6 month old meniscus tear still painful and how to rehab squat

Apologies if this was already submitted - I think there was an error from an earlier attempt.

My wife (28y/o, 5’6", ~140lbs, little athletic/training history) tore/displaced the meniscus in her right knee on Nov 29th 2017, and had arthroscopic surgery to repair it on Dec 13th. It was a bucket handle tear, and the meniscus was folded over lodged in her knee joint, I believe. It occurred somewhat randomly, not during any activity, she was just sitting with her legs folded underneath her and when she straightened them it happened. It could have happened as a result of an old knee injury from when she was younger and her sister pushed her down the stairs. Over the last 15 years, her knee cap has sometimes “popped out of place” and she has worn a brace with patella support. However, the ortho doc did NOT see patella instability in the recent scans…

She began the rehab process shortly after the surgery by working at home and going to a PT 2x/week bending and putting more pressure on the leg, and though the progress was somewhat slower than expected by the ortho doc, she eventually caught up to where she should be and as of early March, the PT stopped needing to see her, and they said you should be able to run/squat within weeks, good luck.

My wife has been very…careful, with how she is using her knee - often putting her body weight on her good knee, and compensating during body weight squats by leaning over to the other side. Since the PT did not rehab any squatting, I suggested to my wife that she start doing body weight squats, optionally holding onto something for support initially, looking in a mirror for symmetry, to get used to the pressure, weight, depth, etc. of a normal squat. This has not been mastered.

She now has goals of getting into shape and losing some fat, but does not care about strength outside of functional daily use (moving furniture or kids, doing yardwork, etc.). She prefers LISS to everything else, but is fine with some barbell work. So, I suggested she do LP with 2x/week 25 minute LISS sessions.

She is in week 3 and since body weight squats are still difficult, I suggested she box squat for now, using it less and less for support, then fading it out to body weight squats, then adding the bar, etc. She is currently box squatting with some weight (dumbbells/empty barbell).

When she squats, however, she feels a sharp pain in her knee…it starts out dull and after a few sets gets gradually sharper. Also, when she attempts to run, the pressure on her knee causes too much pain, and she stops. She uses a bike trainer for stationary bike riding, and after a while her knee tightens up and she has to straighten it and ‘pop’ it.

Questions:

  1. Does it sound like the meniscus did not reattach as expected? Is sharp pain expected (since minimal pressure has been put on it still), or could the pain be from something that didn’t heal correctly?

  2. If it could just be she has not yet gotten accustomed to/overcome the pain, what is the recommended squat rehab procedure? Box–>air–>empty bar? Since she’ll be doing them in the LP squat slot, what should she adjust the sets/reps to?

  3. What is the Barbell Medicine recommended program for people (females) who don’t exactly have strength goals, but instead want to lose body fat %, and slightly increase muscle mass, that is, get “toned”. The Hypertrophy template?

Thank you,
Colin

Hi there,

From my reading of this, it sounds like she has a LOT of fear issues related to the use of her knee, and this is a huge contributor to pain and impaired function. This is something that can be difficult to overcome, and may require the assistance of someone trained in managing this sort of thing.

I would probably start with as high of a box or pin squat as necessary for her to squat without pain, and progress the depth down a bit slower than you’d like, because we aren’t just training her knee here. We’re re-training her brain to be less afraid of knee flexion/extension.

She is nowhere near being ready to apply the templates yet. I’d focus on getting her moving through full ranges of motion more confidently before any of that. Additionally, losing bodyfat will require much more attention to diet than anything else for her right now, since the stress she’s receiving from training is so low.

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