Friday, June 28, 2013

What To Do If Your Physical Therapist Recommends That You Do One-Legged Dips

As most of you know, I try to refrain from giving advice on bad knees. I'm not a doctor, nor am I a physical therapist. Then there's the fact that even if I were, I haven't examined or even laid eyes on your particular knees.

So, generally, I'm not going to second-guess a treatment regimen prescribed by someone who has actually inspected your knees and discussed them at length with you.

However ...

In creeps a little exception.

I have become aware of at least two cases where patients with painful knees have been told to do one-legged dips as part of their exercise routines. (If you've never done one: While balancing on one foot, you bend your leg, dipping down, while trying to maintain a straight line.)

Let's imagine that your buff physical therapist advises you to do one-legged dips to help fix your ailing knees.

Here's what you should do after he says this:
Look into his face. Is it flushed? Are his eyes bloodshot? His pupils dilated? His breathing stertorous? These all can be signs of recreational, judgment-impairing drug use.

Surreptitiously gauge the distance to the door. Could you beat him to the door, even with your bad knee(s), if he made a move to try to restrain you and force you to do a couple of one-legged dips "just for practice"?

If he does suggest you try doing one under his careful supervision, demur gently, perhaps with a line such as, "Oh, maybe not right now, I just ate -- why don't you show me and I promise I’ll do a few as soon as I get home?" (Make sure your fingers are crossed behind your back.)

After your visit ends, when the receptionist says, "And when would you like to schedule your next appointment for?", snap your fingers as if you just thought of something. Then say, "Ah, you know, I just remembered my work unit is being transferred to Tokyo. Oh well! Sayonara!"

Okay, seriously now: I can't think of a good reason why someone with chronic knee pain -- someone who probably has some difficulty climbing a set of stairs -- should be encouraged to do a tricky exercise that involves balancing while putting his or her entire body weight on a weak and possibly unstable knee joint.

Before anyone jumps up and says, "Oh, I know why physical therapists prescribe one-legged dips!" let me be clear: I'm pretty sure I know why they do. In brief, it's basically structuralist thinking run amok. So that's not the issue.

If you really care about fixing your bad knees, the issue is that you have to slowly ease them back to greater and greater strength. The key to getting better isn't doing some demanding exercise that many people would struggle to do with fully healthy knee joints. That just strikes me as absurd.


  1. Count me in as a third case :(

    I was supposed to lower myself off of a step on my bad leg and then push back up on that same bad leg as part of my physical therapy. Also do single leg TKEs. Although this was after some weeks of doing straight leg raises and other safer exercises, I still knew in my heart and from life experience that was way way way too soon to be attempting these things. A mistake. But. It's hard to look at a well meaning and experienced physical therapist and refuse to do something that they say is supposed to help me. And obviously, it works for other patients. So, why not me?

    I did go through a period where I would gamely (albeit fearfully) attempt these activities because it was supposed to be good for me.

    Finally after yet another huge setback (which of course developed only 24-hours after my attempted squat), I tearfully made a promise to myself that I would never never never do a single legged squat ever ever ever again -- no matter who is asking me to do it, I'll just flatly say NO.

    I admitted yes, it was a good way to strengthen my quad and, no it did not cause a flare up every time. But, it was too high risk of an activity. Why risk it??

    This was way before I found Richard's book. So, finding and reading Richard's book and now reading this blog post, too, is very validating of my anti-single-leg-squat vow!


      Do you talk about this in your book, Rich?

      It seems similar the theories you are expounding.

      I got it from here:

    2. I talk about the original Salter study, with rabbits, back in the early 1980s. Not however this study -- which, from the abstract, sounds very interesting, as it seems to supply a biochemical basis for why continuous passive motion works.

    3. I understand why many people are reluctant to try one-legged squats. However, for me it was finding the right type of squats that ultimately allowed me to return to playing soccer after a one year absence at the young age of 45. I was diagnosed with a more severe case of runners knee which was confirmed through MRI's. After months of physical therapy and various exercises, what ultimately worked was to see a Sports Medicine Doctor who specialized in knees. He gave me a series of exercies to perform over a 6 week period to elongate and strengthen the quad muscle. It also included a good amount of stretching before and after. Over the 6 weeks, I added 5 lbs of weight in each hand ending up at about 50lbs total weight. The key was to perform SHORT squats of around 30 degrees, to slowly increase weights, and to stretch lots. With a minor brace, I am now back to playing soccer and I would assess my knee at about 90% recovery. There are still times when my knee is sore, but the difference is encouraging. My knee no longer swells up and is no more painful the next day after a game. What I have learned from this BLOG was to not try to return to the sport too early but give yourself time to rest and try to find the exercises that will work for you. I also found that we need to go through some "mild" pain during exercises to really break the chronic pain cycle. I am a believer that the body will adjust "within reason" to the demands we place on it.

  2. That is interesting squats worked for the above person. Although note that it was not single legged squats.

    In the post he mentioned having some pain as part of the process.

    Doug Kelsey coincidentally just posted an interesting article about "when is it ok to ignore pain?"


    1. Actually, they were one leg squats. I will now go and read the article above.. thanks

  3. Oh my! Well, I'm happy for you that you are doing better. As for me, I'm having yet another setback of sharp stabbing pains despite being (I thought) so careful during my water therapy.

  4. Richard--- I bought your book last night. WOW. My story is so similar to yours it is hard to believe. I am 47 and been and avid racer/tourist/commuter for 25 years. My MRI says mild/moderate chondromalacia. I was told to do 'quad strengthening exercises', including one legged squats and stretch.

    Your book has helped me see what happened, gives me hope, and provides a reference as I map out my recovery.

    I will continue to use the resources you provide and keep you posted.

    Tim Guthrie, CFP

  5. Sorry to hear of your setback, Knee Pain. That's what I hated so much about getting better: it took so long and, on the way, the setbacks were sometimes very hard to figure out.

    Tim, your story does sound similar; definitely check back and keep us all posted on how you do.

    Anonymous who's had success doing one-legged squats: what I call one-legged dips probably are also known as one-legged squats (in fact, that may be the more widely used term; I just thought "dip" seemed a better description).

    Congrats on your success with these exercises. I doubt they're appropriate for most people, but your knee may have been strong enough, or your injury may have been of such a sort, that you were able to benefit from them. I know that they always caused a big pain flare-up for me the next day after I did them in my physical therapist's office.