Training around shattered knee

[hackerhercules]

I have a trainee with a significant knee injury we're trying to figure out how to work around, if possible.

Trainee is in her 20's with Osgood-Schlatter Disease, which caused the tendons in her knee to slack and dislocate four years ago, and when she fell the force of her body snapped the lower portion of her knee, shattering the kneecap. For whatever reason (pain tolerance, secret CIA sleeper agent, whatever) she was under the impression it was a dislocation and continued to walk and train for 9 months (Editors note: What the fuck?) and proceeded to - get this - get a 375 squat PR in mom jeans, (she says to depth) the DAY BEFORE KNEE SURGERY. During the surgery she came out of anesthesia and her movement sustained further damage to her knee, causing her retirement from lifting at that point in addition to causing 3 nerve blocks in her knee so she can't feel much.

Her official diagnosis is: Torn ACL, meniscus, and hamstring, a shattered kneebone, and Osgood-Schlatter disease per above. Her knee is noticeably damaged and missing some muscle.

Working exceptionally cautiously, we tried to find her RPE8 and stopped at 145@9 or 10, with knee wraps. She was a few inches shallow, and she wrapped the wraps herself and said it felt considerably better.

A) Is this trainee well advised to continue squatting as usual, what if any accommodations might be suggested?
B) Should this trainee be strict about hitting depth (she is not interested in competing at a meet) or, considering the damage, is shallow squatting allowable (or necessary)?

[mgil]

Certainly no doc here, but letting her work the ROM that’s available on any given day would seem to be the way forward.

[James]

I broke my ankle in 2020 and kept training on it because I thought it was a bad sprain. Turned out the only thing keeping me standing was the swelling. Broke off the medial malleolus and a long fracture up the tibia.

If she can squat let her squat. You might want to have her try different leg and foot positions to see if anything is more comfortable now because I know my squat changed a lot. Depth is something you can work on later so like mgil said let her squat to what's comfortable for now.

[5hout]

Not a doc/expert/blah blah blah:

I'd certainly 2nd/3rd the "squat to comfortable depth"/whatever ROM is pain free. A few other thoughts I had are:

1. I'd probably want some type of hard safety set up, i.e. pins and not straps and set very conservatively.

2. Rather than worry about ROM, I'd consider varying the stance width over time (maybe with box squats thrown in). Doing waves of narrow all the way out to wide will work the legs/hip hinge from a variety of angles pretty effectively.

3. Reaching back/vertical shins would seem to be key here. She might have (depending on her knee) substantially different ROM with an all vertical shin squat vs letting the shin come forward. You could try have her squatting with the calf against a box down to (another) box to "force" a fully vertical/0 knee travel squat. I'm honestly not sure how the internal forces will balance out (i.e. if this is better or worse) than allowing some knee travel, or just different. But it'd be something to try.

4. Smith machine with a box or some weird setup to produce a quad workout while limiting knee stress?

[asdf]

Her official diagnosis is: Torn ACL, meniscus, and hamstring, a shattered kneebone, and Osgood-Schlatter disease per above. Her knee is noticeably damaged and missing some muscle.

The questions you're asking are best answered by her surgeon, who has seen the inside of her knee and made the repairs. Lots of things could be contraindicated.

[mbasic]

pilates

/endthread

[Renascent]

... she was under the impression it was a dislocation and continued to walk and train for 9 months (Editors note: What the fuck?) and proceeded to - get this - get a 375 squat PR in mom jeans, (she says to depth) the DAY BEFORE KNEE SURGERY.

FML.