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  • #76
    Originally posted by Tomphillips View Post
    Hi,

    Couple of questions about the template....

    Is there another option for the feedback test, the single leg squat to 90 is quite painful (I am pretty weak so it's a significant load for the knee) and seems to flares up symptoms more than the main session does. I thought about holding onto something to reduce the load but feel it would be difficult to be consistent with how much help I am giving myself.

    With load equated tempo squats seem to be more painful than normal speed, is this unusual? should I still be doing them slowly?

    I originally assumed i was dealing with a tendinopathy (maybe VMO), but not so sure now as pain is often within the knee cap or just to the inside of it. Does the actual issue matter that much? Presumably I just do the template the same if it's just non specific PTFJ pain?

    Thanks
    Tom
    Hey Tomphillips , going to be difficult to say what's going on with your knee without a consult. With that said - the template is appropriate for patellar tendinopathy, quad tendinopathy, and Patello-femoral pain syndrome. I've used it for other cases but those are the three I'm comfortable with saying it can be used on your own without guidance.

    I do think you need to have a biofeedback test to help guide the path. We supplied instructions for this scenario. If the biofeedback test can't be completed to standard then I highly recommend a week of isometrics. You can upload a video of you doing the biofeedback test and I can provide some insight.

    Regarding tempo of movements - this doesn't surprise me if the biofeedback test is very sensitized for you. Remember the guidelines to the template, some symptoms during training are to be expected but shouldn't be severely increasing (individualistic) to the point you feel debilitated (unable to go do other life activities).

    I do advise doing the template as instructed and not making alterations away from tempo work on jumping ahead. If you need help guiding the path with the template, I'd be happy to consult with you: https://www.barbellmedicine.com/consults-and-contact/

    Comment


    • #77
      Hi Mike,
      I’d like to say thanks for the template. Certainly fixed my knees.
      I’ve had a bit of history of tendonopothy of both knees, and latest bout had lasted some time and gradually resulted in me stopping full depth squats. Rather than going through the direct physio route I gave the knee template rehab a go. So glad I did, pain cleared up after around 6 weeks so I transitioned to the transition a bit sooner than the template recommends.
      I’m now pain free for a few months now and squatting a reasonable weight again (for me that is) (I have now gone to knee sleeves for heavier squat sessions probably as a comfort thing tho )
      thanks again!
      Dave

      Comment


      • #78
        I just finished phase 1 and the isometric work really aggravated my knees, at the end of the sessions I can't even walk down the stairs without pain. All the movements were bodyweight only so unloading isn't possible.

        On the flip side body weight tempo squats do wonders for my pain, I actually have to warm up my knees with 3-0-3s so I can do the iso work. It's suggested to do iso work till you can do the biofeedback test, but seeing that iso work make my knees hurt more then tempo should I be following that advice? Have you found that some people require more then 1 week of Phase 1 before moving on to tempo work?

        Any suggestions? Last night was day 7 of phase 1 and tonight was suppose to be day 1 of phase 2 but I highly doubt I'll be able to do the biofeedback test so I'm thinking that I may be looking a more iso work.
        Last edited by Therealredding; 03-03-2019, 11:56 PM.

        Comment


        • #79
          Originally posted by Michael Ray View Post

          Hey Tomphillips , going to be difficult to say what's going on with your knee without a consult. With that said - the template is appropriate for patellar tendinopathy, quad tendinopathy, and Patello-femoral pain syndrome. I've used it for other cases but those are the three I'm comfortable with saying it can be used on your own without guidance.

          I do think you need to have a biofeedback test to help guide the path. We supplied instructions for this scenario. If the biofeedback test can't be completed to standard then I highly recommend a week of isometrics. You can upload a video of you doing the biofeedback test and I can provide some insight.

          Regarding tempo of movements - this doesn't surprise me if the biofeedback test is very sensitized for you. Remember the guidelines to the template, some symptoms during training are to be expected but shouldn't be severely increasing (individualistic) to the point you feel debilitated (unable to go do other life activities).

          I do advise doing the template as instructed and not making alterations away from tempo work on jumping ahead. If you need help guiding the path with the template, I'd be happy to consult with you: https://www.barbellmedicine.com/consults-and-contact/
          Thanks for the reply!

          I did do a week of iso's, well about 5 days to be honest. I didn't find they had any effect at all unless I went right down to the really painful range (90-100 deg ish) in which case they would really irritate. They didn't have any effect on the Biofeedback test in that time so I thought as I could do an empty bar squat with 1-2/10 pain i may as well start there. I have had benefit with iso's on a previous adductor tendon issue so the lack of effect is what got me thinking it's probably not tendon.

          Thanks I will get a video before my next session and upload.

          Ok cool I just wanted to check, I will persevere with the template as written, I started 15's again yesterday with empty bar so will go from there, unless you think I should have another crack at Iso's?

          One other question - the template says to build up to one top set over up to 6 warm ups. If your top set is going to be very light would you suggest doing more than one top set as obviously there won't be much in the way of warm ups?

          Many thanks, Tom

          Comment


          • #80
            Originally posted by Fettle View Post
            Hi Mike,
            I’d like to say thanks for the template. Certainly fixed my knees.
            I’ve had a bit of history of tendonopothy of both knees, and latest bout had lasted some time and gradually resulted in me stopping full depth squats. Rather than going through the direct physio route I gave the knee template rehab a go. So glad I did, pain cleared up after around 6 weeks so I transitioned to the transition a bit sooner than the template recommends.
            I’m now pain free for a few months now and squatting a reasonable weight again (for me that is) (I have now gone to knee sleeves for heavier squat sessions probably as a comfort thing tho )
            thanks again!
            Dave
            DUDE! This is awesome. Thanks for sharing your story and very happy to hear the template was helpful.

            Comment


            • #81
              Originally posted by Therealredding View Post
              I just finished phase 1 and the isometric work really aggravated my knees, at the end of the sessions I can't even walk down the stairs without pain. All the movements were bodyweight only so unloading isn't possible.

              On the flip side body weight tempo squats do wonders for my pain, I actually have to warm up my knees with 3-0-3s so I can do the iso work. It's suggested to do iso work till you can do the biofeedback test, but seeing that iso work make my knees hurt more then tempo should I be following that advice? Have you found that some people require more then 1 week of Phase 1 before moving on to tempo work?

              Any suggestions? Last night was day 7 of phase 1 and tonight was suppose to be day 1 of phase 2 but I highly doubt I'll be able to do the biofeedback test so I'm thinking that I may be looking a more iso work.
              Hey, sorry to hear about the difficulties. Admittedly, I often skip isometrics in clinic unless the person is sensitized and struggling with movements like the biofeedback test.

              Isometrics are just an easy way to load the area in a typically less threatening and less demanding manner.

              I'm curious what you think the symptoms mean?

              I see no problem doing an additional week of isometrics but perhaps manipulate time of the isometrics so your symptoms aren't severely increasing. There are no absolutes in these concepts but I think it's important to keep in mind this template isn't a race to the finish and it's much more important to gain a new understanding of load management while going through this process.

              Comment


              • #82
                Originally posted by Tomphillips View Post

                Ok cool I just wanted to check, I will persevere with the template as written, I started 15's again yesterday with empty bar so will go from there, unless you think I should have another crack at Iso's?

                One other question - the template says to build up to one top set over up to 6 warm ups. If your top set is going to be very light would you suggest doing more than one top set as obviously there won't be much in the way of warm ups?

                Many thanks, Tom
                Cool - I'll be on the lookout for the video of the biofeedback test.

                Isos - this would depend on how the biofeedback test is going and your baseline symptoms.

                Regarding - the top set question, can you clarify? I'm not following. The weight really isn't important while going through this template but rather you are able to tolerably load the area to meet the prescribed RPE within the confines of the set limit.
                Last edited by Michael Ray; 03-05-2019, 01:34 AM.

                Comment


                • #83
                  Originally posted by Michael Ray View Post

                  Hey, sorry to hear about the difficulties. Admittedly, I often skip isometrics in clinic unless the person is sensitized and struggling with movements like the biofeedback test.

                  Isometrics are just an easy way to load the area in a typically less threatening and less demanding manner.

                  I'm curious what you think the symptoms mean?

                  I see no problem doing an additional week of isometrics but perhaps manipulate time of the isometrics so your symptoms aren't severely increasing. There are no absolutes in these concepts but I think it's important to keep in mind this template isn't a race to the finish and it's much more important to gain a new understanding of load management while going through this process.
                  I'm not sure I know what the symptoms means, I'm not worried about screwing up my knees more of anything like that. After working with Derek for my shoulder issue I know it just takes time and the right amount of loading for things to improve. I'm not afraid of the work, I was just wondering about your thoughts on the iso work aggravating my knees and tempo making them feel better and if it meant that maybe I should modify the timeline. I don't want to be wasting time doing iso work when I could be doing something more optimal with my training time. However if I need more iso work I'm not opposed to it if it's what I need to do. Either way I'm guessing it's best to just keep following the instructions and I'm adding a 2nd week of phase 1. We'll see how things are at the end of this week.

                  When you say "manipulate time of the isometrics so your symptoms aren't severely increasing" don't go to an absolute @10? Because I've been dealing with this use for a while, I can handle a bit of pain. Right not I see an @10 as the point when the pain just gets too great of I physically can't hold it any longer. Of course after a set ike that I have problems standing up afterwards.

                  One thing that's a sticking point for myself is, like Tom a few posts back, the biofeedback test is a difficult movement. It's makes it hard to figure out if it's the pain or the general lack of leg strength that is the preventative fact in completing the biofeedback test.

                  Worst comes to worst, I can set up a consult I guess.
                  Last edited by Therealredding; 03-05-2019, 04:07 AM.

                  Comment


                  • #84
                    Hi Michael,

                    Sorry I just meant if my RPE 10 is a very light weight (say just the bar) I am unlikely to have done many sets to build up to it whereas the template example below allows 6 sets.

                    Example: Low bar back Squat = Set 1 at 45#, Set 2 at 65#, Set 3 at 95# at RPE 6, Set 4 at 135# at RPE 8, Set 5 at 145# at RPE 9, and Set 6 at 155# at RPE 10.

                    If I arrive at RPE 10 with my second set do I just leave it there and move on?

                    Biofeed backtest is attached.

                    I can't get that last few degrees (pain), and can't do the required tempo on the way up, This was a few days ago and I have been doing Iso's since (spanish squats and leg ext). Should I be aiming to do them in a range that is pain free or do follow the guidelines that some increase from baseline is ok as long as not for 24hrs?


                    Originally posted by Michael Ray View Post

                    Cool - I'll be on the lookout for the video of the biofeedback test.

                    Isos - this would depend on how the biofeedback test is going and your baseline symptoms.

                    Regarding - the top set question, can you clarify? I'm not following. The weight really isn't important while going through this template but rather you are able to tolerably load the area to meet the prescribed RPE within the confines of the set limit.

                     

                    Comment


                    • #85
                      Originally posted by Therealredding View Post

                      I'm not sure I know what the symptoms means, I'm not worried about screwing up my knees more of anything like that. After working with Derek for my shoulder issue I know it just takes time and the right amount of loading for things to improve. I'm not afraid of the work, I was just wondering about your thoughts on the iso work aggravating my knees and tempo making them feel better and if it meant that maybe I should modify the timeline. I don't want to be wasting time doing iso work when I could be doing something more optimal with my training time. However if I need more iso work I'm not opposed to it if it's what I need to do. Either way I'm guessing it's best to just keep following the instructions and I'm adding a 2nd week of phase 1. We'll see how things are at the end of this week.

                      When you say "manipulate time of the isometrics so your symptoms aren't severely increasing" don't go to an absolute @10? Because I've been dealing with this use for a while, I can handle a bit of pain. Right not I see an @10 as the point when the pain just gets too great of I physically can't hold it any longer. Of course after a set ike that I have problems standing up afterwards.

                      One thing that's a sticking point for myself is, like Tom a few posts back, the biofeedback test is a difficult movement. It's makes it hard to figure out if it's the pain or the general lack of leg strength that is the preventative fact in completing the biofeedback test.

                      Worst comes to worst, I can set up a consult I guess.
                      How have things been going since your last post?

                      Regarding modifying isometrics - this would be a time variable or if you are using external loading as well. If you hold the isometric for :45 seconds and notice a severe increase in symptoms then perhaps you can hold :35 with tolerable symptoms.

                      Comment


                      • #86
                        Originally posted by Tomphillips View Post
                        Hi Michael,

                        Sorry I just meant if my RPE 10 is a very light weight (say just the bar) I am unlikely to have done many sets to build up to it whereas the template example below allows 6 sets.

                        Example: Low bar back Squat = Set 1 at 45#, Set 2 at 65#, Set 3 at 95# at RPE 6, Set 4 at 135# at RPE 8, Set 5 at 145# at RPE 9, and Set 6 at 155# at RPE 10.

                        If I arrive at RPE 10 with my second set do I just leave it there and move on?

                        Biofeed backtest is attached.

                        I can't get that last few degrees (pain), and can't do the required tempo on the way up, This was a few days ago and I have been doing Iso's since (spanish squats and leg ext). Should I be aiming to do them in a range that is pain free or do follow the guidelines that some increase from baseline is ok as long as not for 24hrs?




                        To the point about RPE and progressing weight - I'd recommend starting with a lighter load if you are hitting RPE 10 on set 2. Also keep in mind that if the empty barbell is taking you to RPE 10 then there are other bilateral leg movements that can be used like goblet squat or leg press.

                        Biofeedback test - that actually looks pretty good, a bit fast but otherwise pretty good. Remember - the biofeedback test isn't demanding full depth squatting but rather just hitting 90/90 of hip and knee flexion. Regarding isometrics and symptoms - yes, tolerable symptoms is the goal here too.

                        Comment


                        • #87
                          Originally posted by Michael Ray View Post

                          How have things been going since your last post?

                          Regarding modifying isometrics - this would be a time variable or if you are using external loading as well. If you hold the isometric for :45 seconds and notice a severe increase in symptoms then perhaps you can hold :35 with tolerable symptoms.

                          Yeah I started a second week of iso but my symptoms did get rather worse. I had a consult with Derek this morning and he’s gonna help out modifying the template to fit my situation a little better.

                          Comment


                          • #88
                            Hey doctor just purchased the template thank you. I performed the phase 1 isometrics as prescribed for 5 sets of 45 sec holds. I did not experience any significant amount of pain during the holds themselves.However after each set was done the amount of pain increased, I would say moderately set by set. After the session was done my pain symptoms increased significantly on my tenonditis diagnosed left knee. Also my right knee seems to be affected by the isometric exercises and now I'm getting some discomfort on my right knee as well which was not afflicted with tendonitis. Are those symptoms to be expected? Thank you again
                            Last edited by Efthimios Maheras; 03-17-2019, 04:12 PM.

                            Comment


                            • #89
                              Hi. I am a 41 year old male. I've done some version of Starting Strength for the past couple of years, and at the beginning of the year I switched to Olympic lifting with a coach. It was very high volume, and it's taken a toll on my knees (in the process of getting in to see someone, but I highly suspect tendinopathy). I'm probably going to get the knee rehab template with the hopes of someday getting back into oly lifting. That said, the template description says that it's not ideal for transition back into oly, and that the phase three structure would be different for such a transition. I'd like to know if there is a way to consult with you to customize phase three for oly lifting. More generally, I also saw the 4-week oly template says that its not for people of advanced age - is that me? I really enjoy the oly lifts and would like to get back into them if there's a smart way to do it.

                              Thanks in advance for your help.

                              Doug

                              Comment


                              • #90
                                Originally posted by Efthimios Maheras View Post
                                Hey doctor just purchased the template thank you. I performed the phase 1 isometrics as prescribed for 5 sets of 45 sec holds. I did not experience any significant amount of pain during the holds themselves.However after each set was done the amount of pain increased, I would say moderately set by set. After the session was done my pain symptoms increased significantly on my tenonditis diagnosed left knee. Also my right knee seems to be affected by the isometric exercises and now I'm getting some discomfort on my right knee as well which was not afflicted with tendonitis. Are those symptoms to be expected? Thank you again
                                Hey Efthimios Maheras , thanks for purchasing the template. Can you outline specifically what you completed for the week of isometrics (frequency, exercise, sets x reps x weight - if used, and time component)?

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