Announcement

Collapse
No announcement yet.

Knee Rehab Template

Collapse
This is a sticky topic.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Just got the knee rehab program and im keen to start.

    one thing I cant seem to find is recommendations on pain. I've done endless isometric work with wall sits which does help reduce pain, but I'm never pain free. Even just body weight squats bring pain.

    I'm looking at the first session of 6x15 squats followed by 6x15 bulgarian split squat and I can only imagine that my knees would both be in absolute agony before I even finish the squats. even with just bodyweight.

    Should I adjust depth to feel no pain? Some pain? Whats is acceptable in training? Should I stop the workout when pain gets above a 3/10? I'm kinda lost on where to go during the workout. The program itself looks great but I feel like its missing some key info for how to manage pain during workouts and what to adjust/modify when pain does creep up.

    I havent done the workout yet, but like I said, even a bodyweight squat can bring on some pain, and wanting to do 12 total sets sounds like it would just cripple me

    Comment


    • Originally posted by cazzah View Post
      Just got the knee rehab program and im keen to start.

      one thing I cant seem to find is recommendations on pain. I've done endless isometric work with wall sits which does help reduce pain, but I'm never pain free. Even just body weight squats bring pain.

      I'm looking at the first session of 6x15 squats followed by 6x15 bulgarian split squat and I can only imagine that my knees would both be in absolute agony before I even finish the squats. even with just bodyweight.

      Should I adjust depth to feel no pain? Some pain? Whats is acceptable in training? Should I stop the workout when pain gets above a 3/10? I'm kinda lost on where to go during the workout. The program itself looks great but I feel like its missing some key info for how to manage pain during workouts and what to adjust/modify when pain does creep up.

      I havent done the workout yet, but like I said, even a bodyweight squat can bring on some pain, and wanting to do 12 total sets sounds like it would just cripple me
      Hey, thanks for purchasing the template.

      Check out our guide on tendinopathy which goes into detail on experiencing pain. Even if you aren't using the template for tendinopathy but say for PFPS, the recommendations are similar regarding this variable. It's ok to experience some symptoms but these symptoms should be tolerable during and after activity (the first tab of the template discusses a few rules on the topic).

      If you've already been doing isometrics, then don't feel the need to do that part of the template. Instead you can move forward to the isotonics. If you are concerned about the amount of knee loading in the template, it's ok to remove an exercise. I'd prefer to keep in single leg work in that scenario.

      Comment


      • Hi Dr Ray,

        i have just purchased the 16week knee rehab template having struggled this last year with patellar femoral pain in my left knee, and finding myself continually aggravating my knee each time I get it to settle for a month or so by managing my vol/intensity poorly and getting impatient etc. I have a few question before i get started:

        1. Getting started on phase 2 i'm a little confused by the exercise selection portion. In the exercise selection tab there are two different tabs and drop down menus for "Single leg move 1", i chose split squat and unilateral leg press. However I notice when i jump into the Phase 2 tab only one of these exercises appears across the template for all 3 days per week (for me the split squat) and across all 12 weeks. Should i just stick with the one uni-lat exercise across the full 12 weeks? for reference i choose bi-lat Leg press, conventional DL's for the other two exercises.

        2. Looking at the template for phase 2 it is a lot more volume than i am currently doing having not been able to train a huge amount over lock-down, and i am currently relatively weak and unconditioned (currently doing two lower days a week with relatively low volume and two upper days a week). Wanting to avoid any large jumps in volume would you recommend maybe starting with 2 days a week, or reducing the number of sets for each exercise (ie. 4 sets not 6) or reducing total exercises per day? which would be the best approach?

        3. Is it possible to include the RDL or trap bar deadlift in phase 2 as a bi-lat leg move? (sorry to be that guy who wants more options/to change things)

        4. i notice there are slots in the phase 2 template for upper body exercises, am i ok to continue to run the two upper body days from my current programme along side this template (on separate days) in phase 2?

        5. i have noticed that my left quad on my affected side has atrophied a bit in comparison to the right side, and doesn't fire or engage a huge amount during unilateral or bilateral leg exercises. I notice i wake up the next morning after a leg day with doms in my left glute as i imagine my left glute and ham are taking up the slack for my left quad (i know this can be common in grumpy knees). Is this something i should ignore and work through and will sort itself out with time or would you recommend trying to include some unilateral leg extension to isolate that left quad?

        thanks so much in advance for any feedback you can give me!

        Comment


        • Originally posted by joepatrick View Post
          Hi Dr Ray,

          i have just purchased the 16week knee rehab template having struggled this last year with patellar femoral pain in my left knee, and finding myself continually aggravating my knee each time I get it to settle for a month or so by managing my vol/intensity poorly and getting impatient etc. I have a few question before i get started:

          1. Getting started on phase 2 i'm a little confused by the exercise selection portion. In the exercise selection tab there are two different tabs and drop down menus for "Single leg move 1", i chose split squat and unilateral leg press. However I notice when i jump into the Phase 2 tab only one of these exercises appears across the template for all 3 days per week (for me the split squat) and across all 12 weeks. Should i just stick with the one uni-lat exercise across the full 12 weeks? for reference i choose bi-lat Leg press, conventional DL's for the other two exercises.

          2. Looking at the template for phase 2 it is a lot more volume than i am currently doing having not been able to train a huge amount over lock-down, and i am currently relatively weak and unconditioned (currently doing two lower days a week with relatively low volume and two upper days a week). Wanting to avoid any large jumps in volume would you recommend maybe starting with 2 days a week, or reducing the number of sets for each exercise (ie. 4 sets not 6) or reducing total exercises per day? which would be the best approach?

          3. Is it possible to include the RDL or trap bar deadlift in phase 2 as a bi-lat leg move? (sorry to be that guy who wants more options/to change things)

          4. i notice there are slots in the phase 2 template for upper body exercises, am i ok to continue to run the two upper body days from my current programme along side this template (on separate days) in phase 2?

          5. i have noticed that my left quad on my affected side has atrophied a bit in comparison to the right side, and doesn't fire or engage a huge amount during unilateral or bilateral leg exercises. I notice i wake up the next morning after a leg day with doms in my left glute as i imagine my left glute and ham are taking up the slack for my left quad (i know this can be common in grumpy knees). Is this something i should ignore and work through and will sort itself out with time or would you recommend trying to include some unilateral leg extension to isolate that left quad?

          thanks so much in advance for any feedback you can give me!
          Hey, thanks for purchasing the template. I want to caveat my responses with an updated version of the template will be available soon and may address some or all of your questions. You can also email support to ensure you get a copy of the updated template when it's released.

          1. Yes, that should state "single leg move 2" and then update a day with a single leg movement so you aren't doing the same single leg movement every session.
          2. I'd need an individual consultation with you to give specific programming advice. However, I think it's fine to cut the weekly frequency to two days for resistance training. You can also even take out a bilateral movement each session. So it could be something like: Day 1 - Primary bilateral squat and single leg movement, Day 2 - Primary bilateral hip-hinge and single leg movement, and Day 3 - Squat variation and single leg movement.
          3. Totally cool with that. The updated template has more options.
          4. Yep - we didn't want to force folks into pre-programmed upper body movements in case those were going well and not provoking symptoms (e.g. leg drive in the comp bench).
          5. Leg extension is an option in the template. Otherwise, I wouldn't worry too much about this. Situation should sort itself out.

          Comment


          • joepatrick
            joepatrick
            Junior Member
            joepatrick commented
            Editing a comment
            Hi Dr Ray,

            thanks so much for the feedback it is hugely appreciated! I will get onto support and pick up the new template when released.

            1. Great i'll include leg extensions along side split squats

            2. Would you say there is an advantage doing 3 days a week over two ie. an advantage for recovery from a more frequent dosage of loading to the knee?, or is the difference trivial in the grand scheme of things? and focusing more on getting the intensity right and not rushing the protocol more important?

            3. all good here I didn't realise the "lift-offs" were rack pulls so been doing them (was trying to find the least worst hip-hinge option to do at 15 reps!), i was cursing your name by the last set! 6x15 rack pulls is truly horrible, felt sick after the last set !

            4. great thanks, current upper body protocol is not bugging knee at all so will keep running with that.

            5. great thanks good to know

        • Hello Dr.. Ray,

          Thank you for putting together this template.

          After changing the variables (load, ROM, exercise selection, mindset) for a couple weeks, I noticed the knee pain in my left knee is still there and seems to be more aggravated at higher loads, so I decided to try this template out.

          1) How important is it that we do all 16 weeks - that is, if the knee pain seems to go away after week 5 or 6, can we switch over to Phase 3? Or should we rigorously follow weeks 2-15 as prescribed?

          2) Do we have to do the isometric between days 1 and 3 and days 3 and 5? Or is it more so for analgesia?

          3) I have noticed during the first few days my quads have cramped up especially during the single leg work (split squats), is there any recommendations on minimizing this?

          4) Do we have to do the same exercises for all three days? For example, I was thinking of doing conventional deadlifts on day 1, sumo deadlifts on day 3, and trap bar deadlifts on day 5.

          Thank you, and this is seriously one of the toughest templates I have run (may be a result of my lack of aerobic conditioning/cardiovascular endurance), and I appreciate the detailed template!

          Best,
          Alan

          Comment


          • A bit of a cri de coeur here so forgive the plaintive tone all.

            Well, it's been a few years since buying the knee rehab template.

            After over a year of non training with the barbell during COVID, I got back into the gym and got back on it this year. My knee was slightly niggly still, but something I could live with- so I thought I'd continue back with the knee template and see if I could get to the linear progression phase- which is more than I managed before.

            After managing to complete phase 2 (came in about halfway through on 10 reps as could tolerate those loads with no significant pain) But then got about eight weeks into the phase 3/LP and I started experiencing tendonosis type knee pain that lasted more than 24 hours, so shifted back to the rehab/phase 2.

            A few months into rehab, and I'm finding that finishing on an RPE of 10 is exhausting me, I can squat 115KG for 4 on the LP but 12 reps of tempo squats at 80KG (which finish on an RPE of 10) are leaving me much, much more fatigued.

            So the days session beckons- drop the weight and do an RPE of less than 10 (YNDTP)? That's the only answer I guess, unless I'm supposed to be walking around like a pensioner.

            I'm not quite sure where this is all going either- I was delighted to finally get back on the LP- but just a few weeks of maximal loads and the tendonosis comes up again and I'm looking at months, possibly more of dicking about with tempos. When I was doing the rehab originally, I would get down to perhaps reps of 8 but the pain would always return to a point where reducing intensity and increasing volume was always the answer. I was stuck in the rehab phase 2 for over a year.

            It's very easy in this situation to start thinking that you are some sort of genetic mishap with tendons like noodles. Get near a maximal load, and it's tendonosis, rather than failure that stops my progress.

            I don't think I have ever failed a squat or a deadlift in my life.

            I can be as patient as anyone here, but I'm 50 in 3 years time and frankly I am weak after several years of barbell training and discipline. I have actually had some reasonable gains from the tempos, but TBH I feel like I've eaten enough Tempo Pie for a lifetime

            Comment


            • Finishing on RPE 10- literally edging failure ("training your spouse"- "sheet cakes"- "death is imminent")?

              Comment


              • Well, got in today and it was all OK.

                My post above reads a bit hysterically now I'm sitting here bathed in endorphins, but at the end of the day TL DR is it's taking frigging years to progress because of tendinopathy and I can't help wondering what (if anything) I've been doing "wrong"

                Comment


                • Hi Dr. Ray,
                  I just purchased the template and will start week1 tomorrow. I had a couple of basic questions (I'm a 49yo beginner who did a bit of LP a couple of years back and has a chondral medial lesion in the femur- no surgery advised)

                  - Split squats holds @ 90 degrees.... is it the same as the 'isometric lunge" in the exercise video library (on the last page of PDF)
                  - If I can't hold a bodyweight position for the full 45 secs (either for lack of conditioning or for pain) , should I repeat week 1 until I can actually do so?
                  - In this forum there are a few posts mentioning doing isometric work every day in week 1, while templates refers to 3x week only. When should one do exercises daily?
                  -Phase II. Most of the leg exercises are bilateral. I have a pretty marked tendency of loading the non injured legs on bilateral exercises. Would you advise to add or substitute unilateral exercises until I address the imbalance.

                  Thank you in advance!

                  Comment


                  • Hi Dr Ray,
                    I read that the aim is to eventually move towards normal speed(non tempo).

                    The tempo work for me seems to increase the overall patella pain felt during the exercise for me. In short, can I go direct to Phase III if non- tempo work feels better for me or is there an endurance or hypertrophy piece that I need to build up through Phase II.

                    Comment


                    • Originally posted by domitar View Post
                      Hi Dr. Ray,
                      I just purchased the template and will start week1 tomorrow. I had a couple of basic questions (I'm a 49yo beginner who did a bit of LP a couple of years back and has a chondral medial lesion in the femur- no surgery advised)

                      - Split squats holds @ 90 degrees.... is it the same as the 'isometric lunge" in the exercise video library (on the last page of PDF)
                      - If I can't hold a bodyweight position for the full 45 secs (either for lack of conditioning or for pain) , should I repeat week 1 until I can actually do so?
                      - In this forum there are a few posts mentioning doing isometric work every day in week 1, while templates refers to 3x week only. When should one do exercises daily?
                      -Phase II. Most of the leg exercises are bilateral. I have a pretty marked tendency of loading the non injured legs on bilateral exercises. Would you advise to add or substitute unilateral exercises until I address the imbalance.

                      Thank you in advance!
                      Hey Domitar,

                      Yes - split squat holds @ 90 degrees is the isometric lunge.
                      No - Bodyweight position holds for time can and should be adjusted to tolerance levels. It's also ok to skip this week if you don't feel it is needed and can find tolerable loading with the isotonic movements (Phase 2).
                      Not necessary - daily isometrics isn't necessary. The template has gone through updates since the original posting.
                      Yes - Phase 2 includes single leg work for this specific reason.

                      Let me know if you have any other questions!
                      Michael Ray
                      Moderator
                      Last edited by Michael Ray; 11-24-2021, 02:51 AM.

                      Comment


                      • domitar
                        domitar
                        Junior Member
                        domitar commented
                        Editing a comment
                        Thank you for getting back ! Follow up questions
                        - In phase 2 should I stick to bilateral for main and single leg for supplemental?
                        - Main squat lift: ia there value in variation or can one do the same movement for both day! and day 3?
                        Thanks and Happy Thanksgiving!

                    • Originally posted by Commonman View Post
                      Hi Dr Ray,
                      I read that the aim is to eventually move towards normal speed(non tempo).

                      The tempo work for me seems to increase the overall patella pain felt during the exercise for me. In short, can I go direct to Phase III if non- tempo work feels better for me or is there an endurance or hypertrophy piece that I need to build up through Phase II.
                      Great question. I'd still have you go through phase 2 but perhaps mess with tempo to tolerance. The primary reason the tempo is in place is to constrain loading (external intensity). With that in mind, the other option is reducing RPE by a point or two to ensure numbers aren't being chased.
                      Michael Ray
                      Moderator
                      Last edited by Michael Ray; 11-24-2021, 02:56 AM.

                      Comment


                      • Hello Dr Ray,

                        I just came across this sticky thread in the forum here specifically about the knee rehab template. I had made a post below about some issues I ran into recently on my left knee:
                        https://forum.barbellmedicine.com/fo...d-tendinopathy

                        Things are going in the right direction in terms of level and total affected area of pain is reducing.

                        Sorry if these have been answered already but,
                        1) What equipment is needed? I have a power rack/barbell with 300lbs/some bands/dumbbells 5lb to 25lbs.

                        2) Do you think going with the template would take me the next step to back to my normal routine without discomfort? Looking to hit 300lb squat with the SSLP approach. I experienced sharp knee pain (which started this rehab explained in the other thread) at a 275 squat (295 being my best set).

                        Thank you for taking any time to respond. Hope everyone had a good Christmas!

                        Comment


                        • Originally posted by smitty2919 View Post
                          Hello Dr Ray,

                          I just came across this sticky thread in the forum here specifically about the knee rehab template. I had made a post below about some issues I ran into recently on my left knee:
                          https://forum.barbellmedicine.com/fo...d-tendinopathy

                          Things are going in the right direction in terms of level and total affected area of pain is reducing.

                          Sorry if these have been answered already but,
                          1) What equipment is needed? I have a power rack/barbell with 300lbs/some bands/dumbbells 5lb to 25lbs.

                          2) Do you think going with the template would take me the next step to back to my normal routine without discomfort? Looking to hit 300lb squat with the SSLP approach. I experienced sharp knee pain (which started this rehab explained in the other thread) at a 275 squat (295 being my best set).

                          Thank you for taking any time to respond. Hope everyone had a good Christmas!
                          Hey!

                          1) The template allows exercise selection based on available equipment, but you should be fine based on what you've outlined here.
                          2) Difficult to state without more information garnered from a consultation with you. However, the primary premise of the knee rehab template is to help folks return to resistance training activities like squatting. I wouldn't be overly concerned with numbers right now as that's not the goal. Rather, it's to adjust training to tolerance to continue to remain active while symptoms regress. Ideally, you pick up a few tips along the way to help manage in the future should these issues occur again.

                          Hope that helps!

                          Comment

                          Working...
                          X