Deadlifting & Training the Lower Body with “Bad Knees”

In the post-rehab setting we see a lot of adult clients who have knee issues ranging from general pain with use, to meniscal scopes, ACL reconstructions and knee replacements. Many of them understandably have been frustrated in the past trying to maintain a training effect without aggravating any of these lingering problems.

The trick can be finding functional, multi-joint exercises that carry a big “bang-for-your-buck” load of your training while still leaving you with the confidence to push yourself in a safe environment.

Here’s a basic approach to how we may go about exercise selection in this case:

1. Deciding what we can’t do. After our initial assessment (Functional Movement Screen, collecting exercise history, injury history, etc) we may find that loading (adding weight to) what we call knee-dominant patterns is a no-no. In my programs this might include split squats, lunges (forward, reverse, lateral), step-ups, single leg squats, squats and anything else that requires a large range of motion at the knee.

Again, this can be incredibly frustrating to see a long list of stuff you can’t do. Luckily there is plenty that you can do and that’s where we’ll focus your training.

2. If we’re lucky you will have been cleared by the assessment to load more hip-dominant patterns. These are lower body focused movements that require little to no motion at the knee. Examples of this include trap bar deadlifting (yes – deadlifting!), Single Leg RDL’s, RDL’s, bridges of all sorts, hamstring curls on stability balls or TRX, and any variations of these exercises that are appropriate to the client.

Minimal knee flexion required

This is the same exercise as above in my book. 

Where do you fit?

It should go without saying that all of these exercises are programmed with the experience and goals of the client in mind. Not everyone is doing low-volume, heavy deadlift sets but almost everybody I have is learning how to deadlift in some sense!

 3. So we just work on these hip-hinging patterns and ignore anything that puts the knee through a range of motion and we’re good, right? Not exactly. Going back to the screen, if we find there is no pain but considerable movement compensation (this is often the case) with basic movement patterns then we can take a step back and use regressed “corrective” type exercises to improve your patterns without loading until these movements are cleared (hopefully) or until we decide that there are issues that are beyond the scope of the coach. This may include something like TRX assisted split squats, which we use extensively in the early stages of training.

The handles allow us to "deload" the movement and

take stress away from the knee. 

If there is pain, and we’re not sure why, the client is handed off to someone with the skillset to deal with this – in my case they go across the room and see a physical therapist until I get the green light to train normally. If we get clearance, we work through a pain-free range of motion using clean form until we can work through the full-range. This may take a few days or several weeks before it becomes safe to load up but luckily we’ve been getting good strength work all along.