can we determine from these results? If we went ONLY with the functional hop tests, she does very well. Less than 5% deficit is quite good. Look at the leg press, “only” a 13% deficit. According to the functional testing and training gurus, she should be good to go. But what do those tests have in common? It is quite easy to compensate by using different muscles to perform the movement. The gastrocnemius/soleus perform a large percentage of the hopping while the hips do a lot of the leg press; while not intentional, she cheated by using other muscles to perform the movements.
When evaluated, her hip abductor strength was normal, but her knee alignment and ability to tolerate single leg activities was quite poor. I would suggest that the strength deficits at the individual muscles surrounding the knee (e.g., quadriceps and hamstrings, noted in testing) and improper kinematics did not allow proper knee function and led to the knee pain.
Functional strengthening and testing are great . . . but there’s more to rehab and training than that.