Do ligaments strengthen after surgery?

How can I strengthen my legs if they're too weak to squat (no weights, just my body weight) all the way down to a "baseball catcher's position" and get back up?

• I'm about thirty years old and male. I’ve already seen several doctors (neurologist, physical therapist, orthopedic doctor, etc.), I’m addressing what appears to be the root cause of this problem (I was quasi-vegetarian and used to fast a lot), so please focus on answering the question. My legs are weak. What’s weak specifically? I don’t know, but probably ligaments, tendons, muscles, etc. The weakness is mainly in the area of the knees. I have no knee pain whatsoever, unless I get silly and do movements I shouldn't. I’m able to squat (with no weights, just my body weight) down to about where my knees form a ninety degree angle (it looks something like this)... ...but as I attempt to go lower (as if I were picking something up from the ground), I can feel extreme weakness in my knees and I’m just not able to go down any further. I feel that I would definitely tear a bunch of ligaments if I attempted to go all the way down. As a quick side note, in order to sit on the ground I have to lower myself without bending too much at the knees, which involves using my legs in the lunge form, and the use of my arms. Going back to what I was saying, similarly, when I’m sitting on the ground and then slowly and very carefully position myself in the “baseball catcher’s position" (like this)... ...my legs are simply too weak to push myself all the way up; I can barely push up at all. Too much weakness. Biomechanically, I understand that this movement should be avoided, but that’s not the point, the point is that my legs are weak and a healthy young man should be able to do this movement when the occasion calls for it. I'm working on becoming healthy and have made some good progress (initially, my legs were so weak that I could barely support my own body weight), but I just need to continue to strengthen my legs. I'm doing squats (with no weights), lunges, the roman chair against a wall, calf raises, leg extensions and leg curls using ankle weights, using a stepper, I'm even using a spinning bike to warm and up and strengthen my legs, and I just feel like these exercises may be helping but something is missing. I feel as though there might be some exercises, movements that I could be doing to address my problem but I'm just not aware of them. What exercises/movements do you recommend? I’m doing my best to take care of the nutrition part. What exercises would you recommend to strengthen my legs (ligaments, tendons, muscles, and whatever else is in there) to the point where I'm able to squat up and down like a baseball catcher? A well thought out and sensible answer would be greatly appreciated.

• Answer:

  Well this definitely wins for longest question I've seen posted on Quora. Lots of detail. Here's how I see this situation: 1) You won't tear your ligaments going lower. It's uncomfortable for sure, but as long as it's controlled and you aren't going into an extreme valgus (knees rolling way inward), your ligaments will hold up just fine with just bodyweight. You maybe don't want to start jumping and twisting or adding a ton of load, but bodyweight should be no problem on your ligaments. Ligaments have incredible tensile strength it requires a lot of sudden and explosive force typically for them to tear. 2) "Biomechanically, I understand that this movement should be avoided..." This is an untrue statement. Many people for some reason in the western world have come to believe silly things like 'squatting is bad for your knees,' it isn't. Bad technique while squatting might be though. Squatting low like that is actually how a lot of people in the world still well...go to the bathroom. Most people should be able to squat to full depth without any problems and in fact many people in developing countries where they squat often, most of the population can get into this position no problem and these cultures often have less knee and back pain by comparison. Food for thought... 3) If you want to get good at squatting, specifically, you have to squat. Lunges, leg extensions, calf raises, they are all good, but they typically won't make you better at squatting. You need to create a specific adaptation to this imposed demand. The easiest way to do this is to start with support and then add a counterweight. Stick to pain-free ranges of motion. Once you get good at a certain method, you have to move on to a new more challenging method. AND...making sure you're learning a good technique. The baseball catcher position isn't often that great because the knees are often rolled in considerably and many of them stay up on the toes. Good for baseball, but not great for squatting really... Tie a towel around something firm, or link your arms around a pole. Hold on to the towel or pole and lower yourself down into a deep squat position, use your arms to initially help you get out of the position. This is how I teach pretty much everyone to squat who can't start with their body weight. If there is pain, stop. You may need more specific help, or you may need to shorten the range. As you get stronger try to use less and less of your arms for help. Go to one arm instead of two eventually. Then add a small counterweight that you can punch out in front of you, like a 5 or 10 lbs weight that will allow you to transition from the supported squat to the a full squat. Then go to a low cable squat, which again will provide some counterweight while now adding load to the equation. The low cable squat allows you to get into a really good deep squat position, so you get through a full range, but with load. The other thing you can and should consider is actually literally hanging out in the lowest position you can tolerate. Your body learned to squat from the bottom up, not the top down. Yet adults often try to learn the squat from the top, neurologically speaking, your brain identifies better with starting at the bottom. So you can use a bench or step that gets progressively lower, but start squatting to a fixed position that is just above where your strength gives out, hold for 3-4 seconds (but don't relax) and squat back up to standing. This pause eliminates your strength shortening cycle (elastic energy), which can often fool people into thinking they have more starting strength than they might otherwise have. This is especially important if you have limited strength (i.e. you can only squat your bodyweight). I often do a series of mobility drills with clients where (it's a little complicated to fully explain rather than show...) whereby we use a low box or bench and you squat down to a depth you can tolerate (so the box or bench needs to be appropriate to your ability). Use your hands on the bench or box for some support (rather than sitting on it, like the example above), and if you have calf tightness (see #4) you may want to elevate the heels a little bit at first, but make sure you gradually work away from an elevated heel as your calf range of motion improves. Once you're in this bottom position, start practicing some movements like taking one arm and reaching up straight behind or above your ear, then the other hand. Then stand up, so you're getting isometric strength at your lowest possible range but only have to hold the position for a few seconds. Then start adding time and increasing complexity, so you can go down, then practice externally rotating your hips and using your elbows to push your arms out and strengthen the glutes in this position a little more. Or pull your arms straight up overhead and standup. Or hold the bottom position longer and longer while you do more reps from this position. You'll develop a lot of strength and control in the bottom range of your squat by practicing this in all of your warm-ups for instance, which is where I would often put those drills. 4) In some cases there are some limitations that might require intervention. For instance a lot of people do not have the calf flexibility to get low, deep and keep their heels down. Without a formal assessment it's difficult to know what kind of 'hacks' may be appropriate for you. In other cases, it's not your legs that are not allowing you to squat deep, its that your core and hip flexors can't control the tilt of your hips as you decend, so you get stuck. It may be beneficial to strengthen the hip flexion range of motion in this case. In other cases till, a big reason people have a hard time getting out of the bottom of a squat is because of a lack of hip strength in the upper hamstring and gluteals. Some accessory movements like hip hinges and glute bridging can work quite well in helping people control their depth. Knowing what interventions are required and what might work requires an assessment though. Otherwise, it's just guessing... 5) Lastly... Start adding load to the range of motion that you can presently tolerate. If you want to make any exercise easier at first, just shorten the range of motion at first and then gradually increase as you get stronger. So if you can squat to your thighs being almost parallel, then start goblet squatting with an appropriate load (probably 20-50 lbs at first) to the depth that you can muster. Use a target to sit to like a bench or box if you have to at first, gradually work to take the bench away, then increase the depth as you improve at #3. Once you hit 45 lbs on a goblet squat, you can probably start thinking about a barbell (as they are 45 lbs) and either a front squat (my preference to teach first as long as it's tolerable) or a back squat is in order. Here you can set the pins in a power rack so that you never get lower than your ability, just squat down until the bar rests on the safety pins (don't bang them off the pins) and then press back up. Resistance concretes good movement. So contrary to popular opinion that you should solely master your bodyweight first, it is often a good idea to add an appropriate load to off-set your body and solidify the movement faster as a result. It's easier for a lot of people to squat with a weight in the goblet position for instance, than it is for some people to squat with no additional load, because the location of this weight will naturally put your body into a better position to move. Again, make sure your technique is in order. Improving your strength through the range you have, while improving the you have, is a recipe for success in my experience. Furthermore, you build strength at the bottom within about 7-8 degrees below what you can achieve by constantly going to that depth, so it will help you improve your depth as well. In my opinion a healthy, reasonably well resistance trained young man, should be able to back squat about 1.5x their body weight for a few reps. This is also typically easy to achieve in men under the age of 40 (will take most men this age a year at most to learn, depending on how much training they do and their training/injury history). You're only going to lose bone and muscle mass as you age, so it's a good habit to have, maintaining your strength. Oh and as another consideration, spinning won't do much of anything to improve your 'strength' in a bilateral squat position. It's just not specific enough, and you need to be biking at or near your anaerobic threshold anyway to gain any kind of appreciable "strength" with cycling. Lunges are a good exercise, I'd keep them in the routine but later in the session. Always start with squats, you always want to start with what your weak points are, so that you're training it when your nervous system is fresh. It will give you a better training response that way. Roman Chair against a wall? Roman Chairs usually have backs to them? Anyway, put a towel that's about an inch thick in the lower of your back, and practice getting into a squat position with your legs while staying tall, this will improve your range of motion in the squat but also maintain a better spinal position (important for squatting), basically you're doing the exact opposite movement of a squat, by pulling your knees up into your chest. However, you want to do this when you squat anyway, when you get good at squatting you will more naturally pull yourself down into the position (very much like a roman chair knee raise). Leg extensions and leg curls probably aren't going to offer much to your cause, especially if the only load you're using are ankle weights. If you can do 15 leg curls with a physio ball or swiss ball, you should have the hamstring strength to squat. Keep doing step-ups, but again later in your workouts, after you practice your squats. Start making the step higher though, so your knee is above your hips; Think about the position you want your hips to be in the deep squat position, and start training your legs more like that... To accomplish what you want to accomplish in the long run, it's mostly about learning how to manipulate lever systems.