A Scrawny Lifter's Redemption Song

[Gary Gibson]

My long-standing knee problem collided with my Smolov greed and put me out of the running for this year's USAPL Raw Nationals. Here's where I try to put this knee thing to bed with proper rest and rehabilitation.

Next three weeks = Bench specialization in the form of Smolov Jr + NO lower body work.

Week four = rest and test for new bench max

Weeks five through seven = PTP bench (practice/peak) + SLDL

Week eight = rest and test for new bench max

After that = default routine:
Monday) Bench, pull up, kb press
Tuesday) Squat
Thursday) Press, weighted Chin up, DB bench
Friday) SLDL or Sumo DL alternating weeks.

In the interest of knee rehab, I'll be continuing to aspirate as much excess fluid as I can on my own and just doing isotonic holds and unweighted full ROM extensions. Even mere bodyweight squats have recently had the effect of irritating the synovium and producing many ml of excess fluid.

In a month lower body work will resume with stiff-leg stuff to condition the hamstrings without loading the knees through any ROM.

A month after that squats will resume with a "stretched out" Smolov (a traditional linear progression). I'm thinking three weeks each of 2 sets of 12, then 3 of 8, then 4 of 6, then 5x5. This will allow me to break the squat back in with higher rep stuff to get the blood flowing, the connective tissue healing and the muscles growing without too much loading. After I've built up some meat and coordination by specializing on sets of 12 down to sets of 5, I'll work a few weeks of triples, doubles and singles to refine my low rep strength. This will take me to the end of the year and to over 405.

Smolov Jr Bench starts tomorrow...

[Gary Gibson]

05/04/2009

BP 45x10, 95x6, 155x6x6
Pull-up x6x3

Smolov Jr BP begins. I was going to space this out to six weeks, but tonight was so easy that I think I'll just do the 4-day-a-week and get it done in three weeks with a week of rest and test.

Injury Report: Knee almost magically better tonight. Hasn't felt this trouble-free in many months. Draining has been so successful that my last half dozen attempts have been dry taps. Range of motion now 95% and with pressure I can get heel very, very close to the glute. Weakness at certain angles gone after just one night of those little rehab moves (weightless extension and tensing). No catching or soreness during walking. Using ibuprofen (600 or 800 mg 3 or 4 times/day), liniments and medium-sized neoprene sleeve.

Will avoid any heavy loading of the knee especially in ROM and just stick to rehab level work while I Smolov Jr Bench. Progression of lower body loading is planned thus:

Bench w/ no lower body work for 4 weeks (Smolov Jr, rest and test)
Bench w/ SLDL for 2-3 weeks (PTP)
Bench w/ CV DL for 2 weeks
Bench w/ Sumo DL and light/rehab SQ for 2 weeks
Bench w/ SQ

[Gary Gibson]

05/06/2009

BP 45x5, 95x5, 135x3, 165x5x7
Pull Up +10x6x3

[Gary Gibson]

05/08/2009

BP 45x5, 95x5, 135x5, 175x4x8
Pull Up +0x8,x8,x7

Injury Report: Drained a bit more after a lot of failed attempts. Got from infrapatellar lump and medial apprach very near kneecap. Hardly any effusion left at his point and I really have to try to get anything out. Pinching is diminishing upon full extension, but occasionally feels "squelchy" when I stand up quickly from a crouch. Discovered that I had absolutely no strength in the bottom range of flexion (because knee hasn't been able to go that far for months). Lying supine I lift my right leg straight up and perform knee extensions that way. Adding ankle weights and strength is rapidly returning. This glaring strength deficit would explain why I kept getting reinjured. It was impossible to cure while the effusion was present.

[Gary Gibson]

05/09/2009

Bench 45x5, 95x5, 135x3, 185x3x10

Got incredibly smooth and easy at the seventh set.

Injury: Various attempts have resulted in mostly dry taps and one very minute drip from the inferior anterolateral lump. There has been no detectable refill. The synovial lining is probably as calm as it's going to get, though that medial plica is still a problem half the time.

I've done some bodyweight squats, but not to the all-out depth that seems to stress the knee....just two inches below USAPL legal. I don't think waiting two full months is called for this time. I'm thinking to finish this BP Smolov Jr plus the test, then just two weeks of BP PTP and SLDL. Return to squats in six weeks instead of eight.

Supine vertical leg extensions still revealing a lot of weakness, but the quad is overall much stronger than it was. Five more weeks ought to be plenty of time to get the quad back up to speed.

[Gary Gibson]

05/11/2009

BP 45x10, 95x6, 135x3, 165x6x6
SQ 45x10, 135x10x2
Pull Up x8, x8, x5

Bench felt positively easy. I've been loading up on beef and milk. Feel flush, full of pep.

Felt pressure on the swollen thing on the medial side of my knee during squats. Left leg muscles cramping and swelling while right side didn't seem to respond. Some pain directly above kneecap caused some instability.

God damn it to hell.

[Gary Gibson]

Another 40 or so ml out in the past couple of days. Symptoms decrease in proportion to amount of fluid drained. Last couple of times there were rice bodies clearly visible. About 15 ml with first two draws this week, but now only able to get less than 4 with each attempt.

Here's some info on traumatic synovitis: http://www.pubmedcentral.nih.gov/art...?artid=1654240

This is from 1924, but those doctors seemed to have a good grasp of the situation. They all recommend draining of the knee to relieve symptoms and to promote recovery. One commented that extreme effusion tends to result in the atrophy of the quadriceps and special care must be taken to bring that muscle back up to par. This is all in line with my experience. The more I drain, the better the knee gets.

I suspect that I get recurrence because my knee just needs time to pull itself together now that all that fluid (and some of the fibrin) is gone. Even though it feels better because it isn't forcefully distended anymore, it hasn't "pulled itself together" structurally. Plus the quadriceps (and hamstrings and adductors) are atrophied.

Course of action: wait. Wait a couple of weeks and avoid loading, even stiff-legged work. In three weeks start the supine leg extensions (femur perpendicular to floor) again and the SLDL to get the quads and hams working again, but without squat-like loading. Progress to conventional deadlifts and then squats.

Mind, this was the initial plan, but I got greedy as soon as the knee started feeling better. Jumped to light squats two months ahead of schedule! This sort of behavior is why rehab fails. It's just hard for me to accept that I'm that hurt (even though the past 18 months should be proof enough to me that I am).

Smolov Jr Bench Week II, Day II tomorrow...

[Gary Gibson]

05/13/2009

BP 45x5, 95x5, 135x3, 175x5x7
Chin Up x5, +45x5x2

Bench still feeling pretty easy. Keeping rests under 3 minutes. Form is perfect on third set and stays perfect till about sixth set.

Weighed 166-167.

Injury: Multiple drainings yesterday and last night. Medial lump yielded about 30 ml. Went deep below patella and got 7 bloody cc. Getting harder to find and bloodier when I do find it. Old bulges nearly gone this morning. Repeated tensing in full extension failed to produce any catching...but knee is feeling beat up from all the poking. Very sore around that medial condyle where I've gone in so many times. Hard to tell if it's from the poking or if there's fluid or pinching or what when I was walking to work this morning.

Three more weeks of no lower body work and nearly two months before I squat again. Going to keep up GOMAD (2500 kcal) on top of 1500 kcal/day in solids.

[K.Diesel]

Just curious - how did you learn to drain the knee yourself? Did a doc show you, or did you learn from a book/website? Also, if you didn't drain it so often, what would happen? Sorry if I missed the answer from a previous post.

It just blows me away that you're able to do it. I dread needles, and hope to never have to administer them to myself for a medical condition. But I have a type of awe/admiration for those tough guys/girls who do it every day.

[Gary Gibson]

Just curious - how did you learn to drain the knee yourself? Did a doc show you, or did you learn from a book/website? Also, if you didn't drain it so often, what would happen? Sorry if I missed the answer from a previous post.

Kaisheem,

A little of both. One doc did it for me a couple of times. I read hundreds of medical reports and instructions on arthrocentesis online and studied some knee anatomy. The biggest risks are infection and damaging delicate structures like nerves or cartilage. This effusion has been limiting me for so long that I decided it was worth the risks.

I've had the effusion for nearly two years at this point. If I don't drain it, it doesn't go away. This involves several possible complications. The synovial lining is probably thickened and fibrotic and preventing reabsorption. There could be loose bodies, ligament or meniscal damage that's inducing constant fluid production. I do seem to have a medial plica condition wherein a redundant bit of synovium got pinched once (during a box squat, I believe) and has since thickened and now keeps getting caught in the joint at extension. MRIs showed no derangements and arthroscopy would be the next step in order to get a better look in there and fix what can be fixed, but that's terribly expensive. Self-rehab and hope are much cheaper.

The knee only refills when I stress it out further. Large effusions tend to refill, but mine only does so when I ask too much of the knee. I'm hoping over time the knee's synovium will heal up enough to allow me to train again. Recently deep knee bends and excessive walking have caused a considerable amount of refill. I've read that it takes several weeks of healing and several aspirations to return the knee to near normal. Recurrences are still possible and there may be some damage underlying all this that will require arthroscopic intervention.