History of knee complications.

Pain & Rehab Forum [Moderated]
1

Hey Docs, This post may be a bit long so I apologise ahead of time. I am currently working with a client who is 6’3, 290 lbs, 48" waist with a history of previous heart attacks, and two prior knee surgeries. His hypertension is currently being treated, but his knee is continuing to be a major issue in his life. We initially began strength training together. Progressed from quarter squats, to full body weight squats, then to barbell squats with some weight on it, and several other exercises as well all began to see progress. His knee was feeling better for a short period of time. He then wanted to do weights on his own time and our time to be an hour kickboxing conditioning( I am a kickboxing strength+conditioning coach ). I advised against this, and explained the benefits of resistance training, and aerobic training combined. I also recommended that weight loss be his first priority, and to begin reducing calories but said “he wasn’t ready to start changing his diet or routine” So against my recommendations, we began to do hour long conditioning sessions trying to keep the intensity at RPE 7. Most of his subjective ratings were at RPE 9 even after myself telling him to take the intensity down. Alas, the knee pain comes back with a vengeance. He cannot take time off work, and give it time to calm down. He has to go up and down scaffolding quite frequently. He is going to see the same specialist who recommended both surgeries. His initial injury he fell and landed on his knee, there were some chunks of bone floating around his knee for sometime. The first surgery were to remove those,repair a torn ACL and a certain procedure " to stimulate cartilage regrowth" then his leg sat in a perpetual motion machine for 3 months. The second surgery was to further remove bone fragments floating around. I have previously attempted to explain Bio/psycho/social approach ,but have been met with resistance with this topic, client would become defensive. At this point in time I recommended he contact you guys for a consultation before undergoing more surgery. Is there anything I can do further, or could have done differently ?

Also I just wanted to thank all of you at BBM. You have changed my life in more ways that you could know.

2

Honestly, it sounds like you are attempting to do the best you can. In instances like this it is always a discussion of how to proceed with care. I likely would not have acquiesced to him wanting to start kickboxing and shut him down if he did not demonstrate the ability to regulate his own RPE. It is always ultimately up to the client on what activity they want to do and we’re here to offer advice. Whenever someone what a tendency to overshoot what they’re supposed to be doing my advice is always a discussion of this and an attempt at getting them to modify what they are doing so that this does not happen. Readiness to change is always up to the person who needs to be doing the changing though.

3

Ok, Thanks so much for the response. I feel there is not much I can do at this point, it’s unfortunate. I will recommend he contact you for a consultation.

4

Hey guys, I just wanted to give you an update on this original post…

So after his knee pain returned, he sought out many different modalities to alleviate the pain,and swelling. Everything from laser therapy, steroid injections, and acupuncture. Even sought out a 3rd surgery.He fell in a deep bout of depression, took an extended period of time off work, and gained some weight. I slowly, and cautiously reached out to him and his wife sending them material/resources on the topic of conservative knee treatment. Gradually promoting the evidence surrounding knee OA. Stating that " It’s ok to exercise, and doing so will not further degrade your knee"

Well fast forward to now, and he is 40 lbs lighter, boxing training with me twice per week, and squatting ass to grass with 135 for sets of 5. Zero knee pain. Walking up hills, and stairs with confidence. His cardiovascular capacity has drastically improved, and he has more energy than ever.

He says that the information I share with him on pain, and training has been extremely helpful, and he doesn’t know where he’d be without it.

So just a big thanks to you guys for your information you share :slight_smile: