I’m trying to find exercises for a client who has no cartilage in his knees.
When you have a situation such as this, the approach should be to functionally fortify. When the cartilage is gone, you're missing a critical component of the mechanics of shock absorption, dissipation of force and translation in the joint. However, you can still function. You just need to make sure everything else is in tip-top working order.
One thing you have to investigate is the cause. Is there no cartilage due to prior injury, postural faults or both? If there was an injury or trauma that caused the problem, your approach is simpler. If the cause is a structural or postural fault, this makes the approach totally different. If the cause is the latter, you’ll have to figure out the status of the leg. Assessing the entire leg to see what’s working, not working or over working is a great place to start. Key in on the quads, hamstrings, inner thigh complex and IT band, which are common problem areas. Also, find out what movements the client has been doing. Has he been performing exercises that are dominant in the sagittal plane without exposure to the frontal and transverse planes? Has he been doing a lot of machine training, which disrupts the resistance-contraction factor and deconditions the relationship of how the muscles work synergistically?
Remember that a tight muscle may not necessarily be strong; muscles can be tight from overuse or under use. On a muscle that is tight from overuse, a combination of stretching and strengthening can give you some mileage because it will restore the muscle to a working state and be functional.
Now that you’ve done some investigating on the root cause, what exercises do you do? You have to take into consideration any limiting factors that may be exacerbated while performing an exercise. These factors are pain, scar tissue, bone spurs, numbness tingling, etc. If these factors are not limiting, almost all exercises can be performed, with the exclusion of impact. Impact exercises can pose a problem and eventually, if not acutely, aggravate the situation. All other exercises can be performed with this in mind, provided there are no limiting factors. To condition the leg effectively, there should be a nice balance and exposure to:
- Movements in all planes of motion (i.e., frontal, sagittal and transverse).
- Exercises such as supine lateral ball roll, multi-directional lunges, inner/outer thigh work and basic agility drills.
- Avoidance of machine training (leg press, leg extension, etc). This will not teach the leg muscles to work as a unit, and isolation training can make worse an existing imbalance or create one.
- Adequate exposure to basic functional movements such as lunges, squats, deadlifts, etc
These exercises along with others will expose the working muscles to a variety of movements and balance out the system.
It’s also important to establish and maintain good form and proper body mechanics dynamically. If a client can’t perform the exercise with proper form, you can make him worse, so make sure to progress only after the client has mastered an exercise. The better the form is while executing a movement, the more the client will be able to tolerate, even those exercises involving impact because after proper conditioning, the muscles will be able to take the brunt of the force. Of course, this has to be trained on and done with care.
Note: One of the few impact exercises that can be done is treadmill sprinting. Due to the differences in reaction and gravity forces and environmental conditions from running outside or on your own, treadmill sprinting reduces the load and force the body has to dissipate in the knee. Sprinting reduces the contact time on the ground, keeping the actual impact component low. This, of course, should be used if applicable to the client and his conditioning program.