Knee Rehab Template

[Michael Ray]

Hey Everyone,

Please direct all questions related to the knee rehab template here.

Details:

This template was created for strength athletes dealing with knee pain who are unsure how to return to activity. This rehab template is suitable for those dealing with patellofemoral pain syndrome, quadriceps tendinopathy, and patellar tendinopathy*. We’ve created this template in an effort to help those dealing with knee pain return to their desired activity using intelligent programming based on research.

There are three major problems in the rehab world we hope to solve with our rehab templates:
1) Lack of research application
2) Lack of specificity of loading for the individual athlete, and
3) Inappropriate dosage of loading.

This template is designed to titrate the dosage of loaded movement towards normal activity, set appropriate expectations regarding symptoms, and maintain specificity for the athlete’s goals.

Thanks for trusting us to guide the process.

Purchase Link: https://www.barbellmedicine.com/shop...ehab-template/

*Note: This template would be incomplete for athletes whose sport demands dynamic loading (weightlifters, CrossFit, or General Individual or Team Based Sports - Martial Arts, Soccer, Volleyball, etc).

[graystep]

Hi,

Thanks for the template, looks great. I am looking to combine the 12 week strength programme with this template. ie deadlift and upper body from 12 week + knee template. Would that be suitable to do? A couple of quick questions below specifically on the knee template:

- I dont have access to belt squat so was goin to replace with high bar squat for example. Is it ok to do high bar and low bar on same day?
- I see 5 days a week programmed in phase 2 but M/W/F suggested as training days. I presume days 2 and 4 are not specifically considered training days?

[Michael Ray]

Hi,

Thanks for the template, looks great. I am looking to combine the 12 week strength programme with this template. ie deadlift and upper body from 12 week + knee template. Would that be suitable to do? A couple of quick questions below specifically on the knee template:

- I dont have access to belt squat so was goin to replace with high bar squat for example. Is it ok to do high bar and low bar on same day?
- I see 5 days a week programmed in phase 2 but M/W/F suggested as training days. I presume days 2 and 4 are not specifically considered training days?

Hey!

Thanks for purchasing the template.

Given this issue is related to loading and fatigue management, I recommend running the template as prescribed for lower body but you can sub in the other template for upper body and there shouldn't be an issue.

- Preferably let one bilateral leg movement be a squat variation and the other bilateral leg movement a deadlift variation.
- Correct - Phase 2 - days 2 and 4 are there if you are struggling with symptoms the day after but those days are not necessary. I do recommend if you find yourself needing to complete days 2 and 4 on a regular basis then you may need to adjust loading on days 1, 3, and 5 (isoinertial loading days).

Happy to discuss.

[Todd Dunlap]

What sorts of equipment are necessary to run this template?

[yi1221]

Hi,

Instead of making yet another PFPS topic I figured I'd post here as I'm not sure whether the template is a good fit for me, so before I spend a bunch of money:

I'm 25 years old right now and 2 years ago my knee pain started after cycling from and to university on a crappy, way too small, stuck in the highest gear bike for about a year, I didn't do any other exercise. Doctor said my kneecap wasn't tracking correctly and suggested I'd train my quads. I didn't take the exercises too seriously but the pain dissapeared on its own anyway when I switchted to a new bike.

Fast foward to a few months ago, it started acting up again. I was doing the SSLP during this period. I went to a physical therapist last month, as the pain seemed to get worse rather than better, and started interfering with daily activities, like driving or sitting. The therapist diagnosed me with PFPS and suggested I'd take some rest, and then start very slowly on leg press or leg extension.

I heard good things about Painscience so I bought their ebook on PFPS, and realized I might be stressing my knee more than I thought, as I'm biking everyday, and have to take the stairs a lot to travel between labs for my project, in combination with a lot of sitting with bent knees. In an attempt to rest I stopped all knee exercise. The pain has significantly decreased as compared to 4 weeks ago, and now I only feel pain when I do a bodyweight (or loaded) squat.

I enjoy training but my priority is getting rid of the pain, if possible. Do you think training (perhaps with this template) will speed up my recovery?
My initial plan was to rest untill the pain is (almost) gone, and very slowly return to squatting with tempo squats, starting at low weight and volume and increasing it over time. I just saw you guys came out with this template but it seems geared towards strength athletes rather than just a guy with knee pain. Or do you think it would be useful for me as well?

Edit: I forgot to mention what kind of pain, but it's pretty vauge. Generally it hurts on top of or around the kneecap when I bend my knee. It's hard for me to notice patterns, and it seems to come and go almost randomly. However I noticed the symptoms worsening 1-2 days after doing a knee exercise, which is one of the reason why I dropped it altogether.

[Michael Ray]

What sorts of equipment are necessary to run this template?

Depends on the exercises you select to do for your bilateral and single leg exercises but overall nothing out of the ordinary. If you have a barbell and dumbbells/kettlebells then you should be good to go.

[Maitiú]

Can I use a sissy squat 'bench' for the bilateral exercise instead of Spanish squat with the band? Like this one https://www.elitefts.com/elitefts-de...y-squatt1.html

[Michael Ray]

Hi,

Instead of making yet another PFPS topic I figured I'd post here as I'm not sure whether the template is a good fit for me, so before I spend a bunch of money:

I'm 25 years old right now and 2 years ago my knee pain started after cycling from and to university on a crappy, way too small, stuck in the highest gear bike for about a year, I didn't do any other exercise. Doctor said my kneecap wasn't tracking correctly and suggested I'd train my quads. I didn't take the exercises too seriously but the pain dissapeared on its own anyway when I switchted to a new bike.

Fast foward to a few months ago, it started acting up again. I was doing the SSLP during this period. I went to a physical therapist last month, as the pain seemed to get worse rather than better, and started interfering with daily activities, like driving or sitting. The therapist diagnosed me with PFPS and suggested I'd take some rest, and then start very slowly on leg press or leg extension.

I heard good things about Painscience so I bought their ebook on PFPS, and realized I might be stressing my knee more than I thought, as I'm biking everyday, and have to take the stairs a lot to travel between labs for my project, in combination with a lot of sitting with bent knees. In an attempt to rest I stopped all knee exercise. The pain has significantly decreased as compared to 4 weeks ago, and now I only feel pain when I do a bodyweight (or loaded) squat.

I enjoy training but my priority is getting rid of the pain, if possible. Do you think training (perhaps with this template) will speed up my recovery?
My initial plan was to rest untill the pain is (almost) gone, and very slowly return to squatting with tempo squats, starting at low weight and volume and increasing it over time. I just saw you guys came out with this template but it seems geared towards strength athletes rather than just a guy with knee pain. Or do you think it would be useful for me as well?

Edit: I forgot to mention what kind of pain, but it's pretty vauge. Generally it hurts on top of or around the kneecap when I bend my knee. It's hard for me to notice patterns, and it seems to come and go almost randomly. However I noticed the symptoms worsening 1-2 days after doing a knee exercise, which is one of the reason why I dropped it altogether.

Hey,

Based on the information you've supplied, I do think the knee rehab template would be appropriate for you. PFPS is a rather vague diagnosis of pain around the patella, typically activity related. We have evidence risk factors for developing PFPS include hip and knee musculature "weakness" (we'd need to try and define what is meant by weakness) and the go to treatment is hip and knee strengthening exercises (oddly enough). This template can deliver what is recommended for PFPS but I do think it's important pain is reframed based on what we currently know and understand regarding the topic. You may benefit from a consultation with us just so we can ensure you meet your goals when implementing the template (https://www.barbellmedicine.com/consults-and-contact/). The consult would also allow us an opportunity to discuss managing loading and fatigue of cycling in addition to completing the template. Happy to discuss further.

[Jon Loper]

Hi, Thanks for the template. It looks awesome!

I am just wondering how to do the isometric single leg loading in phase one.

For example, for the split squat should I perform 5x45 sec each leg and then rest 2 min? Also, should I elevate my front leg so that it is slightly below parallel and have my rear knee just off the ground?

Furthermore, it seems that the main goals of phase one are to decrease pain and recruit more motor units in the affected leg in preparation for phase two. Therefore, do I load the isometric exercises to an RPE of 10 using as much external load as possible if I can do so without adverse symptoms and continue to progressively overload it in phase two? In other words, does a RPE of 10 with isometric training mean that I should choose an appropriate external load that I fail at the 45-second mark?

Thanks for your help!

Jon Loper

[marc.mccabe]

I just downloaded this template, but none of the video links work. I'm using a mac, opening the template in Numbers. Thanks for any help.

[marc.mccabe]

I downloaded this to my phone and was able to access everything I needed to

[mdelvecchio]

Hey Marc - it's my experience that while the old templates worked when converted to Numbers, the new ones do not and are hopelessly tied to MS Excel in order to be functional. It's unfortunate, as Excel on mobile devices now requires a subscription (subscriptions suck).

Ideally BBM is working w/ an app developer to present these templates in a more suitable app format, as the level of functionality they're putting into the MS Excel sheets rivals an app, but fails to deliver as good of a UX as an app.

[D.Mac]

Hi. Just downloaded the template and a few questions regarding exercises I have never done before.
Bulgarian squat: the video showed the person placing his knee far past his toe which is discouraged in SS LBS (using his TUBOW). Is this ok or is it going to exacerbate my knee pain?
Belt squat: I'm going to buy a "dip belt" from rogue for this. Do I use the same form as I would for a LB squat technique? I assume I'll need to stand on some plates to create some space for the weight to lower down.
Split Squat: Seems to be a lot of confusion between this and Bulgarian SS's when looking up in the web. I gather that I kneel down with my "working leg" at 90 degrees and just raise my knee off the floor?
I noticed Phase 3 uses leg presses. I'm working out in my basement. Any substitution for this lift?
Sorry for the basic questions, but I found out after reading Starting Strength that there are a lot of hidden nuances in exercises!

[Michael Ray]

Hi, Thanks for the template. It looks awesome!

I am just wondering how to do the isometric single leg loading in phase one.

For example, for the split squat should I perform 5x45 sec each leg and then rest 2 min? Also, should I elevate my front leg so that it is slightly below parallel and have my rear knee just off the ground?

Furthermore, it seems that the main goals of phase one are to decrease pain and recruit more motor units in the affected leg in preparation for phase two. Therefore, do I load the isometric exercises to an RPE of 10 using as much external load as possible if I can do so without adverse symptoms and continue to progressively overload it in phase two? In other words, does a RPE of 10 with isometric training mean that I should choose an appropriate external load that I fail at the 45-second mark?

Thanks for your help!

Jon Loper

Hey Jon,

It depends on your level of sensitization. The goal is to perform all 5 sets for :45 seconds however, this can be altered based on your symptoms. You should perform a 2 minute rest between each set of isometric holds, a set would include holding the position for :45 seconds on your left leg and on your right. You certainly can perform a front foot elevated split squat but this isn't necessary. Your rear knee should be just off the ground. Phase 1's only goal is to introduce loading to the area while mitigating symptoms. However, if you are able to pass the biofeedback test without issue then phase 1 can be skipped. If you decide to perform phase 1, then you should reach an RPE 10. External load may not be necessary for some people but may be doable for others. "In other words, does a RPE of 10 with isometric training mean that I should choose an appropriate external load that I fail at the 45-second mark?" - Yes. However, I wouldn't try to transfer any external load to phase 2. Once you start HSR, external loading will likely be drastically changed due to tempo.

[Michael Ray]

I just downloaded this template, but none of the video links work. I'm using a mac, opening the template in Numbers. Thanks for any help.

Is the template working for you now without issue? I'm not sure the template is compatible with Numbers but should work with excel. I have a Mac and iPhone and the template loads in excel on both without issue.

[Michael Ray]

Hi. Just downloaded the template and a few questions regarding exercises I have never done before.
Bulgarian squat: the video showed the person placing his knee far past his toe which is discouraged in SS LBS (using his TUBOW). Is this ok or is it going to exacerbate my knee pain?
Belt squat: I'm going to buy a "dip belt" from rogue for this. Do I use the same form as I would for a LB squat technique? I assume I'll need to stand on some plates to create some space for the weight to lower down.
Split Squat: Seems to be a lot of confusion between this and Bulgarian SS's when looking up in the web. I gather that I kneel down with my "working leg" at 90 degrees and just raise my knee off the floor?
I noticed Phase 3 uses leg presses. I'm working out in my basement. Any substitution for this lift?
Sorry for the basic questions, but I found out after reading Starting Strength that there are a lot of hidden nuances in exercises!

Hey D.Mac,

Thanks for purchasing the template.

I understand you may have been informed previously to not allow the knee go past the toes because "X" but this is not correct and there is nothing inherently wrong with allowing this to happen. With that said, in the beginning stages some people may be highly sensitized and forward travel of the knee may not feel great and may need to be minimized initially and then slowly challenged over time.

Belt squats - We use the "dip belt" at my gym for belt squats; works just fine. Regarding technique, I typically cue the movement similar to a high-bar squat. With that said, just unlock your hips and knees and sit into the bottom of the position; simultaneously your knees should travel forward as hips are going down and back while trying to maintain an upright torso. Usually we have athletes stand on boxes to ensure the weight doesn't hit the ground and they can go through full range of motion. We also usually recommend being near a stable surface that is high enough for you to hold onto for assistance. We usually setup close to the rig and use a barbell at the appropriate height for assistance. Give me a few days and I can see about getting a video uploaded going over the main points for the movement.

Split squat - these are not Bulgarian split squats (rear foot elevated). Take a lunge position (which I call split squat position) and lower down and then stand back-up. I do not call this a lunge because there isn't a forward or reverse movement (walking). Interestingly enough, language on movement tends to vary across communities.

Phase 3 - Remember, you can select the exercises you want to do at the top of the phase tab (See photo). If you don't have a leg press then there are other options. Let me know if you have any other questions.

[yi1221]

Hey,

Based on the information you've supplied, I do think the knee rehab template would be appropriate for you. PFPS is a rather vague diagnosis of pain around the patella, typically activity related. We have evidence risk factors for developing PFPS include hip and knee musculature "weakness" (we'd need to try and define what is meant by weakness) and the go to treatment is hip and knee strengthening exercises (oddly enough). This template can deliver what is recommended for PFPS but I do think it's important pain is reframed based on what we currently know and understand regarding the topic. You may benefit from a consultation with us just so we can ensure you meet your goals when implementing the template (https://www.barbellmedicine.com/consults-and-contact/). The consult would also allow us an opportunity to discuss managing loading and fatigue of cycling in addition to completing the template. Happy to discuss further.

Hi, thanks for the response. Fortunately the pain has dissapeared all of a sudden, except maybe for some mild discomfort during knee loading.

Out of curiosity, about the hip and knee strenthening: I was wondering if it's actually important to get stronger? So would a more trained person need more exercise to see an improvement in symptoms? The PT said I could start exercising lightly on the leg press once I've recovered a bit, starting at body weight but it's so easy I doubt I'm gaining any strength or muscle.

[Jungle Dave]

I bought the knee template today partly out of curiosity but also to add a bit of conviction to the current rehab I'm doing on my left knee.

It's very impressive, I like the way the videos take you through each phase.

I have a couple of questions- first relates to the number of exercises. Are the variety of exercises suggested during phase 2 to lessen stress on the same structures and push adaptation in areas of the knee that the selection of say, merely low bar and DL might not?

Second one is a bit more prosaic- I put the purchase through today before putting the Black Friday discount on it- is that a case of "tough"?