Lax Cross Ligaments in the Knee

Question:

I have a client who has been diagnosed with lax cross ligaments in the knee. Running and sitting for long periods is rather painful for him, and he has been fearful of any exercise with impact in case he hurts himself. This has resulted in an unhealthy lifestyle with him carrying excess weight, especially around the abdomen, which adds extra pressure on the knees. He is also rather tall (6' 5"), and I sure it has definitely been a cause if not an antagonist to the problem. I need to convince him not all exercise is bad! I'd like to give him a more rigorous exercise program and get him better results all over! How can I best strengthen those ligaments?

Answer:

It is important to remember that ligaments attach bone to bone and are composed of non contractile semi-plastic materials. Since they are semi-plastic, excessive elongation can cause permanent change in their length and thus laxity. Therefore, you will more than likely never strength/shorten the actual ligaments themselves. You can, however, strengthen the supporting musculature and work to improve neural (proprioceptive) control of the knee. It may be beneficial for him to spend some time working with a physical therapist to lay the ground work for a more intense program.

Here are some exercises you may try. I would perform one to two exercises each for the quads, hamstrings and hips and for balance. Only progress when proficiency is demonstrated.

EASIEST EXERCISES

• Quad Sets - Tighten your thigh muscle. Try to straighten your knee. Hold for five to 10 seconds. Repeat this exercise approximately 10 times during a two-minute period, rest one minute and repeat. Continue until your thigh feels fatigued.
• Straight Leg Raises - Tighten the thigh muscle with your knee fully straightened on the bed, as with the Quad Sets. Lift your leg several inches. Hold for five to 10 seconds. Slowly lower. Repeat until your thigh feels fatigued. You also can do Leg Raises while sitting. Fully tighten your thigh muscle and hold your knee fully straightened with your leg unsupported. Repeat as above. Continue these exercises periodically until full strength returns to your thigh.
• Stationary Bike - Start with a level of tension that fatigues the quadriceps over a 20-minute period. Work on increasing the tension as the quad muscles become stronger. Perform three or four times a week.
• Hamstring Curls with Theraband - He can do this standing or laying on his back. I would avoid putting him on a leg curl machine due to the added torque within the knee. Lay (or sit) on the ground. Make a loop out of the TB and attach it to a solid object. Put your foot through the loop. Straighten your let out and adjust the TB so there is slight tension. Bend your knee and slide your foot toward your buttocks as you stretch the band. Hold the contraction and slowly return. Perform two to three sets to fatigue. To perform while standing, stand on the loop with one foot and put the other foot through the loop. Curl the foot up to the buttocks and hold the contraction for five to 10 seconds. Slowly return and repeat until fatigue. Repeat for two to three sets.
• Balance Work - One leg standing on the ground look for control. Once control is demonstrated, turn activity dynamic by having him step forward, laterally, backward, rotational, down and up from a step onto one foot. Once again, look for control before moving on. Once he demonstrates instantaneous control, he can progress.
• Hip Work - Lateral and medial leg raise, hip abduction from flex position. Monster walks with TB around ankles.

MODERATE EXERCISES

• One Leg Quarter Squats – Stand on one foot on a four-inch step. Hold onto a solid structure to help with balance if need be. Keeping the base foot flat with the majority of the weight on the outside edge of the heel, push the hips back, allowing the cheek to drop forward and creating a slight V at the hip joint. Drop into a six to 12 inch squat, concentrating on a strong quadriceps activation. Perform until fatigued.
• Standing Terminal Knee Extension - Attach your TB to a solid object and place your leg though the loop so it is at knee height. Face the solid object and slight bend the involved leg (15 to 20 degrees). Adjust the TB so you have slight tension. Straighten the leg stretching the band. Be cautious not to hyper extend the knee.
• Balance Work - Standing on a balance board, perform quarter squats, alternate one leg and perform various reaching activities. You can also incorporate standing on a mini trampoline for balance work. This is done in the same manner as the balance board, but you can also include some dynamic activities from the one leg stand drills.
• Step Ups (Different Types) - Step forward, laterally, across and rotationally onto steps of challenging heights. Be sure to push through the heel to stand up and demonstrate control and balance at the top and during the decent.
• Wall Sits - Assume a full squat position with the back against the wall. Lift toes off ground and hold position. You can also squeeze the ball between your knees or place TB around the knees and push out.
• One Leg RDLs - Start with body weight and progress to dumbbells. You can also attach a “D” handle to a low pulley and perform the same motion with horizontal loading.
• Lunges - Perform in different directions.
• Hamstring Curls on the Ball - Pay close attention to excessive extension of the knee joint. Client must demonstrate control.