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Old 05-18-2009, 01:28 PM   #1
Jason Sharpe
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Location: Nashville  TN
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Training an individual with knee issues...

Do any of you have experience with or could offer advice on the following:

I have a new client (2 weeks in) that has had knee surgery in the past year. Since he started he's had a numbness (intermittent, not always while excercising) on the outside of the affected knee. He also spent a day doing yard work on his knees that same week. He expressed concern over his knee and squatting among other knee involved exercises. I told him to ask his doc since he was going to see him last week anyways. His doctor told him:

"...repetitive exercises past 90 degrees would greatly increase my chances for damage to my knee. He also advised against heavy lifting coming out of the squatting position or coming explosively out of the squatting position forever. Because the meniscus at a certain point is gone, it will/could cause damage."

I've explained, with my limited basis of knowledge, the importance of squatting below 90, the functionality of squatting, etc.

Should I attempt to train him in without full ROM in the squat, or without any explosiveness from a squat (even quarter or less squat) position? I told him that his progress would be severely limited without these movements as they account for a very large percentage of the movements CF uses. He's naturally a very conservative person and is truly at a beginner level athletically. Mid 40's.

My background is teaching group training classes at the Y, CF'ing for over 2 years, L1 certified, and personal training utilizing CF out of my garage for over a year.

Any professional thoughts and advice are welcome. Thanks in advance.
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Old 05-18-2009, 05:32 PM   #2
Lou Cabales
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Location: Jacksonville  FL
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Re: Training an individual with knee issues...

my mom recently had surgery for spinal stenosis ......
i sent a list of questions to dr. and surgeon the questions were like can she do some functional exercises like squat aka getting of toilet--- body weight depth as tolerated and or assiste, no weights 2sets of 3

....raising hands over head with 6 # weight total ....functional hanging a wet towel...... 2 x 3 steps 8 inches eg. walking up stairs

you get the idea well the MD's said no to all exercise but ADL's ok (activities of daily living) ok. no exercise but ok adl ??????

so you see a contradiction already. well in a nut shell some, not all practitioners will be inclined to tell you the answer that keeps them in work. i'm not implying malpractice or neglience, but if you studied and was taught a certain way for 12 plus years then that is what you will forward.

so even if you consulted with his MD the answer may still be skewed.

as any new client you should asses ROM tolerance pain stregnth edurance etc etc. and scale to client level and level of comfort.

after all you want him/her to return.

if his squat is questionable start with assisted, pole or band even limted rom box air squats as tolerated

if that is not tolerated, have him do some small step ups say 12 inch box

maybe even stretch him out, pool squats

also teach some Myofascia self release. roller (often IT band in knee issues), ham glute stretches

i've had client (ok cousin) with arthritic knees couldn't walk up stairs at all. couldn't get past first 20% of squat with out pain, with IT band myofascia self release, stretching, gradual third world squat stretch and progressive/ scaled squat. is up to about 95% rom squat without pain and is tolerating stairs. from a poor prognosis to 95%ROM

as with many with poor knee prognosis once the supporting muscles are strengthened, stretched and balanced.... much ROM will return with marked decrease in pain levels.

Sure his progress is going to be slow. but any progress is good. you can't pigeon hole any client into a certain crossfit standard. you could customize some wods for him. rehab his weakness work up his strengths. until he reaches a level where he can do scaled wods. you might want to include rehab in your role as trainer.

limited ROM thrusters

box assisted air squats

limted ROM deads etc etc

wall push up with jumping clap vs burpees

remember all exercises and movements, are ultimately scalable
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Old 05-19-2009, 08:39 AM   #3
Jose M. Perez
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Re: Training an individual with knee issues...

Based on my personal experience, I think your client's MD is just being conservative. When I was about 20, I had an L-shape tear in the medial meniscus of my left knee. The surgeon recommended that I avoid sports/activities that require a lot of lateral movement, primarily because the ligaments in my knee were loose enough to allow enough movement to cause injury. He also commented that keeping the leg muscles strong would reduce the chance of another injury. Like your client, I also experienced some numbness, especially around the incision, but it eventually went away.

For rehab, the surgeon had me do leg curls and extensions and run figure-8s. I started lifting weights, because it seemed silly to be in the weight room for just the few minutes it took to do my rehab. Eventually, I was able to squat 495 pound 1RM. I have not had any issues with my knee, except when I slacked off and didn't maintain my leg strength. I generally squat below parallel and have not experienced any problems doing so.

If your client expects to be able to do yard work and avoid future problems, he needs to increase his leg strength and learn how to lift properly. Unless he plans to pay someone to mulch his yard or play with his kids and grandkids, this is important to maintain his ability to perform normal activities.

Start him off with air squats and progress to light weights. He does not have to squat explosively, but there isn't any reason he can't squat up to 2x bodyweight...unless the damage was more extensive than indicated.
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Old 05-20-2009, 09:43 AM   #4
Jason Sharpe
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Re: Training an individual with knee issues...

Thanks guys for your input. I'm going to continue with him and see how well he tolerates the training.
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Old 05-21-2009, 04:31 AM   #5
Colin McNulty
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Re: Training an individual with knee issues...

Hi Jason,

I can't really comment on your specific cases, but I can give you my own personal experience. Before starting Crossfit I've suffered knee pain for 15 years and did zero exercise as a result. I couldn't kick football without falling down and even had to be careful walking down stairs. I'd been through 2 sets of consultants, had x-rays, MRI scans and operations, non of which fixed the problem.

So to say I was nervous about starting Crossfit is an understatement. Under advice from my coaches, I did the same exercises as everyone else, with scaled weights of course, except at times when my knees felt sore. If my knees felt bad, I subbed out exercises for something else and felt personally able to say that enough was enough if they started to hurt mid session. The key was that the exercises themselves weren't modified. I did full depth squats, I still did box jumpers and wall ball etc.

After 3 months I was pain free for the first time in 15 years! 2 years on, I continue to have no pain and am completely free of symptoms. E.g I have a near 2x body weight deadlift and back squat and have started competing in olympic weightlifting competitions.

My layman's conclusion is that Crossfit fixes knees, well at least mine anyway, possibly simply by the strengthening of all muscles involved.
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Old 05-26-2009, 01:06 PM   #6
Sara Welch
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Talking Re: Training an individual with knee issues...

I have had complete knee reconstruction twice. I have a great deal of numbness in that knee and I have found that the more range of motion exercises I do, the better I feel. I have continued to work on my quad and hamstring strength, which helps the knee out tremendously. I would recommend continuing to train the client, just reminding the client to work only to tolerance. There are days that running and squating bother me; there are days that running and squating DONT bother me.

The bottom line, I guess, is how much can your client handle? The stronger the muslces surrounding the joint, the more mobile he will become.... but swelling and numbness (in my experience) is normal.The MD is most certainly going to be cautious, but they usually recommend "no squating" and "no running", however.... I love both and think, over time, has made my knee better! Good Luck!
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