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  • Hi again Mike,

    So I just completed my first day of phase 2. 24 hours later my symptoms are definitely above baseline. In the template you say that if this occurs, modifications should be made. By this do you mean that isometrics should be performed?

    Update: 48 hours later my pain is even more above baseline. In hindsight, I don't think I should have skipped the isometrics week. I skipped it because I passed the biofeedback test, but I appear to be very sensitive even after one session of tempo work, 2 days later. Do you think a good approach would be to start over and complete the full week of isometrics ?
    Thank you
    Last edited by Shlentz; 06-09-2019, 10:19 PM.

    Comment


    • Michael Ray
      Michael Ray commented
      Editing a comment
      Hey, sorry to hear about the recent onset of symptoms. Yes, you can go back and complete phase 1 and re-assess after that. In the future, modifications would mean drop RPE by a point or reduce total sets completed, add in an additional rest day between next session. There are a number of variables that could be modified and there isn't a right answer here.

  • Hi,

    I a Male 36 y/o and have been training for ~4 months starting with SSLP and then the bridge. I just purchased the General strength and conditioning template with the intention of doing that starting next week (Last week of bridge right now). For the past 3 weeks I have been having pain / sensitivity just above the kneecap mostly outside the gym, it gets exacerbated when I stand for extended periods and feels painful to sit/squat down after that, but is otherwise mostly pain free. My squats went up by 25 lbs during the bridge before I started having pain and started deloading them, and my deadlifts have continued to go up consistently week on week. After my warm up sets, I can squat/deadlift pain free, so I am wondering if it is worth doing the rehab template or if the symptoms are too mild to be worth doing that and just switching exercises to a different variation or some other form of management might be the answer? Thanks!

    Comment


    • Originally posted by dkarthik View Post
      Hi,

      I a Male 36 y/o and have been training for ~4 months starting with SSLP and then the bridge. I just purchased the General strength and conditioning template with the intention of doing that starting next week (Last week of bridge right now). For the past 3 weeks I have been having pain / sensitivity just above the kneecap mostly outside the gym, it gets exacerbated when I stand for extended periods and feels painful to sit/squat down after that, but is otherwise mostly pain free. My squats went up by 25 lbs during the bridge before I started having pain and started deloading them, and my deadlifts have continued to go up consistently week on week. After my warm up sets, I can squat/deadlift pain free, so I am wondering if it is worth doing the rehab template or if the symptoms are too mild to be worth doing that and just switching exercises to a different variation or some other form of management might be the answer? Thanks!
      Excellent question dkarthik if this is the first time these symptoms have occurred and given the recent onset, I'm inclined to say not to purchase the knee rehab template. Instead, you'd likely find relief by regulating loading to the area. A new template will come with a new exercise prescription and will help guide the path with RPE. If symptoms worsen then I'd likely say you need more-intensive guidance via the knee rehab template.

      Comment


      • dkarthik
        dkarthik commented
        Editing a comment
        Thanks for the reply. Yes it is the first time, so I will continue with my planned template. Thanks!

    • Quick question,

      One of the rules is that elevated symptoms should last no longer than 24 hours. Hypothetically if symptoms last 24 hours but diminish after performing the biofeedback test for two rounds, should one proceed as normal? My understanding is that the biofeedback test is sort of the litmus test to see if you tolerated the previous session. I am currently on the isometrics phase and experienced this situation yesterday, but symptoms went away during the biofeedback test.
      Last edited by Shlentz; 06-14-2019, 11:55 AM.

      Comment


      • Originally posted by Shlentz View Post
        Quick question,

        One of the rules is that elevated symptoms should last no longer than 24 hours. Hypothetically if symptoms last 24 hours but diminish after performing the biofeedback test for two rounds, should one proceed as normal? My understanding is that the biofeedback test is sort of the litmus test to see if you tolerated the previous session. I am currently on the isometrics phase and experienced this situation yesterday, but symptoms went away during the biofeedback test.
        Shlentz Yes - in that scenario I would proceed as normal. Often, when tendons are in a reactive phase (symptomatic), the person will experience a "warming-up" period, when load is introduced the area feels better. If however you are finding symptoms are consistently elevating after each session and staying higher than usual then it is likely changes need to be made to training.

        Comment


        • Hi Barbell Medicine team! I'm 12 weeks postop from an MPFL reconstruction to correct a moderate trochlear dysplasia (i.e avoid repeated patella luxations). Since i couldn't afford a proper consultation Charlie suggested that the knee rehab template may be a good fit to apply progressive load to the area and thus allow me to build sufficient lower body strength to safely get back to grappling practice (thanks Charlie!). Now armed with the template, i've some questions about fatigue management and program adaptation.


          How do i use sRPE, A:C ratio and all the other metrics prescribed to determine whether i'm doing too much or not enough on a weekly basis ? (i.e risk of reinjury vs not enough stress to stimulate adaptation)


          Following the first question, how to dial back on the program to adapt to one's physical level without altering the desired adaptation ?


          Here's my situation… I'm already doing two physiotherapy sessions per week which currently mostly consist of low volume - low intensity lower body strengthening (sRPE 6.5 ~, mainly bodyweight squat variations bi and unilateral). PT sessions will likely progress to more agility and sport specific drills as well as plyometrics over the following month so i would like to keep them for that "dynamic" component.


          Considering i'm a beginner (overweight, poor S&C level) i fear following the program as it is would push me into overtraining so i'm planning to add no more than two Knee Rehab Template sessions per week on top of PT sessions while also applying a -2 reduction on sets RPE during Phase 2 & 3. Load would likely start with the lightest kettlebell already. Does that plan sounds correct to you ? Is there a better way i could adapt the program to my level ?


          Best,
          Last edited by heavygrappler; 06-30-2019, 04:10 PM.

          Comment


          • Hi Mike,

            This week will be week 4. I will miss Wednesday and Friday due to vacation and will not have access to a gym. Should I repeat week 4 when I get back?

            Comment


            • Hi,

              Thank you for your work!

              I am an 41 year old martial artist. 13 month ago, during a pre competition sparring, my training partner jumped on my leg, causing a rupture of the inside meniscus. After 5 month I agreed to a surgery where the meniscus was stitched up (with 3 fast fix). About 4 weeks into rehab, the bursa under the patella started filling with blood. Even after several punctuations the bursa would not become normal. So, 4 month ago, I had another surgery, where the bursa was cut out. In the first weeks after that, the rehab worked fine. I did a lot of stabilization exercises. For some weeks now, I am back doing squats, deadlifts with very light weights.

              However, I still cannot bend my knee in the full range (too tight) and I have pain on inside meniscus region when I do certain movements or squatting with higher loads. In addition, I lately have pain in hollow of the knee and the knee swells up. So, I am quite far away from practicing my sport, let alone competing at it.

              Here are my questions:
              What do you recommend doing? And more specifically, is the knee pain template a good advise for me?

              I am looking forward hearing from you!

              Best regards
              Michael

              Comment


              • Originally posted by heavygrappler View Post
                Hi Barbell Medicine team! I'm 12 weeks postop from an MPFL reconstruction to correct a moderate trochlear dysplasia (i.e avoid repeated patella luxations). Since i couldn't afford a proper consultation Charlie suggested that the knee rehab template may be a good fit to apply progressive load to the area and thus allow me to build sufficient lower body strength to safely get back to grappling practice (thanks Charlie!). Now armed with the template, i've some questions about fatigue management and program adaptation.


                How do i use sRPE, A:C ratio and all the other metrics prescribed to determine whether i'm doing too much or not enough on a weekly basis ? (i.e risk of reinjury vs not enough stress to stimulate adaptation)


                Following the first question, how to dial back on the program to adapt to one's physical level without altering the desired adaptation ?


                Here's my situation… I'm already doing two physiotherapy sessions per week which currently mostly consist of low volume - low intensity lower body strengthening (sRPE 6.5 ~, mainly bodyweight squat variations bi and unilateral). PT sessions will likely progress to more agility and sport specific drills as well as plyometrics over the following month so i would like to keep them for that "dynamic" component.


                Considering i'm a beginner (overweight, poor S&C level) i fear following the program as it is would push me into overtraining so i'm planning to add no more than two Knee Rehab Template sessions per week on top of PT sessions while also applying a -2 reduction on sets RPE during Phase 2 & 3. Load would likely start with the lightest kettlebell already. Does that plan sounds correct to you ? Is there a better way i could adapt the program to my level ?


                Best,
                Hey heavygrappler - thanks for the questions. Since you are currently being seen by a clinician, I suggest checking with them first to ensure you are cleared to complete the movements listed in the template.

                I wouldn't pay too much attention to the A:C ratios but you can monitor your sRPEs. If you start noticing you are reporting 9-10s regularly then it is likely time to make alterations to training.

                I think, if your physio clears it, 2 sessions per week from the template would be fine (one day with squat and accessories and another day with deadlift and accessories). The template was not specifically designed for your scenario so the dosage is not likely the most effective for your goals but if it can be adapted to your situation then it should be beneficial for RTS. Dropping RPE is likely a good idea, especially if you are new to this type of training. Keep us posted. Happy to help if need be. Ideally, your physio can help you implement the template and we provide a section specifically for clinicians in the template.
                Last edited by Michael Ray; 07-01-2019, 02:26 AM.

                Comment


                • Originally posted by Shlentz View Post
                  Hi Mike,

                  This week will be week 4. I will miss Wednesday and Friday due to vacation and will not have access to a gym. Should I repeat week 4 when I get back?
                  Yes, that should be fine.

                  Comment


                  • Originally posted by Michael1978 View Post
                    Hi,

                    Thank you for your work!

                    I am an 41 year old martial artist. 13 month ago, during a pre competition sparring, my training partner jumped on my leg, causing a rupture of the inside meniscus. After 5 month I agreed to a surgery where the meniscus was stitched up (with 3 fast fix). About 4 weeks into rehab, the bursa under the patella started filling with blood. Even after several punctuations the bursa would not become normal. So, 4 month ago, I had another surgery, where the bursa was cut out. In the first weeks after that, the rehab worked fine. I did a lot of stabilization exercises. For some weeks now, I am back doing squats, deadlifts with very light weights.

                    However, I still cannot bend my knee in the full range (too tight) and I have pain on inside meniscus region when I do certain movements or squatting with higher loads. In addition, I lately have pain in hollow of the knee and the knee swells up. So, I am quite far away from practicing my sport, let alone competing at it.

                    Here are my questions:
                    What do you recommend doing? And more specifically, is the knee pain template a good advise for me?

                    I am looking forward hearing from you!

                    Best regards
                    Michael
                    Hey Michael1978 - thanks for the questions. Sorry to hear about your situation. I don't think the template would be a good fit for your situation. However, I'd be happy to consult with you and see if I can help guide the path back to sport. https://www.barbellmedicine.com/consults-and-contact/

                    We will likely need to work through some narratives about your situation and then collaboratively design a game-plan to move you towards your activity goals. Happy to help.

                    Comment


                    • Hi

                      Sorry if a similar question has already been posted, but I wasn't able to find it using the search function:

                      Is there a way to modify phase 2 of the template to a 4 day split instead of 3 day? I just started phase 2 and the sessions take me much longer than sessions in the bridge or hypertrophy templates. I would normally rest 2-3 minutes between working sets on previous templates, but 4 exercises per session with 2-3 minutes between every set chews up a lot of time.

                      Thanks

                      Comment


                      • Is Phase one supposed to be done every day? Once a day every day, or even twice a day every day?

                        So if I'm otherwise working out three times a week, I'd skip the upper body workout on the other four days.

                        At this point, I can't perform the biofeedback test. The Spanish Squat and Split Squat are killing my knees pretty good, but it generally feels better when I stop. I'm using TRX straps to help balance and get into position.

                        Hopefully, I can get rid of the straps at some point and then eventually move to phase two.

                        Comment


                        • Originally posted by Michael Ray View Post

                          Hey heavygrappler - thanks for the questions. Since you are currently being seen by a clinician, I suggest checking with them first to ensure you are cleared to complete the movements listed in the template.

                          I wouldn't pay too much attention to the A:C ratios but you can monitor your sRPEs. If you start noticing you are reporting 9-10s regularly then it is likely time to make alterations to training.

                          I think, if your physio clears it, 2 sessions per week from the template would be fine (one day with squat and accessories and another day with deadlift and accessories). The template was not specifically designed for your scenario so the dosage is not likely the most effective for your goals but if it can be adapted to your situation then it should be beneficial for RTS. Dropping RPE is likely a good idea, especially if you are new to this type of training. Keep us posted. Happy to help if need be. Ideally, your physio can help you implement the template and we provide a section specifically for clinicians in the template.
                          Hey Michael Ray , i sent my physiotherapist the original template, as well as some suggested modifications based on our exchanges in here, he didn't have much to say about it unfortunately, but i'm cleared to do it. So basically, i substracted two sets per exercice, and i modified RPE the following way, in order : 5,6,7,8. As you suggested i will alternate between squat days and deadlift days completed by one unilateral exercice choosen in the template. I'll also do ligth functional movements such as going up stairs on some off days, just to go trougth the motions. What do you think about that ? Any modifications to recommend ?
                          Thank you for your time, if my french insurance plan convered BM consults, be sure i would have taken one already.

                          Comment


                          • Originally posted by alewife View Post
                            Hi

                            Sorry if a similar question has already been posted, but I wasn't able to find it using the search function:

                            Is there a way to modify phase 2 of the template to a 4 day split instead of 3 day? I just started phase 2 and the sessions take me much longer than sessions in the bridge or hypertrophy templates. I would normally rest 2-3 minutes between working sets on previous templates, but 4 exercises per session with 2-3 minutes between every set chews up a lot of time.

                            Thanks
                            alewife Sure, you can modify the template to fit your needs and schedule. You can also decrease/increase rest time based on how you are responding. These are general guidelines in the template. My only caveat - for provocative lifts I'd try to give yourself a day of rest between those sessions. Meaning if squat has been bothersome previously - I'd watch staking back to back sessions of squatting.
                            Last edited by Michael Ray; 07-18-2019, 03:32 AM.

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