Squats, Lunges & Meniscectomy

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February 9, 2021 at 9:53 am #50624

Jacopo Volta
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I had a meniscectomy surgery one month ago, after months struggling with pain during running since last summer. The surgery was pretty light and the part of the meniscus that has been removed quite small, so now that I feel good I’m planning to gradually restart running next week, in agreement with the orthopedic doctor. But he suggested me to avoid strength exercises that put too much pressure (in his opinion) on knee joints and cartilage, above all squats.
I’m a bit confused, since squats, lunges and those type of exercises are one of the main resource to train legs strength, and for a trail runner that lives in a flat city like me are almost the only way to simulate uphills and partially train the specific requests of mountain running. Every strength training plan contains those type of exercises.
What is your opinion? Could it be correct to avoid squats, lunges and jumps for a “weak” knee? If yes, what other exercises can I use to train legs strength? Can isometric exercises be a solution or they will be too light?

Let me specify that this meniscus injury had probably nothing to do with running, and instead it is linked with a soccer accident occured 10 years ago, after which I had a MRI that showed exactly that meniscus rupture. From that time, and after adequate rest, I had no issues for the subsequent years (even if I almost stopped sports for other reasons).
Since I started to run 4 years ago I have been able to train and race for years (40-50 kms/week with 20k to 50k trail races) and my knee was never an issue, until last summer when the pain restarted. Interesting that this happened after the 4-5 months with less running of my short career (because of lockdowns for pandemic) and with much more strenght training than usual performed indoor.
For those reasons I’m worried that the change in training routine and the strength training I did in the first months of 2020 have a role in my injury, turning on again the meniscus issue after years without pain.
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Posted In: Injury & Rehab

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Jacopo Volta on February 24, 2021 at 3:08 am #51177

Hi everyone, any idea about my question?
For me it would be useful to know if I can start with a strength program like “Chamonix Mountain Fit”, that looks really useful for city-based trail runners like me, or if I should try different type of exercise to preserve my knee.

Thank you in advance!
Jacopo

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mike on February 25, 2021 at 3:20 pm #51261

I am 59 and have had two meniscus scopes on each knee, to remove torn cartilage. The last scope was about 6-7 years ago. What I have found is that squats and lunges seem to be okay. Weighted, walking lunges tend to hurt them much more. Most of my squatting is either goblet squats or KB front squats. The further I go towards “ass to grass”, the more it bothers my knees (the next couple of days). Rear elevated single leg squats are a great alternative. I have found, while not the most mountain specific, road and mountain biking is really good for my knees. It seems Mountain biking tends to build more strength and the road biking motion seems to lube the knees. Like everything else, I think if you use good judgement, don’t do things that hurt or alter the expertise, you should be fine.

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PaulB on March 1, 2021 at 12:08 pm #51414

I second what Mike said. I had my meniscus done a few years ago and as I worked back into strength training I couldn’t go ass-to-grass anymore without some pain or discomfort, at least not with weight. I still do bodyweight squats all the way down, but even now don’t do more than a half squat with weight. SL squat (with rear leg up) have been good along with step ups and step downs. Step-ups I started low and moved to taller steps. Lunges took longer to re-start but now are no problem. Road cycling is definitely a great way to lube the knee. Overall, my experience was not that squats and lunges are gone forever but that it’s best to not jump straight back into heavy, deep squats or lunges right away.

One thing I’ve also learned along the way is to look at what is really needed. Are heavy ass-to-grass squats “better” than heavy half squats or SL squats? Maybe, maybe not. But are they really needed for what I do (running and backcountry skiing)? Probably not. As long as I have that range of motion with bodyweight I focus on half squats, SL squats, etc., for strength.

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Pete Dickinson MS,PT on March 9, 2021 at 11:49 am #51785

Sorry for my late reply as I’ve been out traveling with the World Cup team in Europe. Rehab post meniscus surgery should definitely include robust strengthening of the lower leg. This is down progressively with help from a PT so you don’t overreach, I mean it, have help as you recover from surgery!! We all need a team around us as we deal with the trauma’s of life. You don’t get through an active life without getting ‘dinged’ up!!
Strengthening post surgery is progressive as I said. It starts out with body weight abbreviated movements, moves towards greater range of motion, then increases loads and moves to some single leg work. Lots of little steps here which I won’t go into. But yes, you can and should squat, deadlift, and gradually return to activity as your skill/strength/tissue quality allows for.
Cheers,
Pete

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Jacopo Volta on March 17, 2021 at 3:33 pm #52132

Thank you Mike, Paul and Pete for the suggestions, really helpful!
I guess I will try to gradually reintroduce strength exercises in my training routine, at the beginning just with bodyweight to be safe.
Good idea to focus on more “sport-oriented” movements like single leg squats and step-ups: in the past maybe I was too focused on “gym-oriented” exercises, not thinking enough about what my sport (trail running) really needs, and probably putting too much pressure on joints without the correct graduality.

I forgot to say that I’m 33, so I hope that my knee will be able to recover in a proper way, without long-term consequences.

Thank you again!
Jacopo

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ibuxton on June 22, 2022 at 3:40 pm #68446

Jacopo
Pinging this thread again to see how recovery has been for you? I am about 10 months behind where you are and also a trail runner. I waited the longest to return to running and it seems to be going slowly (maybe I just read too many internet posts of folks doing crazy runs a few months post surgery 🙂 ). Had relapse this past weekend and knee is swollen and sore. How has it been for you? What distances or weekly mileage are you back to and does it feel back to “normal”? How long did it take?
Thanks
-Ian

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Jacopo Volta on July 8, 2022 at 9:15 am #68965

Hi Ian, sorry for the late reply.
I’ll try to give you an overview of my rehab: I had my surgey on 13th january 2021 and I waited 10 days for the first walk and another week for some easy indoor cycling. Meanwhile I did all the rehab exercises suggested by the PT. After exactly one month from the surgery I started with alternate walk/run “workouts”, adding minutes of running each session, to gradually take confidence with the gesture of running. After one month, so in the middle of march 2021, I restarted with “real” running, initially for 30 minutes and increasing to 1h in the following weeks. After that it was all a matter of increase mileage and introduce some pickups to get the legs used to a semblance of speed. After 3 months from the surgery I was able to run 2 hours with no stops and I finally restart with mountains and trail running.

My recovery has been going well, all in all, no major issues and no real pain in the process: I tried to be careful, even more than suggested by the doctors, because I was really scared to mess up with the recovery, and I guess that this caution paid off.
In the last year I get back to my usual training habits (40/50kms per week with a quality session and a long run of 2-3 hours) and to racing. I did some mountain races from 20 to 50K and I did not have any issues with the knee. My last race was Cortina Trail two weeks ago: it was my first 50K in 3 years and it went pretty well considering that I was not used to running for 7 hours from a long time.

Still, sometimes I feel like something is “not totally ok” with the knee, like if it is more fatigued than the other after the running efforts, or after the familiy walks with my son on the shoulders. But it’s not a real pain, not at all, just a feeling of discomfort. Maybe it’s normal and I just need to get used to it for the rest of my life because of the meniscus and the cartilages not completely ok.

Oh, about streght training: I restart the last winter with some TFTUA suggested exercises (split jump squats, step-ups, etc) and I found them useful for my legs and knees. Unfortunately I’m very bad at consistency when it comes to strength training, so I did it for some months, then stopped and then start again. My opinion is that it is very useful if done properly and at least one-two times per week, in particular for people with weak joints, because it gives you the strength necessary to “trust” your knees and the confidence to run on trails (even more for people like me that live in flat cities).

I hope it was helpful, good luck with your recovery and don’t be afraid to get in touch if you need more feedbacks.

Cheers
Jacopo