this question should better be addressed to a doctor and physical therapist who can make appropriate recommendations after having evaluated her situation. the fact that she has both pain and fluid build-up indicates that something is still wrong, and whatever she is doing at this point in time is not working.
Pain should always be an indicator for us to refer out until the cause of it is known.
I would not work with her on any lower body exercises until I have the necessary information.
I agree that TWO YEARS post meniscus surgery and still having pain and fluid build-up in the surgically repaired knee needs medical evaluation. I would refer my client to her physician with this problem before continuing her lower body exercise program, because one of our primary goals as a trainer should be to “do no harm.” By referring your client to her physician to try to determine the source of this continued pain and swelling, AND to ask whether what she is currently doing with you is ok to continue, you will have taken responsible steps to ensure that what you are doing with your client is helping, not hurting.
I hope that this helps.
Thank you for the great responses! My client is in the care of a doctor who tells her to walk, do Pilates, and that eventually she will need a replacement. His approach is to drain, give her a cort. shot occasionally, and just wait. She is one of those bullish people who wants to push through, which I believe is why she is in this shape-she pushed too hard too soon after surgery. She comes twice a week, and has benefited SO much, but it is getting harder.
If you are going to train her here are some things to take into consideration:
Make sure she has
1. Full knee flexion and extension
2. She is able to fully carry her weight
3. She has minimal swelling
4. She has medical clearance
5. She is at least four weeks post-operative
6. She has no anterior knee pain
Having said the above, if you are going to approach training her using Pilates, you’ll likely have to utilize the reformer, stability chair and cadillac.
Best to you.