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  • Dr. Ray,

    Firstly, many thanks for this template. I have had persistent patellofemoral pain for a few months and since starting this template, I have noticed substantial improvements.

    My question is about Phase 2. The crux of the issue is that I can't complete the workouts. To emphasise, this is not because of pain, but because of weakness and lack of recovery. I find the idea of 3 exercises at 6x15 RPE10 a crazy amount of intensity, probably because i'm very weak and it doesn't feel like i'm recovering between workouts; I could barely do the first week of isometric exercises at body weight. N.B. I am running a separate upper-body routine on another 3 days.

    For example, here is what I have done so far. I'm in my second week now.

    Tuesday:
    Squat - 6 x15
    Romanian DL* - 6 x 15, 15, 12, 10, 10, 8
    Bulgarian Split squats (bodyweight) - 6 x 10, 10, 8, 8, 6, 5

    Sunday (I didn't feel ready to work out again until Sunday)
    Wall-sits - 6x45seconds
    Bulgarian Split squats (bodyweight) - 6 x 10

    Tuesday**:
    Squat - 6 x 15
    Bulgarian Split squats (bodyweight) - 4 x 11, 10, 6, 5
    Romanian DL - 2 x 5, 6

    * Romanian DL because using a home gym set-up amidst covid, conventional DL seems difficult to do well
    ** My form was beginning to break down like crazy and so I didn't push any further on the split-squats or the RDLs

    My question is this: What is the best approach to Phase 2 given I can't complete it as is. Pushing too much feels like overtraining. I feel like two options are:
    - Reduce volume of sets, and have 2 exercise for 3 workouts
    - Keep volume and only workout twice a week

    Very interested to hear your thoughts, and thanks again.

    Comment


    • rorywatts thanks for purchasing the template and glad it has been helpful.

      Regarding dosage of activity, no worries here. The template is merely a roadmap that can be altered as needed. I think either reducing frequency from 3 days to 2 days or performing one major squat movement and one hinge movement are both reasonable options to help with symptoms, recovery, and adaptation.

      Comment


      • Originally posted by Michael Ray View Post
        rorywatts thanks for purchasing the template and glad it has been helpful.

        Regarding dosage of activity, no worries here. The template is merely a roadmap that can be altered as needed. I think either reducing frequency from 3 days to 2 days or performing one major squat movement and one hinge movement are both reasonable options to help with symptoms, recovery, and adaptation.
        Thanks very much for the reply, greatly appreciated.

        Comment


        • Hi Dr Ray,

          Thanks for the template. Hopefully it can help with the pain I’m experiencing, but at the least, I’m getting some enjoyment from it now the 3-0-3 x 15s are finally behind me.

          If you have a moment, could I get your thoughts on a couple of things?

          My background:

          Endurance/mountain runner. Roughly 1 year’s experience with strength training using barbells.
          Early in the year, I began to experience a pretty mild pain in the back of my right knee. I believe this is around the insertion of the semitendinosus/semimembranous, but I’m not pretending to be a doctor, so apologies if I’ve got that wrong.

          Obviously, covid-19 is limiting my access to non-essential medical consults, so I thought I’d try the template: Although you haven’t explicitly recommended it for my symptoms, they seem very close to conditions you do recommend for, so it seemed worth a shot.

          I’m towards the end of Week 3, having selected squats, conventional deadlifts and step-ups as my exercises.

          I’ve tolerated everything pretty well, but one observation I’ve made is that where I’ve had severe DOMS, it seems to be local to the biceps fermoris, not the site of my existing pain. I don’t know if this is relevant or not, but it seems worth mentioning.

          Thoughts/questions:

          1) Do you think my exercise selection is sound? I had previously been trying to fix myself with RDLs, but these didn’t show up in the dropdown in the template, so I’m guessing they’re out for a reason?
          3) I realise that tendon pain can take up to 12 weeks of rehab to resolve, and many cases don’t even resolve with that, and I also realise that any progress won’t be linear. That said, is there a 'cutoff' you would recommend with this template? For example if I haven’t experienced the slightest improvement after, say, 8 weeks, would trying to see a local physician possibly be a better use of my time?
          4) I realise that phase 3 of the template isn’t suited for my sport. Is there any chance you can give very 'top level' direction on where I should head next? I’m happy doing my own research and planning, but I’d be grateful for any advice you can offer.

          Thanks, Chris.
          Last edited by skipchris; 06-10-2020, 08:39 PM. Reason: (edited out question about step-ups which i realised was a stupid question)

          Comment


          • Hi Dr Ray,

            I am considering purchasing the knee rehab template, but before I do i want to make sure it is right for me. (43 years old - used to power lift in my 20's, still fairly strong, and mostly lean with about 20% body fat - desk worker)

            I started with very sharp pain on the front of my left kneecap about 6 years ago while playing hockey. I stopped the activity when the event occurred and the pain went away. However the pain would come back any time i tried to do an explosive movement - jumping seems to be the easiest way to trigger the issue.

            Fast forward a few years and I tried squatting lightly for the first time in 5 or 6 years and all was well until i put a little more weight on the bar and bam - very sharp pain on the decent of the squat.

            I went to the doctors and they did ultrasound, xray and MRI... all were negative, no damage noted.

            I gave up squatting but have been an avid cyclist the last 6 years without any knee pain. About 3 months ago I tried squatting again, same thing happened, fine on very light weight, but the first try with 185lb i got a very sharp pain on the decent. I was doing a 'low bar' starting strength style squat this time, whereas in the past i was doing high bar.

            I started experimenting with a 'box squat' of just above parallel and found that i can do that without aggravating my knee. I have been working up my box squat for the past 12 weeks and was able to do 5 sets of 5 at 275lb with a 17" box. I then tried just 95lb without a box and around rep 15 or 16 i felt the pain starting, but it was much subdued compared to previous.

            My current plan was to slowly reduce the height of the box over the next 12 weeks, today i did 6 set of 5 at 185 with a 15" box and didn't have any pain... But i tried one power clean with an empty bar and my knee screamed with sharp pain.

            Will I be able to do power movements again? Will your program help?

            Comment


            • Originally posted by skipchris View Post
              Hi Dr Ray,

              Thoughts/questions:

              1) Do you think my exercise selection is sound? I had previously been trying to fix myself with RDLs, but these didn’t show up in the dropdown in the template, so I’m guessing they’re out for a reason?
              3) I realise that tendon pain can take up to 12 weeks of rehab to resolve, and many cases don’t even resolve with that, and I also realise that any progress won’t be linear. That said, is there a 'cutoff' you would recommend with this template? For example if I haven’t experienced the slightest improvement after, say, 8 weeks, would trying to see a local physician possibly be a better use of my time?
              4) I realise that phase 3 of the template isn’t suited for my sport. Is there any chance you can give very 'top level' direction on where I should head next? I’m happy doing my own research and planning, but I’d be grateful for any advice you can offer.

              Thanks, Chris.
              Hey skipchris thanks for purchasing the templates and your questions. I'd likely need a consult to give detailed guidance. However, I'll try to answer your questions:

              1) I'd be fine with you doing RDLs based on the information you've provided. However, since your symptoms are unilateral, I'd recommend likely doing a single leg variant such as landmine RDL, or kettlebell/dumbbell RDL. You can also add in single leg curls (lying or seated) if equipment is available.
              2) Did you have a question 2 and maybe it was deleted or something?
              3) I think that is reasonable if you've not seen any improvement in 8 weeks. We'd also be happy to consult with you. https://docs.google.com/forms/d/e/1F...ilUWA/viewform
              4) Endurance running - yeah much of my conversations on this topic are similar to returning to resistance training; undulating volume, intensity, frequency, duration accordingly to aid with finding an entry point into activity with which to build from. For running I usually frame volume inclusive of frequency (days of running) and time (how long are you running for); intensity would be external (the terrain you are running on), time (how quickly you are running a particular distance), and internal (RPE and Heart Rate); duration is the number of weeks you are running for a particular goal. I'd likely have someone start "low and slow", finding a tolerable entry point comparatively to what they've been doing in the weeks prior to symptoms and more importantly what you've been doing most recently, seeing where to progress based on end goal of returning to sport.
              Last edited by Michael Ray; 06-11-2020, 03:58 PM.

              Comment


              • Originally posted by gerry-w View Post
                Hi Dr Ray,


                Will I be able to do power movements again? Will your program help?
                gerry-w thanks for the question. I wouldn't actually advise buying the template at this time given your symptoms seem isolated to squatting and you've already implemented a solid game-plan to address the situation. The template does not included dynamic loading such as jumping, running, or power movements like you've described. In such a scenario of power clean, I'd likely start you out with a muscle clean to begin training the movement specifically, while also introducing some low volume/intensity level jumping (example can you jump on a single leg in place for a time factor - don't worry about height of jump). If you need individual guidance, we'd be happy to consult with you: https://docs.google.com/forms/d/e/1F...ilUWA/viewform

                Comment


                • Cheers for your answers, Dr. Ray:

                  Originally posted by Michael Ray View Post
                  1) I'd be fine with you doing RDLs based on the information you've provided. However, since your symptoms are unilateral, I'd recommend likely doing a single leg variant such as landmine RDL, or kettlebell/dumbbell RDL. You can also add in single leg curls (lying or seated) if equipment is available.
                  Cool. So would this replace the current single leg exercise, or the current hinge? (i.e. switch from squats/DLs/steps to squats/SLRDLs/steps or squats/DLs/SLRDLs)?

                  Originally posted by Michael Ray View Post
                  2) Did you have a question 2 and maybe it was deleted or something?
                  I did, and although there’s technically no such thing as a stupid question… It was quite a stupid question, so I went back and deleted it.

                  Originally posted by Michael Ray View Post
                  3) I think that is reasonable if you've not seen any improvement in 8 weeks. We'd also be happy to consult with you. https://docs.google.com/forms/d/e/1F...ilUWA/viewform
                  Great, thanks. I have a moderate preference to see someone in-person, but a strong preference to see someone competent, so if I can’t find anyone local to me who I trust, I’m likely to take you up on this.

                  Cheers for the thoughts on returning to running

                  Comment


                  • Originally posted by skipchris View Post
                    Cheers for your answers, Dr. Ray:



                    Cool. So would this replace the current single leg exercise, or the current hinge? (i.e. switch from squats/DLs/steps to squats/SLRDLs/steps or squats/DLs/SLRDLs)?



                    I did, and although there’s technically no such thing as a stupid question… It was quite a stupid question, so I went back and deleted it.



                    Great, thanks. I have a moderate preference to see someone in-person, but a strong preference to see someone competent, so if I can’t find anyone local to me who I trust, I’m likely to take you up on this.

                    Cheers for the thoughts on returning to running
                    Exercise selection - I'd probably do squats/SLRDLs/Steps and see how you progress. Dual stance DLs can be layered back in at a later date.

                    Noted on question 2, no worries.

                    Clinician consult - I get that. Let us know if we can help in the future.
                    Last edited by Michael Ray; 06-18-2020, 03:51 PM.

                    Comment


                    • For some reason, the link in the OP isn't working for me. If you're like me, here ya go:
                      https://www.barbellmedicine.com/shop...ehab-template/
                      Last edited by BrewinBombers; 06-24-2020, 12:12 PM.

                      Comment


                      • Michael Ray
                        Michael Ray commented
                        Editing a comment
                        Thanks for letting me know. I've updated the link on the OP.

                    • Hey BBM crew, I just wanted to ask a simple question regarding the frequency of training in gnus template. If an individual is only able to train 2x per week would the template still be as effective or would a possible comprise be to extend the template by an extra week each phase?

                      thanks for taking the time!

                      Comment


                      • Dr. Ray,

                        I'm brand new to Barbell Medicine, but wound up purchasing the Knee Rehab program after my Brother In-Law recommended your site highly.

                        I suspect I'll have more questions to come, but first a technical one about the sheet. On the exercise selection page, the dropdown for the Isometrics Double Leg selection looks like this:
                        Click image for larger version

Name:	Counterbalance SquatLeg Extension1.jpg
Views:	202
Size:	113.3 KB
ID:	57342

                        Then, if I select "Counterbalance SquatLeg Extension" that's what shows up during phase 1 and phase 2 as well.

                        Am I correct in assuming that "Counterbalance SquatLeg Extension" isn't a new exercise I haven't heard of but rather a technical problem? If so, is there a fix for it?

                        Thank you for the help. I'm looking forward to starting the program!

                        -J.P.

                        Comment


                        • Originally posted by dulan458 View Post
                          Hey BBM crew, I just wanted to ask a simple question regarding the frequency of training in gnus template. If an individual is only able to train 2x per week would the template still be as effective or would a possible comprise be to extend the template by an extra week each phase?

                          thanks for taking the time!
                          Thanks for the question. I would need some more information on background and what's going to provide insight. But overall, dropping a day doesn't concern me. I'd probably just ensure you have a primary squat day and primary deadlift day with accessories on both days.

                          Comment


                          • Originally posted by PlatoFunFactory View Post
                            Dr. Ray,

                            I'm brand new to Barbell Medicine, but wound up purchasing the Knee Rehab program after my Brother In-Law recommended your site highly.

                            I suspect I'll have more questions to come, but first a technical one about the sheet. On the exercise selection page, the dropdown for the Isometrics Double Leg selection looks like this:
                            Click image for larger version

Name:	Counterbalance SquatLeg Extension1.jpg
Views:	202
Size:	113.3 KB
ID:	57342

                            Then, if I select "Counterbalance SquatLeg Extension" that's what shows up during phase 1 and phase 2 as well.

                            Am I correct in assuming that "Counterbalance SquatLeg Extension" isn't a new exercise I haven't heard of but rather a technical problem? If so, is there a fix for it?

                            Thank you for the help. I'm looking forward to starting the program!

                            -J.P.
                            Thanks for purchasing the template and for the question. That's indeed an error that I wasn't aware of. Can you email [email protected] and they can likely take care of this for you. In the meantime, I'd say pick whichever option you prefer, counterbalanced squat or leg extension.

                            Comment


                            • Hello, I recently found out about this program for knee issues. I have quadracept and patellar tendinitis. Both knees. Will this program help me get back to squating and deadlifts etc?

                              Can it be combined with other programs such as general strength and conditioning?

                              So I'm a martial artist and use strength training basically just for that activity. What do you mean by this statement.
                              *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).
                              Last edited by Eric777; 07-26-2020, 03:35 AM.

                              Comment

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