T Nation

Exercises to Work Around Client's Knee Pain


#1

I have a client who experiences a 'burning' and 'tearing' sensation everytime she bends her right knee. Palpating the area while she flexes / extends her knee, I feel a vibration and something like a grinding / groaning. She has a family history of terrible knee conditions, her mother and grandmother have both had total knee replacements. She says she's just waiting till she inevitably has to get one.

Unfortunately she cannot bend her knee in any fashion without the sensation; No high box squats, sumo deadlifts, leg presses, ball squats, side band walks nothing. This is making trying to think of lower body exercises for her interesting. When I ask her where in the knee she feels the pain she says she doesn't really know, which is a little frustrating.

She has no plans to see a doctor about it, and I don't want to take the risk of having her do motions that aggravate her knee.

I'm presently having her do a lot of upper body, but to try and get SOME lower body I have her doing various stiff-leg single leg exercises with bands and stiff-leg deadlift. Any other ideas for exercises or ANY idea what her problem could be from my extremely vague description would be greatly appreciated.


#2

Sounds like it could be chondromalacia patella- usually caused by knee maltracking. What about terminal knee extensions with a band to help strengthen the VMO? Her vastus lateralis is likely stronger than the VMO, causing the maltracking. The knee extensions would hopefully be minimal enough in movement to prevent any pain arising from doing them. It is usually women who suffer from this condition, due to wider hip structures in relation to their knees, as the Q-angle is typically greater. Also, do you have her foam roll her IT Band?


#3

Maybe check Masch's log over in PW. She needed alternative exercises before her knee surgery. Bet you would find some nice ones over there :slightly_smiling:


#4

watermelon_2001 may be correct in his assessment. In addition to the SMR and TKEs, another option is Romanian Deadlifts making sure she keeps the knees at about 10 degree flexion. Among healthy population, anywhere from 10-20 is the standard, but for her, you'll of course have to modify.

The reason for the posterior chain work is that the hamstring complex helps to isometrically stabilize the knee. This is a reason why I also like the seated unilateral hamstring curl (which your client may or may not be able to do as the force vector is opposite of extension). The leg curl targets the biceps femoris short head (the only muscle in the hamstring complex which does NOT extend the hip but only flexes at the knee).

That said, you're in a bind IMO. As a trainer, there comes a point in which we must refer a client out to get medical diagnosis. Not only is this the ethical move, it covers your tail legally. However, in this economy, trainers have enough trouble finding clients with discretionary income.

I've had clients just like the one you're describing. It's frustrating to say the least and I had to show them the door because the best I could do - and I flat out told them - is that I can train around the injury but I refuse to program any movements that could cause further trauma.

The ultimate decision with this person is yours, of course. Maybe you can write up a custom waiver in which you specifically state that: 1) you advised a medical examination and the client refused; 2) you and client agreed to train around the injury until said client had the issue diagnosed.