LCL strains and heel hooking

Last week I managed to strain/partially tear the LCL in my right knee (Grade II/III strain) while heel hooking. Last year I injured my left knee in a similar manner, though less severely.

Both these injuries occurred because I externally rotate my knee too much when I heel hook (i.e. with the toes pointing outwards instead of straight up). Of course, I'll try to alter my technique going forwards and generally limit that specific type of heel hook.

Does anyone know any "prehab" or strengthening exercises for knee ligaments, so that I can avoid this in the future?

The best thing to do is strengthen the legs. My go to exercise for climbers would be a pistol/single leg squat.
But the fact of the matter is that the human knee was never meant to be levered off of as it is in a heel hook, heel/toe cam or any variations there of.

No matter what you do those techniques will always be risky.

Brent Apgar wrote:But the fact of the matter is that the human knee was never meant to be levered off of as it is in a heel hook, heel/toe cam or any variations there of. No matter what you do those techniques will always be risky.

Hmmm, coming from an area where heel hooks, toe hooks, full no-hands hangs from foot locks, and knee bars were a common if not an every day deal, I can't say I've ever heard those techniques characterized as 'risky'. And none of us ever encountered any problems from employing them, it makes me think there must be something else going on in this case.

Healyje wrote: Hmmm, coming from an area where heel, hooks, toe hooks, full no-hands hangs from foot locks, and knee bars were a common if not an every day deal, I can't say I've ever heard those techniques characterized as 'risky'. And none of us ever encountered any problems from employing them, it makes me think there must be something else going on in this case.

Yeah, I wouldn't call heel hooking "risky" either. The OP said the injury occurred because the foot was rotated outward during the pulling motion of the heel hook and this rotation does put a lot more stress on the knee during techniques like this. Really, twisting your knee or applying some from of lateral force to it is bad. However, I don't think that under normal circumstances heel hooking with your foot rotated should cause a Grade III strain. Perhaps there was some other factor the OP isnt mentioning? Perhaps a fall occurred while heel hooking, which could introduce a lot more force on the joint.

I sustained a similar knee injury in high school, but not because of climbing. I left it untreated way too long because I am an idiot, so I still have some issues from it, but I did go to the doctor and PT eventually. My PT had me balance one footed on one of these:


They also had me to pistol squats, like Brent mentioned. They also had me do lunges, squats, leg curls/extensions, and light running. I don't know if this is even worth mentioning but they also used electrostimulation on my quadricep muscles. They said it would help to strengthen them, since they help to stabilize the knee. Basically, they attached electrodes to the bottom left part of my right thigh and the top right and then let a current flow through it for a while. It went in on-off cycles for like 15 seconds each. Felt super weird.

No fall or anything. Pure weighting of the heel in a mechanically disadvantageous position. No warning or signs of fatigue, just a nasty crunch/pop followed by a buckling of the joint. My ortho was surprised as well; he was sure that I had some meniscal involvement, but the MRI showed that the strain is localized to the LCL.

You can't strengthen ligaments directly. Because they are "passive", connecting bone to bone. The tissues may strengthen over time with general mechanical stress to the joint, similar to how some of the passive tissues in the fingers get thicker in climbers' hands over long periods of time from climbing. But you can't actively work a ligament by itself.

I would add hamstring curls on a theraball when your knee is recovered just to balance out the joint a bit more and ensure you don't then strain a hammie during heel hooking.

You could also consider squatting with a (circular) theraband around both legs and positioned just below the knees - when you squat, you push outward with your knees. This could apply some "good stress" to the LCL. And lastly you should work on changing the technique of heel hooking to avoid torsion of the ligament. (And, oh yeah, you suffered a sprain, not a strain... ;) )

I found good results doing a "bridge" pose on one leg and doing reps pushing your pelvis up from the ground (concentrate on squeezing glute and hamstring). Start with one leg raised, other heel on a yoga ball or "bosu balance board" flipped with the flat face down, drive through that heel.

Single leg romanian deadlift is great if your hamstring/glutes need strengthening also.

ChrisHau wrote:No fall or anything. Pure weighting of the heel in a mechanically disadvantageous position.

Well, sorry to hear that, kind of a bummer when anything knee-related goes south. Is it possibly a case of over-reaching with your leg to establish the heel hook or were you were trying to do it around some obstruction?

Some of it may come down to dumb luck.
I say risky as a relative term. When it comes to lower extremity complaints in climbers I treat,
#1 is ankle due to falls
#2 is some sort of knee or hamstring tweak (occasionally a low back) from a heel hook.
This is not scientific just my observation.

Just had the same type of thing happen to me.  Heel hooked out the the left on a 45 degree over hang.  Weighted the heel and went to move out left for a hold and heard pop.  It did not really swell at all and I haven't noticed any real instability in my knee.  I do have a significant dull pain on the outside if my knee if I try to heel hook with my left leg but other than that I don't notice it.  Just wondering about how long it will take to get back to normal?  Its been a little over a month since it happened.