Meet Soo. She’s a 48-year-old health researcher and mother of three kids. A couple of years ago, she developed knee pain so debilitating and unexplainable, it turned her life upside down. Basic things like walking and climbing stairs became daunting, difficult and painful. The diagnosis wasn’t very helpful, either. She was diagnosed with a combination of osteoarthritis and a burst Baker’s cyst. Not good.
Fast forward to now, and Soo is nearly completely pain-free – and a lot stronger than most people (even athletic people) in their 20s and 30s. How did she do it? That’s what we’ll cover in this article.
If you’d like to see Soo tell you her own story, you can check it out in this 5-minute video:
And if you’d like help with your own knee pain (even if nothing else has worked), we have a special program called “The Knee Pain Reversal Program.” To see whether you qualify for this program, just fill out the application form on our home page. Doing so does not obligate you to anything. It simply sets up a quick, 10-15-minute chat where we discuss your situation, and figure out whether we can help you. There’s no pressure or sales pitch.
Soo’s Life Before
Soo is a busy health researcher. She works at a major university, and is the mother (AKA chauffeur) of two teenage kids.
She was going on about her daily life and had this vague notion that “I should start strength training.” She knew it’s good for her, and particularly important as she got older, but it was always just a vague notion. Besides, it had been over a decade since she’s strength trained.
Fast forward a few years, and she developed severe knee pain that affected everything she did. As mentioned earlier, that included things like walking, going up the stairs, getting out of her chair/couch, etc. The pain got to be so bad, it was even interfering with her sleep.
The most common thing people do when they have that kind of pain is they go to their family doctor, so that’s what she did. The doctor referred her to physio. She went to physio faithfully, and despite that, nothing happened. No reduction in knee pain, and no improvement in function. She went back to her family doctor, reported her results, and he escalated her to the next level. He sent her to a sports medicine doctor.
The sports medicine doctor gave her both a brace and cortisone shots.
Unfortunately, that didn’t help either.
A few years earlier, I had done a presentation at her job, and she subscribed to my newsletter. She’s been getting it all this time. Eventually, she read a case study of one of our other clients who dramatically improved her knee arthritis. She thought that if other approaches hadn’t worked for her, maybe she’ll try this one.
She reached out to me, I set her up with her online personal trainer, Meagan, and they got to work.
Why did she go with online personal training? A few reasons:
- It fit her schedule. There’s no driving to a gym. She barely had time as it is. To take an extra 10-30 minutes to drive to a gym and then 10-30 minutes to drive back would eat up a lot of her time.
- It fits her logistics. Soo isn’t home all the time. Sometimes she goes to the cottage. She doesn’t want to take time off personal training for weeks at a time just because she’s in a different place.
- Meagan’s too modest, but I’ll toot her horn for her – you don’t just find trainers as good as Meagan in your average gym. It’s a dirty little secret of the personal training industry that to become a personal trainer only takes a 24-hour course (8 hours Friday, Saturday and Sunday). I don’t hire those personal trainers. Meagan has a 4-year degree in kinesiology, 12 years of experience, and additional industry-specific certifications up the wazoo.
Soo’s Exercise Program
Three of the most common mistakes professionals make when rehabbing osteoarthritic knees are:
- Only strengthening the quads, while neglecting other muscles. Yes, quad strengthening is important, but it’s only a small piece of the puzzle. You have to strengthen every muscle around the knee – not just one.
- Not caring about transfer from training to real life. Just because something looks good on a therapy table doesn’t mean it’ll have a meaningful carryover to things like climbing stairs, walking, and getting out of a chair.
- Not using appropriate load/progression. For muscles to get stronger, they need to be challenged. Unfortunately most physios don’t adequately challenge muscles. Physiotherapists mistakenly think that exercise selection is the most important factor. It isn’t. It’s an important factor, but not the most important. As I talk about in my articles on the most important factor in an exercise program and rapid rehab, the most important factors are the progression model, and load selection.
But Igor don’t hire no fools 😉
Meagan’s program for Soo:
- Strengthened all the muscles around the knee – not just the quads.
- Used exercises that carry over to life outside the “gym” (it’s in quotation marks because Soo exercises online, in her own home).
- Progressively increased the weights/difficulty over time.
Here are some of the highlights from one of Soo’s programs (she’s been with us for 3 years, so she’s had multiple programs over her time with us):
Clamshells and Glute Bridges
These are both exercises for the glutes (the butt muscles). More precisely, clamshells work the gluteus medius and glute bridges work the gluteus maximus.
If the problem is at the knee, why are we working the hip muscles? Because the knee is a slave to the joints above (the hip) and below (the ankle). Furthermore, plenty of research shows that glute strengthening helps knee pain about as much as quad strengthening.
Step Downs
Step downs are an exercise that works the quads. But there are a million exercises that work the quads. Why did Meagan specifically select this one? Because a competent personal trainer needs to think not just about the muscle being worked, but about the type of muscle contraction. There are 3 possible contractions:
- Concentric: when a muscle is shortening
- Eccentric: when a muscle is lengthening under tension
- Isometric: when a muscle is static (neither lengthening, nor shortening)
In some people with knee osteoarthritis, there isn’t just a lack of quad strength, but also the inability to control muscle lengthening under tension. Step downs train this exact ability.
At first, Soo was doing step downs off a minimal height (textbook), because her knees hurt so much. Eventually, she progressed to greater and greater heights.
Side Lying Hip Adduction
This exercise works the muscles of the inner thigh. Again, it’s not just the quads that are responsible for knee control. The inner thigh muscles have a role to play as well. So it only makes sense to train them.
Calf Raises and Toe Raises
While all the previous exercises worked the muscles above the knee, these two work the muscles below the knee (for the purists, yes, I know that the gastrocnemius has an attachment above the knee. But this article is not written for the purists).
Why should we work the muscles below the knee? Remember how I mentioned earlier that the knee is a slave to the joints above and below? The previous exercises addressed both the knee and the joint above (the hip). These two exercises address the joint below (the ankle).
When the muscles surrounding all three joints (ankle, knee, hip) are in sync, the knee pain is reduced.
As mentioned earlier, these exercises are simply highlights from one of her earlier programs. Traditional exercises for the knees like squats, wall sits, hamstring curls and others hurt too much initially. But once Soo’s pain reduced, these more traditional exercises were introduced.
Furthermore, if you just read about the exercises, you’d miss the “secret sauce” of the exercise program – the progression model, and the workout-by-workout adjustments that were made based on Soo’s progress from the previous series of workouts, energy/fatigue levels, and more. After all, no exercise program should be a static program, where you’re doing the same exercises for the same weights, sets and reps every single time. An exercise program should be dynamic, intelligently, purposefully, and systematically changing the exercise variables to move the client forward… as opposed to haphazardly changing the program whenever you feel like it, without rhyme or reason… like a lot of personal trainers do.
Soo’s Progress
Methods are nice, but results are nicer. So what were the results? Nothing short of extraordinary – and I don’t use that word lightly. Soo came to us for pain reductions. Not necessarily for improvements in strength (that happened to be a major bonus), so let’s discuss how her pain levels changed (after all, there’s no point in looking at strength improvements if improvements in strength don’t lead to reductions in pain).
- When Soo first started, she tried doing step-downs off a 3-inch step. The amount of pain this caused was 7/10. She now steps down off much greater heights, with only a pain level of about 1.5/10. At 3 inches, there’s no pain whatsoever.
- Previously, a one-legged deadlift with a light weight would hurt at a level of about 3.5/10. Now, she’s doing 90 pounds per leg, and it doesn’t hurt at all.
- Before, split squats were completely out of the picture. Even a single rep with no weight used to hurt too much. She’s now doing split squats with 100 pounds, and the degree of pain is no higher than 1.5/10. Most women (heck, even men) in their 20s and 30s can’t do that. She’s doing that at 48, after only about 3 years of consistent strength training, starting from a lower point than most people start.
- Although it’s not the main reason she came to us, she also had shoulder pain. That’s completely gone now (just some residual tightness, but no pain), and on top of that, she’s doing 10 chinups. Just so you know how crazy it is for Soo (or any woman) to do 10 chinups, it’s estimated that fewer than 5% of all women in the world can do one chinup. Soo is doing 10. At 48 years old. Let that sink in.
Soo’s Obstacles
You might read about Soo’s progress and think “that’s not for me.” Au contraire. It wasn’t exactly a straight line from injured to fit beyond belief. There were certainly some obstacles along the way.
- As a busy mom, she also happens to be her kids’ chauffeur. Not only is she working 40-hour weeks, when she’s done working, she goes to her next job: chauffeuring her kids. Her time is very limited.
- She also likes to go to the cottage. She doesn’t have a full set of equipment there, so even with very limited equipment, she stays consistent, and makes progress.
Despite those 2 obstacles, she’s made incredible progress.
How Soo’s Life is Different Now
How’s Soo’s life different now that she’s almost completely pain-free, and has otherworldly strength levels? Substantially.
- Before, when even things like walking, climbing stairs and getting out of her chair were painful, a lot of activities were off limits, like going for a hike, taking a yoga class, etc. Now, nothing is off limits.
- In fact, she now plays ultimate frisbee – a very demanding sport.
- The whole reason that she started working with us – to reduce her pain has been accomplished. Nowadays, she basically only feels pain in a very controlled, safe environment – when lifting ungodly amounts of weight during her workouts. But outside of that environment, no pain whatsoever.
- Her shoulder pain is completely gone (as mentioned earlier, pain turned to some minor residual tightness).
- The pain used to give her problems sleeping. Now, she sleeps just fine.
Overall, we’re very proud of Soo and how much she’s been able to accomplish.
If you’d like help with your own knee pain (even if nothing else has worked), we have a special program called “The Knee Pain Reversal Program.” To see whether you qualify for this program, just fill out the application form on our home page. Doing so does not obligate you to anything. It simply sets up a quick, 10-15-minute chat where we discuss your situation, and figure out whether we can help you. There’s no pressure or sales pitch.
