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  • Stalling knee rehab and clunky knee



    Hello guys, I decided to embark on the knee rehab template back in November when the area below the left kneecap became too painful to lift while on an LP. I had Osgoods as a kid and the lump there is fairly impressive- but after chatting here and being reassured I knew that the template was the way forward and it was tendons that needed strengthening.

    The onset of the principle pain that got me on the template was gradual and indeed there has always been some tenderness there since starting lifting a year or two back- I really noticed it when getting stairs fitted at home when I got my loft converted last year as lame as that sounds) so I kind of ignored it until it became too painful to squat heavy.

    However, there is also another pain that has been present in the inside of my knee, the MCL/head of the quad/top of the shin area, since around the summer last year- while the original pain that I started the knee template for has abated as expected, this secondary pain has developed, and since around the time I started the rehab I have been aware of a catching sensation that initially eased then returned with a vengeance when increasing intensity to approaching bodyweight during the knee template.

    There was an incident during the summer last year when I bollocksed up a pistol squat and felt a nasty painful "squish" sensation in the side of the knee. It hurt, but it didn't feel like I'd really put the kybosh on my knee at all and I was back squatting normally under the bar within a few days. The knee might have felt a bit loose and jangly afterwards for a few weeks. Possibly "catching". Sure, it could be a result of that... I'm starting to become skeptical of this though as my right knee is beginning to sound a little snappy too over the last few days although it is not "catching" anything like the left.

    I have been doing the template since November, so as you can imagine I have had to go back several times to repeat a week because of this side of the knee pain cropping up. Although I'm getting sick of tempos, that's life- it's really the catching knee thing that is doing my head in. Typically, if my knee is bent a little such as driving or sitting at a desk, it also feels like it "slips out of place" when I rotate a little on the leg, and lately even when walking occasionally, I will extend the leg and the knee will snap and it will feel "back on track". When walking if I don't perform this manoeuvre when it's required it gets a bit uncomfortable.

    My related activities are, a desk job, and the knee template that's pretty much it.

    I've not been short of narratives:

    Wearing anti pronation insoles in my 20s and 30s has made the joint out of whack - skeptical

    My squat is shit - possible but I'm fairly sure it's not dangerous and it might even be quite nice

    I knackered the knee doing that bloody pistol squat - stranger things have happened

    I am getting the RPE wrong on the template, perhaps overloading the bar when progressing from 12s to 10s and so on (I did find that transition difficult) and consequently rushing my tempo squats as I increase the intensity, thereby negating the principle of the rehab

    I'd say the smart money is on the final explanation- although I've only caught myself rushing a couple of times on the last squat or two of an RPE 9 or 10 and I thought I'd more or less had it locked down. It's possible I'm getting so thirsty to get out of tempo land I'm stitching myself up subconsciously.

    Whaddaya reckon?








    Last edited by Jungle Dave; 02-16-2019, 08:10 AM.

  • #2
    Originally posted by Jungle Dave View Post

    Hello guys, I decided to embark on the knee rehab template back in November when the area below the left kneecap became too painful to lift while on an LP. I had Osgoods as a kid and the lump there is fairly impressive- but after chatting here and being reassured I knew that the template was the way forward and it was tendons that needed strengthening.

    The onset of the principle pain that got me on the template was gradual and indeed there has always been some tenderness there since starting lifting a year or two back- I really noticed it when getting stairs fitted at home when I got my loft converted last year as lame as that sounds) so I kind of ignored it until it became too painful to squat heavy.

    However, there is also another pain that has been present in the inside of my knee, the MCL/head of the quad/top of the shin area, since around the summer last year- while the original pain that I started the knee template for has abated as expected, this secondary pain has developed, and since around the time I started the rehab I have been aware of a catching sensation that initially eased then returned with a vengeance when increasing intensity to approaching bodyweight during the knee template.

    There was an incident during the summer last year when I bollocksed up a pistol squat and felt a nasty painful "squish" sensation in the side of the knee. It hurt, but it didn't feel like I'd really put the kybosh on my knee at all and I was back squatting normally under the bar within a few days. The knee might have felt a bit loose and jangly afterwards for a few weeks. Possibly "catching". Sure, it could be a result of that... I'm starting to become skeptical of this though as my right knee is beginning to sound a little snappy too over the last few days although it is not "catching" anything like the left.

    I have been doing the template since November, so as you can imagine I have had to go back several times to repeat a week because of this side of the knee pain cropping up. Although I'm getting sick of tempos, that's life- it's really the catching knee thing that is doing my head in. Typically, if my knee is bent a little such as driving or sitting at a desk, it also feels like it "slips out of place" when I rotate a little on the leg, and lately even when walking occasionally, I will extend the leg and the knee will snap and it will feel "back on track". When walking if I don't perform this manoeuvre when it's required it gets a bit uncomfortable.

    My related activities are, a desk job, and the knee template that's pretty much it.

    I've not been short of narratives:

    Wearing anti pronation insoles in my 20s and 30s has made the joint out of whack - skeptical

    My squat is shit - possible but I'm fairly sure it's not dangerous and it might even be quite nice

    I knackered the knee doing that bloody pistol squat - stranger things have happened

    I am getting the RPE wrong on the template, perhaps overloading the bar when progressing from 12s to 10s and so on (I did find that transition difficult) and consequently rushing my tempo squats as I increase the intensity, thereby negating the principle of the rehab

    I'd say the smart money is on the final explanation- although I've only caught myself rushing a couple of times on the last squat or two of an RPE 9 or 10 and I thought I'd more or less had it locked down. It's possible I'm getting so thirsty to get out of tempo land I'm stitching myself up subconsciously.

    Whaddaya reckon?







    Hey Jungle Dave , thanks for posting this thread. When you watch your knee flex and extend, do you notice if the patella "jumps tracks" at all? Just curious. When the knee "catches" does it ever stay fixated in a particular position and you can't get it unlocked? These situations wouldn't necessarily change my recommendation but am curious. Any recent traumas to the knee?

    My initial recommendation to get you started, make sure you are exercising to tolerable level symptoms (if you are having severely increased symptoms during or after training then load adjustments need to be made).

    Comment


    • #3
      Originally posted by Michael Ray View Post

      Hey Jungle Dave , thanks for posting this thread. When you watch your knee flex and extend, do you notice if the patella "jumps tracks" at all? Just curious. When the knee "catches" does it ever stay fixated in a particular position and you can't get it unlocked? These situations wouldn't necessarily change my recommendation but am curious. Any recent traumas to the knee?

      My initial recommendation to get you started, make sure you are exercising to tolerable level symptoms (if you are having severely increased symptoms during or after training then load adjustments need to be made).
      Hi Michael. I haven't noticed any visual movement of the patella "jumping tracks" at all- in fact the clicking sensation almost feels like the femur "slipping" on top of the tibia when I move sideways occasionally or rotationally to turn around rather than the patella riding in the wrong place. Sort of loose. And it has never locked, only "caught", and again I'm not even sure the patella is involved.

      No acute traumas for ages- hurt the knee back in August last year but as I said after the initial event it wasn't all that painful, could train on it after a short while. Perhaps that injury created "a new normal" which is mildly irritating but not sinister, although I have noticed the clicking/slipping has increased with loading, so the chances of it being some weird subclinical special snowflake condition has to be low huh?


      I already cut the intensity back to reps of 12 (15? I'd rather be injured) and I've decided to throw away the records for a week or two. Just lift really mindfully and slowly, make sure those three seconds are exactly just that all the way up as well as down, if I underestimate the RPE, then fine, maybe lift even slower until it hurts enough to call it an 8 or a 9 or whatever, within reason.

      The problem for me I suspect is that the template worked so well initially (as in it felt like a bit of a plateau buster and I was putting on some good weight) that I may have got fixated on the numbers and what they "should be" rather than letting the RPE lead the way. Then before I know it I'm doing an RPE 10 and hip driving hard to make sure I get that load up in the air for the last rep. It's tough doing an RPE 10 and maintaining the discipline to keep it tempo at the best of times anyway.

      Thanks again for your help using this protocol, it's becoming extremely useful.







      Comment


      • #4
        Quick update, it's a couple of weeks into resetting the template- I decided to bite the bullet and go to sets of 15 for a couple of weeks and really go perfect on the tempos- see if the clunking improved.

        Well, sort of. It hasn't got worse. But it is no better really. And thinking about sets of 15 is worse than doing them.

        I know that the program needs to progress in order to be effective and pain will perhaps be part of the process, so I will attempt sets of 12 this coming week and up the intensity again, this time maintaining the attention to the tempo and form.

        But seeing as this is the third or forth time I have had to re-set, I am attempting my tempo squats to just above where it begins to hurt, and see if this helps. This is at around a touch above parallel, and this does decrease as the sets progress.

        I do have a couple of narratives playing in my mind as I train ATM, the first being that I wore trainer inserts for pronation for years, second is that it is an inflamed bursa that can't be rehabbed by the template.

        Again, I am sure this is just more bullshit narrative although inevitably the worry pops into my head when I move my leg and the femur feels like it "slipped" a bit on top of the tibia, my brain just keeps going "perhaps it's X?"- X usually being a reason why doing what I'm doing will not work or be "making it worse".

        The up side is that I think my form has got a lot better and I do feel quite fit in spite of not doing my fives since October last year

        .

        Comment


        • #5
          OK, pain and catching worse today. I think I'm going to exchange the deadlift for a Romanian DL to see if that element of the ROM is part of the problem, it means can also lower the weight again. Fairly sure the squat is not the movement I need to adjust as the lateral pain came on strong after doing a DL PR back in November. Dropping back down to 15s for another week.

          May try and incorporate bodyweight single leg presses or split squat this week in spite of time constraints. My leg stability when I do unilateral exercises is highly questionable, wobbles all over the place, suggesting to me this may be where I need to focus...

          I'll get off first base one of these days

          Comment


          • #6
            Originally posted by Jungle Dave View Post
            OK, pain and catching worse today. I think I'm going to exchange the deadlift for a Romanian DL to see if that element of the ROM is part of the problem, it means can also lower the weight again. Fairly sure the squat is not the movement I need to adjust as the lateral pain came on strong after doing a DL PR back in November. Dropping back down to 15s for another week.

            May try and incorporate bodyweight single leg presses or split squat this week in spite of time constraints. My leg stability when I do unilateral exercises is highly questionable, wobbles all over the place, suggesting to me this may be where I need to focus...

            I'll get off first base one of these days
            Hey, sorry for the delayed response. Just catching up on this situation. At this point - I recommend getting a consult so we can help guide the path. It sounds like there is a good possibility there is ongoing overreaching accompanied with some worrisome thoughts that we need to address. Perhaps we can consult and provide some insight on how to move forward and what changes, if any, need to be made. https://www.barbellmedicine.com/consults-and-contact/

            Comment


            • #7
              Cheers Michael. A quick update is that going back to sets of 15 for has helped, it has improved.

              Yes there is catching, but it is has reduced to certain movements as opposed to almost constant. I will try sets of 12 again after another week of 15s.

              I will get in touch, as I'm not sure why the modest weights I'm lifting at tempo would be causing me to overreach.

              One thing I have noticed, is that I train three times a week, and on my second rest day pain will actually be more apparent than any other day of the week. Conversely, when the gym shut over Christmas & New Year I had to train every other day for a while to make up for the days the gym was shut- my pain and symptoms were actually at their lowest... this is a shame as I get beef from the wife for three times a week, never mind more...



              Comment


              • #8
                Up to sets of 12 again for a couple of weeks, felt good, knee starting to catch so did sets of 15 today, will return to sets of 12 day after tomorrow and continue the progression to sets of ten if all feels good.

                I've lost four or five kilos of blubber over the last month so I'm hoping that might have a positive effect on whatever. The work outs feel good still, the tempos are strict now, I think I can anticipate the moment to backpedal the intensity so I don't have to backpedal for too long.

                That's the plan...

                Comment


                • #9
                  About to transition to sets of 10, things going great pain wise. Still the knee continues to clunk and seemingly mis-track, although still it is more or less painless.

                  I did notice recently when palpating the back of my knee that there is a grape-sized mass of some sort deep inside the knee that is not present in the asymptomatic knee. It doesn't present when the leg is extended, only when bent and I can get my fingers right in there.

                  I'm not concerned, I'm assuming it's either a Baker's cyst or similar but I'll get it checked out to be on the safe side that it's not an extra head growing or whatever.

                  Feeling pretty happy about the training (met my abs again after a 15 year hiatus the other day), there are occasionally nagging doubts about the origins of the "mis tracking" but I'm gradually accepting those kinds of thoughts are just par for the course and shouldn't be elevated above the facts. There isn't a condition out there that matches the symptoms that would suggest changing my approach.

                  And of course I've looked

                  Comment


                  • #10
                    Went to the GP today to get them to check the mass inside my knee, it appears to be a little larger now and somewhat harder than you might expect from a fluid filled Baker's cyst. I've got an appointment to see Musculo-Skeletal clinic in a few months, which is a bit shit regarding the epic wait but at least I know that the symptoms aren't necessarily training related.

                    So I think, I'm going to continue to train within the parameters of the knee rehab template, I assume it can only benefit me... it's relatively painless, it aches more on my rest days really so I think I'll crack on.

                    The knee rehab template has actually been really good for my body composition, I feel pretty great in fact all things considered, so a few more months of lower intensity and higher volume won't hurt.

                    Comment


                    • #11
                      Originally posted by Jungle Dave View Post
                      Went to the GP today to get them to check the mass inside my knee, it appears to be a little larger now and somewhat harder than you might expect from a fluid filled Baker's cyst. I've got an appointment to see Musculo-Skeletal clinic in a few months, which is a bit shit regarding the epic wait but at least I know that the symptoms aren't necessarily training related.

                      So I think, I'm going to continue to train within the parameters of the knee rehab template, I assume it can only benefit me... it's relatively painless, it aches more on my rest days really so I think I'll crack on.

                      The knee rehab template has actually been really good for my body composition, I feel pretty great in fact all things considered, so a few more months of lower intensity and higher volume won't hurt.
                      So what was the mass? Don't leave us hanging

                      Comment


                      • #12
                        Well, the good news is I'm keeping the leg!

                        The mass... well I'm both relieved and slightly sheepish to say that it was merely a very large blood vessel of some sort that expands and hardens when in flexion- the guy doing the ultrasound showed me the other knee which did the same but did not present as a hard lump- owing to what he surmised were "age related changes" in the affected knee, there was supposedly more pressure which caused this hard lump.

                        So I feel a bit of a prick right now to be fair, cheers.

                        So he asked me if I wanted to X ray to see what these age related changes are and I think the right answer here was "no, I need to work out how to titrate my training properly, sorry to waste your time".

                        I was seduced by the idea of a quick syringe and an instant fix if I'm being honest after all these months of tempos. Holding the valsalva over tempo deadlifts is almost as challenging as the weight.

                        Still not sure how such low weights are causing me trouble but I'll be back in the gym again tomorrow working up towards those final sets at RPE10

                        Comment

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