No ACL for 17 years. Meniscus surgery 2011. Re-injury 2019. Painful recovery.

Pain & Rehab Forum [Moderated]
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Dear Dr. Baraki and Feigenbaum,

Thanks for hosting this forum and taking questions from people like me. I benefitted tremendously from you guys.

I am 42 years old. I had an ACL tear in 2003 and never had the reconstruction surgery. However, I had meniscus surgery in 2009. In addition to my left knee, I had chronic back pain for years. I am 6 foot tall and weigh about 220.

In May 2017, I started powerlifting with the SS program. By April 2019, I deadlifted 600, squatted 475, benched 315, and overhead pressed 215.

My knee felt strong, and I started playing basketball in 2018, although I have no ACL in my left knee. In June 2019, I injured my left knee severely again, during a basketball: a lot of swelling, some bone edema, and lots of internal bleeding. After the injury, I didn’t lift about four weeks. Then, I started lifting, and once I increased the weights to in about four weeks (8 weeks after the injury) to 135lbs squat and 225 lbs deadlift, the pain became overwhelming. I took 3-4 weeks of a break. My doctor in Boston (a sports medicine doctor who performs about 250 call surgeries a year) suggested that I do not need to get an ACL reconstruction surgery to get back to powerlifting. He knows my history as I have been seeing him since 2016.

In September 2019, I started with an empty bar and went up to 285lbs squat and 335lbs deadlift by January 2020. Though, I felt a slight pop on my injured knee and pain in January. I took a few days off and continued lifting until COVID-19 hit, and gyms are closed mid-March. My knee was hurting in March, and I have not worked out for three months until last month. During the gym break, my knee pain and clicking diminished dramatically.

Since then, I started again and have been doing a super simple Day A: 5x5 (squat + OHP) and Day B: 5x5 (deadlift + bench). I work out every other day. I started with super low weight: squat 45 lbs and deadlift 95lbs. I add 10lbs each time. In the past month, I increased squat to 105lbs and deadlift to 125lbs. About a week ago, my knee started to hurt again when I walk.

By the way, I have ready everything Dr. Baraki wrote about pain and every video he posted (both Barbell Medicine and SS website). My doctor, who is a sports medicine orthopedist and an expert on ACL and knee in general, told me that I should be able to lift. I saw him in November the last time. Though, because of COVID-19, my March appointment got canceled.

Dr. Baraki’s suggestions worked well for my back: my back pain episodes are less frequent and last for a shorter duration now.

However, I am a bit confused about my knee. My experience was not consistent with my readings and what my physician suggested. I should repeat that the 3-month break from mid-March to mid-June improved my knee a lot. I could walk a few miles without any before last week. Now, it hurts, but it is not as bad as it was three months ago.
What do you think I should do? Should I continue with incremental loading? Or, should I take a break? Or should I do overloading at low weights (5lbs every other training day) for 2-3 weeks and take a break for one week? Could it be torn meniscus again?

While I notice that this is a lengthy forum post, I would greatly appreciate any feedback from you guys.

Best regards,

Ross_C

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Hey Ross, I will do my best to give a thorough response here but also, if you are in the Boston area Michael Amato, one of our physical therapists practices in Medford at Boston PT and Wellness and may be worth reaching out to for an in person conversation if you are close. I agree with your surgeon and likely would not have advocated for a surgical intervention given your history. With knee injuries such as this, it is often beneficial to check for limb symmetry indexes (LSI). You can certainly manage this by just performing the three main lifts, but it would more than likely expedite the process to supplement this with some more isolated work. It is relatively common after a knee injury to have a quadriceps deficit on the injured leg. There are a few ways that we can check for this without any fancy equipment. The easiest is if you are lifting in a more globo gym set up, and they have a knee extension machine, to perform a set of 5 at RPE 8 on each leg. If, for example, your 8 were 50# on your left knee and 100# on your right knee, this would make your LSI 50%. The goal is rarely to achieve 100% symmetry, but working on some isolated strengthening exercises such as leg press, knee extension machines, split squats can be beneficial for increasing that index. If you do not have access to a knee extension machine, a leg press can work as well but here we are not so much isolating the quadriceps. It still does give us a proxy from which to work. If you do not have access to either, I will often have athletes perform a set of split squats on each leg to 2 reps in reserve. This is obviously a little more of an endurance test than straight strength but it still does allow us to find an index from which to begin work.

As far as training recommendations, I would check for the index listed above. If it is less than 80%, I would highly recommend incorporating some more isolated work into your training program. This can be under the more traditional bodybuilding type rep schemes working sets of 8 or even lighter weights closer to failure. I would venture that some of the symptoms diminished during your hiatus from the gym due to not really pushing activity as much and getting back into training has exposed you to the ceiling you can currently tolerate. The overall goal is to raise that ceiling. If you need help managing this, you can always reach out to use at the pain and rehab team as well.

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Thank you, Derek. I am grateful for the feedback! Currently, I am traveling and won’t be back in New England until the end of August. However, I already scheduled a virtual appointment with my orthopedist physician at Mass General for next week. I will try to ask a referral from him to see Dr. Michael Amato. If a virtual appointment is possible, I will do it ASAP. If you do not mind, I will ask for one more favor. My current residence is in Fairfield County, Connecticut, which is about 40 miles north of NYC. If you know healthcare providers, e.g., PT, Chiropractor, and physicians, who can help lifters like me in my area, can you forward their names to me? Alternatively, if there is a link to the list of providers you recommend, I would appreciate it if you could direct me to that list—best wishes, Ross.

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I don’t know anyone in Fairfield. Within proximity, I would highly recommend Eric Lagoy but he said he is approximately an hour away. He could certainly help in terms of both your knee and your back. I reached out to him and he said Ryan VanNieuwenhuyze runs a cash based clinic approximately 30 minutes away and you would also be in good hands there.
Derek

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Thank you so much, Derek. I do not mind driving a bit to get the help I need from the right person! I will get in touch with Eric Lagoy once I get back in town. Regards, Ross!