Another BFR Success Story: Elite Powerlifter Plagued By Knee Pain


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Another BFR Success Story: Elite Powerlifter Plagued
By Knee Pain
Nicholas M. Licameli, PT,DPT

“My knees only hurt when I squat over 500lbs.”  That was what my 29-year-old elite powerlifter told me on our initial evaluation.  It was then that I realized this was not going to be just an ordinary case.  This particular athlete’s best lifts were a 675-pound squat, 730-pound deadlift, and 410-pound bench press at a bodyweight of 220lbs.  As you can see, this is not your everyday weight lifter.  

This individual reported onset of bilateral knee pain after finishing up his 2019 competitive season.  He was able to bench press and deadlift without limitation, but heavy squatting over 500lbs would consistently flare up his symptoms.  He took 2020 off from competition, partially because of his knees and partially because of the COVID-19 lockdown.  He sought me out in the summer of 2021 as he was preparing for his 2021 competition season starting in October.  His goal was to break the state squat record, which was well within reach.  His knees would be the one and only reason why he didn’t get the record, so he decided to seek out treatment and guidance.

He had been to PT before and unfortunately was told that he had weak hips, a weak core, tight IT bands, poor patellar tracking, a VMO that wasn’t turning on, and tight quads.  Naturally, the prescription was equally as unfortunate: clamshells, birddogs, and of course the instruction to stop squatting.  Naturally, this approach did not work.  I know, shocking…

We initially tried modifying the depth of the squat with a box squat, but the heavy loads continued to be painful.  We tried safety bar squats, low bar squats, and even belt squats…all were equally as painful.  Finally, we sacrificed specificity and shifted to a hack squat for his main squatting pattern.  It turned out that even hack squats were sensitive to load.  Time was ticking.  As we were trying different approaches, the days and weeks were flying by.  We needed to desensitize the pain response, maintain a training effect without heavy loads, and build ourselves back up to break that squat record in the fall!  

I suggested we try blood flow restriction training.  He had heard of BFR training before, but had never tried it.  At this point, he was willing to try anything. I suggested starting with BFR on just leg extensions at first to allow for an acclimation phase and to get used to the sensation of occlusion training.  He absolutely loved it!  Eager to do more, we added BFR to the hack squat the following week.  Same response!  We were able to use light loads and avoid re-sensitizing the pain response all while maintaining a training effect.  He was extremely happy and excited to be able to train pain free with high intensity.  He felt like he was finally on his way back!

So what’s the plan from here?  We are going to slowly transition away from BFR training and reintroduce heavier loads through graded exposure to get him ready for his record-breaking fall season!  In this example, BFR training was used to help an elite powerlifter suffering from knee pain train with light loads, avoid pain, and maintain a training effect.  Stay tuned for what’s to come!


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