I have a lady I train(49,5"10,140lb and all legs) She has been training for 2 years and made steady progress in all lifts,with impeccable form,but whenever she squats to,or below parallel she experiences pain in a knee she injured in car wreak as a teen.We have even added knee sleeves when she squats.
I have tried restarting things a couple of times by lighting the weight considerably(bar-65lb) and keep it to warm ups and (3x8)RPE 5-6 where she experiences no pain,but as soon as we cross the threshold where I think it would be an RPE lift of 8 which is only 85lb at most the pain is there.Various leg press variations seem to be worse.
I have considered just leaving her at the weight she is using and putting more emphasis on other exercises,or just having her squat above parallel,but open to suggestions.
Hey Indy, first I want to applaud you for training this woman and continuing to train her even though she is experiencing pain as some may just tell her to stop training cause she will hurt herself which is a shitty narrative to give. I think it is very important to point out that this is a case where the psychosocial aspect of pain really applies as you said she had a traumatic experience years ago, a car wreak. She maybe associating the knee pain with the traumatic incident which may be influencing her pain when the weight increases, she feels the increased weight and may be getting nervous due to the increased intensity. Education on pain science here would be extremely useful and highly beneficial for your trainee. In terms of knee sleeves I personally don’t have a problem with them if that’s one way she can train consistently and productively. I believe the only issue here would become an over reliance and need for the knee sleeves. I wouldn’t want her to say forget them one day and start freaking out because she believes that they are keeping her knees safe and without them she is doomed. In terms of programing I find it very useful to expose someone to multiple types of exercise variants say front squats, box squats, or tempo squats and maybe you find a variation that works for her with little to no pain where she can progressively load the bar without having to almost deload her constantly. I assume she is not competing in any specific lift so the world is your oyster, so many things available to you guys to get her strong and keep her strong while having her realize that movement is good and not dangerous. #HUMANSDONTBREAK!!
Thank you so much for the reply. We started out with no knee sleeves at all, then went to using them only on work sets in an attempt to give her mental confidence.Once we added the sleeves,her form went from being overly cautions to squatting with confidence,then the problem reared it ugly head again.Although I am sure there is some real pain there,a lot of the issue is mental.Once it “feels heavy” I think it triggers the be cautious and or it may hurt responses. I think she is creating some of her own outcomes. I will try moving to other exercises to help remove some of those preconceived notions,and start without the sleeves so she doesnt start associating them with too heavy or pain is coming.
I have seen her rip 150lb off the floor for a set of 5 with perfect form in the deadlift then proceed to tell me how heavy it was even though the bar was moving quick.