Moving Forward from Impact Induced Lasting Knee Pain

Pain & Rehab Forum [Moderated]
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Hello BBM crew,

Thank you in advance for any advice you might be able to provide on my situation.

Male, 38
204lbs, 39" wc

2yrs strength training
Estimated 1rms from recent powerbuilding I block:
Squat 266 → 395
Bench 183 → 245
Deadlift 340 → 380
No specific or lasting pain from the movements included in training

I have had two knee surgeries on my right medial meniscus in 2005 and 2007 respectively. The first was to address a large bucket handle tear in the meniscus, the second was a meniscus graph to address the pain felt during everyday activities following the first surgery. I was informed that the graph would last approx 10 years and I would be due for a knee replacement at some point. In 2016 I began SSLP and stopped due to shoulder pain issues and divorce. I have done some amount of training off and on since 2018 and in December of 2020 I developed the courage to run on my knee and began making a healthier lifestyle decisions. In June of 2021 I ran the first phase of the beginner template and stopped running that due to boredom and the I got COVID pretty bad. Once I was over it, I bought Powerbuilding 1 as it seem like something I could do with a finish line so to speak and it was different enough to hold my attention. Saw huge gains especially in squat strength and my physique has changed fairly dramatically (for me).

From time to time I engage in activity that is dynamic, and not very much like lifting a barbell (Basketball, Ping Pong, volleyball, etc.). These activities tend to result in pain/weakness in my knee which prevents me from running and also leg extensions notably. Obviously, it also precludes continued participation in sport. Given my training history and medical history, is there any programming that I could incorporate in any program that I might run which has demonstrated improved sport related performance or at the very least less pain derived from participation? About 3 weeks ago I participated in a freaking sac race and today is the first time I have been able to perform a light jog for >20 minutes sustained. Thanks for any direction you might be able to provide.

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Hey man, there are a few components here. Whenever I see surgery mentioned, I typically want to check quad strength in some manner. I went into a detailed description of how to do this HERE. If there is a decent quad difference side to side (>30%) I would start programming some knee extensions into your workout to get some quad specific work. I tend to take these relatively close to failure and treat it like more traditional bodybuilding style programming. So 3-4 sets of 8-12 at RPE 9. If there isn’t much a difference side to side, odds are you need to start working on some things that more mimic the sports you are playing. There is a lot of jumping and change of direction in the sports listed and it is good to have some of that in your programming as well. The issue tends to be more that when we play basketball/ping pong/volleyball we go out and compete every time. This is similar to only lifting once a week and going an @9/10 every session. Some lower level drills are good to work on and even just going out and shooting around versus playing. I have a lot of athletes do things like the old school dot drills, bounding, high knees, basically all the stuff our high school coaches made us do before practice.

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Thank you Derek, I appreciate the response. I’ll test out the quads with a seated leg extension, that seems like my most available proxy and also the most remarkable difference in performance. I know if I did it today, my Limb Symmetry Index would probably be <20%. Though I expect it to get much higher soon, as I have been tolerating 20-30 min outdoor runs quite well over the past 3 days. I’ll begin adding the seated extensions now in my training, targeting a 6(?) RPE while the pain persists, and moving to the 9 once the pain subsides a bit more. I really appreciate the help.