Outer knee pain hampering meet preparation; rehab advice?

Hi there!

Powerlifting newbie here. I have a problem with persistent left knee pain, located on the outer left and back-left side of my left knee. I am familiar with the injury rehab articles by Dr. Baraki and Charlie Dickson and this one tendinopathy BBM article, but I’m asking for your comments and suggestions about my plan for how to keep training while rehabilitating from this injury. I am about one-third in into the Strength I template, and I’m set to finish the template at my very first powerlifting meet in November 2022. I’d like to partake in the non-licensed series they have, just to get my first meet experience, but I don’t know if I should with this injury!

Below I will detail the symptoms, then my plan, and finally a bit of my training background. Sorry for the lengthy post, but I wanted to be thorough to make this post count.

The injury started to show itself about five weeks ago when it was my 1st time incorporating heavy singles. The first symptoms were noticeable stiffness of the knee with no pain, and lasting about one week. Since then, about half of the time, it’s almost pain free, and the other half it hurts quite a lot in certain movements/positions (pain spiking at 3-6 out of 10), and being quite limiting of my movement e.g. forcing me to limp. The pain is most noticeable either when I am walking; when stepping down stairs and lowering myself down with my weight on the ball of my left foot; when I try to raise my left heel towards my butt while standing; or when I lower myself to squat or lower myself to the starting position of conventional deadlift. The pain is most intense at a 30–40-degree knee angle and almost disappears at angles before and after that. The pain usually subsides during the latter half of my workouts but then gets worse the next day, lasting for 1-2 days.

After the injury appeared, I was able to continue with my program without deloading, but unlike the usual aches and pains, this one hasn’t gone away with time (5 weeks and counting) and normal training, seeming only to get worse instead.

Now my plan is to reduce squat and deadlift loads by replacing singles and sets of 4-5 first with sets of 10 for one week while maintaining the prescribed RPE (or perhaps undershooting a bit to be safe); then sets of 8 for one week; then 6; before hopefully being finally able to resume the programmed training carefully. I will also look for variations of the programmed movements that would cause less immediate discomfort and pain in the knee. For example, for GPP LISS, light cycling seems to cause me no pain (I havent even dared trying the usual running/sprinting).

My background is that I’m a 29-y-o male weighing 80 kg, height 171 cm and waist circumference of 93 cm. I have trained on-and-off in the gym for about 8 years with an inconsistent upper-/lower body split, but I never really had the consistency or motivation to make any notable progress until last spring. That’s when I found and got excited and encouraged by the BBM content on Instagram. Since then, I have focused on barbell training and completed the Hypertrophy I template. I’m currently into the 5th week of Strength I template. During the past 5 months, I’ve grown stronger and fitter than ever, with my current average-performance singles being 115 kg squat, 95 kg bench, and 150 kg deadlight, each @RPE8. Before starting the BBM templates, my heaviest lifts ever were fives with 90 kg on squat, 60 kg bench and 100 kg deadlift. I sleep 9 hours a night and my diet consists of perhaps 70% according to a decent healthy plate model and 30% of junk and snacks.

I’m very motivated to keep training, since it’s the best alone time, recovery from study and meditation for me, in addition to enjoying the hypertrophy and strength gains. ### I feel like I would have had it in me to reach 120-125 kg squat and 170 deadlift singles @RPE10 for my meet but the exacerbating knee pain is making me hesitate to do heavy singles on squat/dl during training. I am unsure whether I should even consider partaking in the meet because of this. On the other hand, I don’t know whether I should just push through the pain and train according to the template, but the worsening symptoms seem to warn against this.

So, what do you think of my plan? Should I give up my expectations for my meet and instead allocate more time for a lengthier rehab period and/or deload? Any other tips to manage the pain?

Best regards,
Alex from Finland

PS. I can’t overstate how wonderful I think the work you all at BBM are doing. I believe I am not alone when I say it has helped me to realize my dream of being a more stronger/fitter version of myself, giving me a new economically viable goal-oriented hobby - without even mentioning the improved mood and confidence gains. Please keep up the good fight!

Hey @AlexTheFinn ,

First off, congrats on the huge improvements in your lifts over the past 5 months! I’m glad to hear our content has been helpful and that you’re still highly motivated to continue training despite this setback.

Thank you for providing the extra context surrounding the knee issue you’ve been dealing with. This does sound like an instance where the increase in intensity (via the introduction of singles) led to some increased sensitivity around your knee, and dialing things back via increasing the rep ranges, adding tempo, modifying range of motion, and/or altering exercise selection could all be beneficial. Dr. Baraki’s article on dealing with Pain in Training outlines our general approach for managing these types of issues.

I think the bigger question here comes down to Could vs Should: Could you make some of these modifications to your current routine for the next 3-4 weeks, ramp up intensity in the last few weeks leading into the meet, and potentially hit a 120-125kg squat and 170kg deadlift? Maybe, but there is also some inherent risk of exacerbating symptoms again and feeling the frustration/uncertainty that comes along with it.

Should you make those modifications and take the risk for your first meet? I don’t think so. There is always going to be another meet and I think postponing to allocate more time for a lengthier ‘rehab’ block where you can gradually build back up to those higher intensities is the wiser choice. As far as what that block should look like, we do offer remote consultations and rehab focused programming here if you would like a more hands-on, individualized approach. Generally speaking, going through a lower intensity block similar to our knee rehab template should help with finding an entry point and gradually building back up to baseline over time.

Either way, wishing you the best with whichever direction you decide on moving forward!

-Charlie

Hi @Charlie_Dickson ,

Thanks for your reply and advice!

I agree with you and I decided to opt for the knee rehab template and skipping the meet. The first workout felt great with novel leg movements like Spanish squats, and the unilateral work seemed to show that my injured left leg is clearly weaker than my right leg, like 2-3 RPE difference in 15 rep single leg press. I’m really looking forward to seeing what the rest of the program will do.

Best regards,
Alex