T Nation

Knee Pain

I started CW’s Quattro Dynamo program yesterday. It felt great except for the last couple of sets of squats.

I got this really sharp nagging pain right underneath my knee cap as I would come up out of the hole. It hurt all the way up, but would stop at the end of the rep.

I’ve never had knee problems before, so I’m a little concerned about what is happening.

I tried to squat today with 120 less pounds on the bar, but on the first workset, I got the same pain around rep 15-16 (2 X 25 day).

Any ideas on what it might be? I really can’t afford an injury right now. But such is my luck it seems.

rainjack,
By “right under my knee cap” do you mean
1)underneath your knee cap or
2)further down my leg from my knee cap (proceeding towards the shin)
old dogg

Right underneath the kneecap. It only hurts when I have weight on the bar. I can do bodyweight squats till I puke, and there is no pain.

Do you have any problem maintaining your form on your heavier and/or higher rep sets?

Do you favor one side, do extra work on one side?

Hell, I’m sure you know more about this stuff than I do, just trying to be helpful. Maybe back off to low volume and light weight for a couple workouts and see if you can carefully ramp back up.

I can see how you’d want to keep the squats going right now!

It’s more frustrating than anything else. I’m pretty sure I am using good form. I’m not favoring either side, and a go ass to grass.

It doesn’t hurt right out of the hole, but when I get to parallel - that’s when it hits. And it hurts all the way up till just short of vertical.

Maybe my form needs a good critiquing. But just try to find somebody in my town that even knows what a squat is, much less good form.

There was not much of the pain at all today - I did 1 set of ten with 135 just to see if it hurt, and there was not nearly the pain that there was Mnday and Tuesday.

Go figure.

[quote]rainjack wrote:
Right underneath the kneecap. It only hurts when I have weight on the bar. I can do bodyweight squats till I puke, and there is no pain.[/quote]

I’m not a doctor, but it sounds as if you could be suffering from patello- femoral syndrome, also known as runners/jumpers knee. PF tends to show its ugly teeth especially with repeated stress on the knee. In runners, they will usually experience it while running but then it immediately stops when they stop, and it doesn’t bother them while walking.

One of my old clients who trained for half-tris had the exact same problem, real bad pain right underneath his knee cap while squatting (especially during high reps), but almost none when doing body weight squats. I referred him to an orthopedic specialist who diagnosed him with PF, (now he wears one of those McDavid Jumper Knee Straps
http://mcdavidusa.com/kneesupports.html ) and has no pain while jumping or doing heavy squats.

Make sure you scroll down near the bottom of that page, the product is

414-Jumper’s Knee Strap

p.s. iceing and rest isn’t such a terrible thing either RJ, this isn’t accounting season you know :wink:

[quote]vroom wrote:
Do you have any problem maintaining your form on your heavier and/or higher rep sets?

Do you favor one side, do extra work on one side?

Hell, I’m sure you know more about this stuff than I do, just trying to be helpful. Maybe back off to low volume and light weight for a couple workouts and see if you can carefully ramp back up.

I can see how you’d want to keep the squats going right now![/quote]

Vroom, nothing but love, but I don’t feel like this is the best advice. If it’s a persistent pain or if he does have PF, (which it sounds like it is) i think he’d be better off missing his next squat (GASP!!) day, and using the RICE bethod to take care of himself, perhaps get that knee band as well. It’s amazing what missing one day of squatting will do for a nagging leg injury (esp on those old joints of his)

j/k on that last one

Hoosier, I certainly agree it would probably be best to miss a few squat sessions.

However, I’m thinking Rainjack is not very willing to cut them out completely right now… :wink:

It would probably be better to cut out a few sessions now, and then be able to resume them carefully, then be forced to leave them out completely later on though.

Rainjack,
Given your description, I don’t have another suggestion than the PF one made above (diagnosis via the web is a little challenging). I assume as an experienced trainer you know the differance between pain and injury. I’d strongly recommend you not try to “work through this” as the body tends to adjust to pain, leading to injuries in other areas.
old dogg

Rainjack,

Not to be dense, but are you referring to underneath as, below or behind?

Below- probable patellar tendon, pain increases with forceful quad contraction.

Behind- possible retropatellar cartilage irritation.

As the original post was several days ago, let me know how it is progressing.
Any additional info would help me give you more useful info.

Take care,

Ryan

What volume/ weight were you using and how does that compare to what you were doing prior to starting the program?

Thanks for all the input, guys.

The pain is right underneath my patella, i.e. if you were to remove the kneecap like taking a lid off a jar, the pain would be located right underneath the lid.

Let me try my pseudo-A/P speak. It is not distal to the patella. It is medial (towards the center?). So I never made it to vet school.

Anyhow. It started last Monday. The prior two weeks had been actually quite motivating in that my back felt great and I was moving back up in weight after a tax-season long layoff from going heavy.

I had been up to 325 for 5X3. But Monday, I went back down to 255 to start CW’s QD program. The third set was when I felt the pain. It was more than just a creaky-knee, or a sore knee. It felt like there was a knife blade laying across my knee, and from about parallel to just short of lock out - the knife was stabbing my knee.

The next day was 2X25 - so I only put 135 on the bar after a painless warmup set using only the bar. I got to about the 12th or 13th rep on the first set before I had to holler calf-rope, and rack tthe bar. Same pain. Same location. Same ROM.

Saturday was 6X3 power reps using 18RM. I was doing power lunges with only 115lbs. First rep out of the box, and I racked the weight. Pain was more intense - seemed to be more concentrated in the lower half of the knee cap.

What botheres me is that doing BW squats, or minimal weight - there is no pain. There is no pain when I walk, or sit. Only when I have the bar loaded with weight.

And this was supposed to be “The Summer of Squat”.

I had a simialr problem. Seem to have been cause by less than optimal length/tension in the quads, hip flexors, ITB and hamstrings. Solved it with Ian King’s article on this site End Needless Knee Pain.

[quote]rainjack wrote:

What botheres me is that doing BW squats, or minimal weight - there is no pain. There is no pain when I walk, or sit. Only when I have the bar loaded with weight.
[/quote]

Under load, the tensioning in the quads is different than when squatting bodyweight or minimal weight, and also the angle of the trunk to the thigh is different. Since the quads are bi-directional, this can be all it takes to make a significant difference in tensioning of the structures at the knee, distort the geometry of the joint, and produce the pain.

Do your quads seem tighter than usual? If you were having cartilage trouble under the patella I think you’d feel at least a slight grating sensation while walking.

[quote]endgamer711 wrote:
Do your quads seem tighter than usual? If you were having cartilage trouble under the patella I think you’d feel at least a slight grating sensation while walking.[/quote]

They have been ungodly tight (pumped) since right before I started feeling the pain.

I have no pain/grating sensation at all when I walk or jog. I have purposely not tried to run, so I can’t tell you if any irritation is present then.

Hang tough, RJ and get better quick.

Kuz

[quote]rainjack wrote:
endgamer711 wrote:
Do your quads seem tighter than usual? If you were having cartilage trouble under the patella I think you’d feel at least a slight grating sensation while walking.

They have been ungodly tight (pumped) since right before I started feeling the pain.

I have no pain/grating sensation at all when I walk or jog. I have purposely not tried to run, so I can’t tell you if any irritation is present then.[/quote]

Can’t beleive I for got to ask you this, but how would you rate yourself in terms of overall and esp lower body flexibility? Flexible, semi-, tight as all get out?

[quote]hoosierdaddy wrote:
Can’t beleive I for got to ask you this, but how would you rate yourself in terms of overall and esp lower body flexibility? Flexible, semi-, tight as all get out?

[/quote]

Well - I can’t wrap my legas around my head like a Thai hooker, nor am I a stiff legged gimp.

I’d say I am semi-tight wrt to flexibility. Right now, I am carrying such a huge pump around (up alomost an inch in my thighs in the last 10 days - all pump) that my flexibility is probably somewhat hampered.

But I can do GM’s, or SLDL’s, or GHR’s - and I don’t notice any loss of flexibility. And for that matter - I don’t “feel” tight when I squat, or lunge. I just feel the pain - which ends the quad training.

[quote]rainjack wrote:
endgamer711 wrote:
Do your quads seem tighter than usual? …

They have been ungodly tight (pumped) since right before I started feeling the pain.

I have no pain/grating sensation at all when I walk or jog…[/quote]

What do you have in your program for hamstrings? The reason I ask is this is sounding more and more like something that can be fixed by balancing the tensions around the knee. The suggestion about the Ian King knee program is probably a good place to start.

[quote]endgamer711 wrote:
What do you have in your program for hamstrings? The reason I ask is this is sounding more and more like something that can be fixed by balancing the tensions around the knee. The suggestion about the Ian King knee program is probably a good place to start.
[/quote]

Funny you should mention this as I have seen quite a bit of growth in my hammies (probably pump as well) in the last 3 or four weeks.

I do Romanian dead lifts, SLDLs, GHR’s and leg curls.