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Recently I was told by my doctor that I have a fully torn anterior cruciate ligament (ACL) and I've been told to stay away from karate (specifically Shorinji-Ryu Karate-Do Renshinkan) for the time being and that as of right now I'm not a good canidate for sugury for various reasons.

I have been contimplating where I was going with regards to Renshinkan for awhile now as it does require some fairly low stances and I'm signficantly taller than the average and the doctor thinks the low stances might have been putting too much stress on my knee as I ulimiately fully tore it while going to throw washi giri (round kick) during kumite after having had it paritally torn two years ago.

For now the doctor is taking a very conservitive treatment approch as I have extremely good knee stability (ran a 5k on it recently) but I was wondering what my options are with regards to martial arts that don't put a lot of pressure on the knees. I have been told that kendo might be an option and I've always had an interest in it, but I'm wondering if there are other options that I should take a look at.

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Something I've heard and you may want to look in to is that weaknesses in some of the knee ligaments can be overcome by strengthening the quads (this morsel of goodness comes from rugby players, they are prone to knee ligamnt problems). –  slugster Jan 12 '13 at 1:39

4 Answers 4

Talk to your doctor/physical therapist for the details on what you should avoid, but in general:

  • Avoid arts that involve kicks, especially high kicks.
  • Avoid arts that emphasize deep stances.
  • Avoid tournament arts.

Kicking and deeper stances are, in general, significantly harder on the knees and the surrounding tissue. Not that you can't work up to it eventually, but generally if you are having knee problems I recommend avoiding arts that have a high focus there.

Tournament arts, especially hand-to-hand tournament arts, are another one I generally recommend avoiding in these situations, because there's a high temptation to push your body to get just that extra inch of reach or go just a little further on adrenaline than you would otherwise consider. There's also a higher chance of re-injury from an opponent.

This is less of a problem for highly constrained weapon arts (e.g., kendo), but is a problem for a lot of freer form fighting.

As far as specific arts, without knowing the specifics of your area or your interests, I'd talk to the instructors of a few different martial arts that you are interested in and ask:

  • If they anticipate a problem in terms of stances or other techniques, given your medical restrictions.
  • If they emphasize avoiding self-injury (or as my instructor likes to say "if it hurts, don't do it!").
  • If they are okay with you going slower to accommodate for your injury.

If you like the answers to these and otherwise like the school/art, then you've found a good match. Otherwise, keep looking, and keep the standard advice for looking for a new dojang in mind.

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One art to look into is Shotokan. It explicitly holds that kicks should not be above knee-level. –  Pulsehead Jan 11 '13 at 19:46

the doctor thinks the low stances might have been putting too much stress on my knee

I would tend to contradict your doctor to a certain degree - low stances do not produce adverse stress on the knee joint1 unless you do specific things like let the knee drift out further than your big toe or you fail to maintain a straight perpendicular back (i.e. you let you butt drift back and you tend to lean forward).

Your instructor should be skilled and experienced enough to spot common stance issues like this.

I ulimiately fully tore it while going to throw washi giri (round kick) during kumite

I would suggest that this occurred due to poor technique. If it was on your support leg then it was most likely one (or more) of these:

  • you failed to rotate your support foot
  • you didn't bring your hips up and over
  • you were over-reaching
  • you left the ground and landed incorrectly

If it was on your kicking leg then you were sloppy and didn't deliver focus at the correct point (i.e. you didn't tense at the moment of impact).

Ligaments can take a long time to heal properly and I would advise professional help with it (use a physiotherapist). Once it is healed you will still have a certain amount of natural inbuilt apprehension when it comes time to start using that joint full on, that can be counter productive so do be aware of it. Other than that, I would concur with David's answer regarding ongoing training, and focus more on straight kicks like mai geri as they don't stress the knee in the same way.


1 This is generally true regardless of your physical dimensions unless you are an extreme case. The only time I would change someone's practice of low stances is if they were enormously fat, had a deformed skeletal system (like a warped spine), or they had a pre-existing condition (bone degradation, arthritis, artifical joints, unhealed breakages/tears, etc). Of course a low stance is like all other techniques, it takes time and practice to perfect and you shouldn't go for the ultimate low stance immediately - as mentioned above this comes back to the experience of the instructor.

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Following the MRI the doctor said that the ACL actually developed a cyst from an older partial tear so the round kick might not have been what did it in. In short, it was going to go, it as just a matter of when and any activity that placed pressure on it could have caused it to go. For example, walking up the stairs with groceries could have been just as likely. During the kumite session I actually was only starting to bring my knee up to through the kick when it went. –  rob Feb 5 '13 at 14:01
    
@RobZ Thanks for the follow up and I hope you are making progress with healing it. Yours is an edge case (the footnote covers your case :), but I'll leave my answer as-is because it still applies to normal people and may be of help to someone else.Hope you're back to normal practice soon! –  slugster Feb 5 '13 at 22:12

I have had ACL issues for a long time, and I am still in martial arts after surgery(6 years ago) and a complete tear in the other ACL one year ago. For me careful training with strengthening my leg muscles and paying great attention to the technical details so that I won't force my knee in a wrong manner worked perfectly. I have very rare and painless instability issues in the knee with the torn ACL.

I have been into a few styles since: Kickboxing, Taekwon-do and Judo and I'm fine so I wouldn't worry about it, just go slow and let your body learn the techniques correctly(correct them if necessary) and strengthen your legs.

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The main problem that you're going to run into with non surgical rehab is that part of the purpose of that runs contrary to what you need for martial arts.

The function of the ACL is to stabilize the knee when planting and/or turning. Given that we are often planting the foot and using it as a brace when kicking, or turning on the leg, it's arguably more important to a martial artist than many other sports.

The non surgical treatment usually relies on strengthening the upper leg muscles, and getting them to shorten a bit to take over for the stabilization. The problem for martial artists is that the flexibility training runs counter to that notion.

The other risk is that by going with a non surgical intervention such as muscle strengthening, you run a greater risk of injury to the remaining ligaments (PCL, MCL, LCL) and the meniscus if you do injure it further.

If it's just the ACL, then walking and even running or cycling aren't going to pose much difficulty, as there is almost no pivoting/turning in those activities. I'm just afraid that you may "slide" off your knee when doing something in martial arts and do much worse damage. Also, because of the instability, you may damage the meniscus more over time than you would if you had the repair.

From the writeup on this page the replacement surgery has a pretty high success rate (82-95%), and the more active you are in a cutting/planting type sport, the more they encourage the repair.

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