Knee Rehab Template

[Michael Ray]

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.

Yeah, prior training history as it relates to the cited studies on PFPS is a relevant discussion. It's also difficult to quantify strong, and what is strong enough as it relates to framing what is weak. Typically, the approach is are you strong enough to perform the activities you are attempting - which is a load management discussion. It's difficult to give personal advice without consulting with you but if you run the template as prescribed then this will help with managing loads over the next 15-16 weeks. The guiding factors throughout the template is RPE and A:C ratios to help with load management.

[Michael Ray]

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"?

Hey Jungle Dave,

Thanks for purchasing the template and glad you like it.

Exercise selection was programmed for the needs of strength-based athletes and what we typically see in the literature for HSR for the knee. Squatting and Deadlifting are a part of the templates but we've also included single leg exercises because that's how we see it in the research typically. Anecdotally the thought here is to ensure we are driving adaptation to the symptomatic extremity with single leg exercises.

Sorry to hear about missing out on the sale. Email: [email protected] and perhaps they can help you out.

[rainevi]

Hello,

Thank you for the work on the template. Just began the 8th week of HLM 1.0 and having been experiencing symptoms on my right knee for a while now (more specifically, back of the knee during bottom of squat and deadlift), I've decided to start the knee rehab template and mix it with the upper body from HLM.

For bilateral movements, I've chosen low bar squat and deadlift, with the reasoning that both of those are causing mild, tolerable symptoms, and I'm comfortable with them. (Deadlift I cannot tolerate at high intensity, but squats are tolerable I'd say.) With these exercises selected, the first workout proved to be a bit challenging. In both of these, I could hardly do 10 reps (out of 15) with 30kg at the given 3-0-3 tempo. Instead of RPE 5-10 throughout the prescribed sets, I ended up doing 10 reps at 8-10 RPE in most of them. Given that hitting 15 reps is a challenge, how should I proceed moving forward?

As a side note, I think describing the process for exercise selection in the template spreadsheet itself would be a great addition.

Thanks!

[sooghs]

Good evening Dr. Ray,

Thank you and the rest of the Barbell Medicine team for your incredible work in synthesizing this beautiful template. I am eager to learn the from the rehabilitation principles and methods you all used in designing it.

My question is, would such a template be suitable for someone recovering from a partial knee fracture?

The person of interest is a 60 year-old woman who strength trains recreationally while more keenly pursuing other activities, such as hiking, biking, etc. She is currently out of her cast (no surgery) and pursuing the road back previous levels of strength, pain, and function.

Many, many thanks!

[Michael Ray]

D.Mac Here's a link to the belt squat video. https://www.dropbox.com/s/upp7wcm0ho...Squat.mov?dl=0

[Michael Ray]

Hello,

Thank you for the work on the template. Just began the 8th week of HLM 1.0 and having been experiencing symptoms on my right knee for a while now (more specifically, back of the knee during bottom of squat and deadlift), I've decided to start the knee rehab template and mix it with the upper body from HLM.

For bilateral movements, I've chosen low bar squat and deadlift, with the reasoning that both of those are causing mild, tolerable symptoms, and I'm comfortable with them. (Deadlift I cannot tolerate at high intensity, but squats are tolerable I'd say.) With these exercises selected, the first workout proved to be a bit challenging. In both of these, I could hardly do 10 reps (out of 15) with 30kg at the given 3-0-3 tempo. Instead of RPE 5-10 throughout the prescribed sets, I ended up doing 10 reps at 8-10 RPE in most of them. Given that hitting 15 reps is a challenge, how should I proceed moving forward?

As a side note, I think describing the process for exercise selection in the template spreadsheet itself would be a great addition.

Thanks!

Hey, thanks for purchasing the template. I'd recommend dropping the load more so you can complete the prescribed sets and reps. If need be you can regress to an empty barbell for both movements. You could also further regress the squat to a goblet squat with a kettlebell or dumbbell (lighter than a standard barbell). You can do the same with the deadlift. If the barbell is too much, then you can perform an outside the leg kettlebell deadlift or a sumo style kb deadlift. Thanks for the feedback about exercise selection, that's a good point.

[Michael Ray]

Good evening Dr. Ray,

Thank you and the rest of the Barbell Medicine team for your incredible work in synthesizing this beautiful template. I am eager to learn the from the rehabilitation principles and methods you all used in designing it.

My question is, would such a template be suitable for someone recovering from a partial knee fracture?

The person of interest is a 60 year-old woman who strength trains recreationally while more keenly pursuing other activities, such as hiking, biking, etc. She is currently out of her cast (no surgery) and pursuing the road back previous levels of strength, pain, and function.

Many, many thanks!

Hey, what fracture occurred and how? Is the person scheduled to attend rehab at a facility? What information has she received from her current provider regarding return to activity? Potentially the template would be helpful but I'll need the above information and potentially a consult to speak more confidently about the matter.

[Marouane]

Hi Michael Ray, I just bought yesterday the knee rehab template, and I have a few questions.

I was diagnosed with patellar tendinopathy in both of my knees which I got about a year ago from running starting strength LP and not paying attention to my fatigue levels (with hindsight, I went from squatting once per week to 3 times per week, my knees weren't able to adjust).

Before buying the template, I was already doing a modified version of the Hsr protocol (https://onlinelibrary.wiley.com/doi/...8.2009.00949.x) plus one session per week with a PT. I only did 2 sessions per week and on only squats (high bar) because I didn't want it to add up to too much because of the PT session (he makes me do ketbell squats, lunges, small jumps stuff like that) .

My question : last session I thought about squatting normally (without a tempo and below parallel) to see how it felt, and it felt good. I had no pain in my knees (while I had some with a HSR style squat) and I still have no extra pain 2 days afterwards.

1) Can I run the knee template phase 2 program with a regular squat (since it doesn't cause me pain) and the other exercises or do I have to do the Hsr one?

Does a HSR style squat promote faster healing ?

Thank you for your time and attention.

[Jungle Dave]

Hey Jungle Dave,

Thanks for purchasing the template and glad you like it.

Exercise selection was programmed for the needs of strength-based athletes and what we typically see in the literature for HSR for the knee. Squatting and Deadlifting are a part of the templates but we've also included single leg exercises because that's how we see it in the research typically. Anecdotally the thought here is to ensure we are driving adaptation to the symptomatic extremity with single leg exercises.

Sorry to hear about missing out on the sale. Email: [email protected] and perhaps they can help you out.

All sorted. Thanks again. Template is excellent- been enthusing about it to my 74 year old Dad who has been lacking knee cartilage since he was 19, I'll let you know if I have any luck getting him running again...

[Michael Ray]

Hi Michael Ray, I just bought yesterday the knee rehab template, and I have a few questions.

I was diagnosed with patellar tendinopathy in both of my knees which I got about a year ago from running starting strength LP and not paying attention to my fatigue levels (with hindsight, I went from squatting once per week to 3 times per week, my knees weren't able to adjust).

Before buying the template, I was already doing a modified version of the Hsr protocol (https://onlinelibrary.wiley.com/doi/...8.2009.00949.x) plus one session per week with a PT. I only did 2 sessions per week and on only squats (high bar) because I didn't want it to add up to too much because of the PT session (he makes me do ketbell squats, lunges, small jumps stuff like that) .

My question : last session I thought about squatting normally (without a tempo and below parallel) to see how it felt, and it felt good. I had no pain in my knees (while I had some with a HSR style squat) and I still have no extra pain 2 days afterwards.

1) Can I run the knee template phase 2 program with a regular squat (since it doesn't cause me pain) and the other exercises or do I have to do the Hsr one?

Does a HSR style squat promote faster healing ?

Thank you for your time and attention.

Yeah, this is a really good question and I'm not sure I have a great answer right now. There are several factors that seem important to mention when discussing tendinopathy interventions:
1) Symptoms are a part of the process - meaning if HSR does cause you discomfort then that is ok but we wouldn't want baseline symptoms severely increasing and leaving you feeling debilitated.
2) I tend to like HSR because it allows for regulation of loading by performing a tempo pace which typically mitigates trying to increase external intensity (load being lifted) quickly but allows for internal intensity (RPE) to stay higher and leave the person feeling as though they are training.

Now for the tricky points....

3) Can you continue the template on without using tempo work? Maybe, I don't think supportive evidence exists that says you can't or shouldn't. With that said, my concern here is the premise will be concerning oneself with load being lifted rather than embracing the process.

4) We can likely get symptom mitigation with a multitude of muscle contraction types (isometric, concentric and eccentric, and eccentric only) but whether this provides long term positive outcomes is likely a different discussion.

We know we are making adaptations to the area with higher magnitude loads and over longer periods of time (>12 weeks) - whether these adaptations mean morphological, mechanical, or otherwise and to what extent it matters - we can have a very long nuanced debate over and I'm not sure it would be clinically meaningful for the patient (decreased symptoms and return to function/play). Here's an article I like that we discussed on a previous podcast with Jason Eure:

Podcast: http://www.clinicalathlete.com/clini...for-the-donuts

Bohm et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532714/

As an aside - I will look into this more and see if I can provide a better answer.

[Marouane]

Thank you Michael Ray for taking the time to answer my questions.

I like this particular point of yours: "With that said, my concern here is the premise will be concerning oneself with load being lifted rather than embracing the process."

I will keep it in mind while going through the process and not try increasing the weight just for the sake of increasing it.

I will also try another session this evening (I liive in France and it is morning right now) with a regular squat and I will keep you posted.

[PanosP]

Hello!

I'm going to start the knee rehab template next week (I've diagnosed with patellar tendionpathy a few months ago). I have 2 questions.
1. Can I change the 2 bilateral movements in the middle of Phase 2? For example first 6 weeks with HB Squat and Conventional Dl and the rest 6 with LB Squat and Sumo DL? I'm in the off season (next meet I'll compete will be on May, so I want to include some different variations every few weeks.
2. Can I add some more lower body exercises (like in the format of your 7 wk hypertrophy program) like SLDL,GM with minimal knee flexion or RDL? I also want to add some kg on my BW and I'll be on a slight surplus so I'd like to add some more stimulus!
Thanks in advance!

[Michael Ray]

Hello!

I'm going to start the knee rehab template next week (I've diagnosed with patellar tendionpathy a few months ago). I have 2 questions.
1. Can I change the 2 bilateral movements in the middle of Phase 2? For example first 6 weeks with HB Squat and Conventional Dl and the rest 6 with LB Squat and Sumo DL? I'm in the off season (next meet I'll compete will be on May, so I want to include some different variations every few weeks.
2. Can I add some more lower body exercises (like in the format of your 7 wk hypertrophy program) like SLDL,GM with minimal knee flexion or RDL? I also want to add some kg on my BW and I'll be on a slight surplus so I'd like to add some more stimulus!
Thanks in advance!

Hey! Thanks for purchasing the template.

1. Yes, this is fine but you may notice alterations in the loads you've been lifting when you make changes to exercise selection. Just something to be cognizant of.
2. Yes, you can add exercises but I'd be cautious as tendinopathies are load based issues (volume and/or intensity). Adding exercises will increase loading to the area, not a bad thing necessarily - again just something to be cognizant of. Regarding specific exercises - can you type out the name of the exercises you abbreviated (to ensure we are discussing the same things).

[Marouane]

Hi Michael, I just did yesterday the third session of week 2. But I think there might be a confusion with people who start the program. It certainly happened to me.
Let me explain:

In the instructions, it says that the frequency is 3 times per week. So I went to the gym 3 times per week this past week ( 2 days with ISOINERTIAL exercises and in between a day with isometric exercises), thinking that I finished one week of phase 2.

Only today I realized that the isometrics don't count in the frequency, so I am still missing one day of ISOINERTIALs.

So in my opinion, it should say in the instructions that the frequency is 5 times per week (which is a lot, I am not sure I can find time to go 5 times to the gym per week)

Can we skip the isometric days, or do them at home (wall sits for instance), so we only go 3 times per week to the gym?

[Michael Ray]

Hi Michael, I just did yesterday the third session of week 2. But I think there might be a confusion with people who start the program. It certainly happened to me.
Let me explain:

In the instructions, it says that the frequency is 3 times per week. So I went to the gym 3 times per week this past week ( 2 days with ISOINERTIAL exercises and in between a day with isometric exercises), thinking that I finished one week of phase 2.

Only today I realized that the isometrics don't count in the frequency, so I am still missing one day of ISOINERTIALs.

So in my opinion, it should say in the instructions that the frequency is 5 times per week (which is a lot, I am not sure I can find time to go 5 times to the gym per week)

Can we skip the isometric days, or do them at home (wall sits for instance), so we only go 3 times per week to the gym?

Hey, thanks for the questions and the feedback. For phase 2, the isoinertial days are what matter; days 2 and 4 can be skipped and are NOT necessary. They are programmed in as a means to load the area for analgesic purposes if the person has an increase in baseline symptoms that remain 24 hours after training.