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Need Good Advice on a Bad Knee

Hi all,

First time posting here. Hoping someone can help me with some good advice for a problem that is beginning to really frustrate/discourage me. Sorry for the lengthy posting; trying to provide as much info as possible so folks know what is going on. Thanks in advance if you choose to read on.

Here’s the deal: From December-April, I was doing a ton of heavy squatting and deadlifting. I was definitely overtraining, which was stupid. One day in April, I spun around quickly and felt something in my knee pop. I didn’t take any time off from lifting, and quickly I had a massively swollen left knee that I couldn’t fully bend. Probably six weeks later, I finally ended up seeing a sports doc in Singapore, where I was based at the time, and he ordered an MRI.

The MRI showed no damage within the knee; the doc said the joint was “pristine” and that I was just suffering from a ton of inflammation and maybe a tweaked poplitea. In turn, I had just a bit of irritation under the kneecap, visible in the MRI, which the doc said was chondromalacia.

I did the whole rest, ice, ibuprofen routine, and saw an Australian osteopath who did a few adjustments that led to a massive reduction in swelling. All was looking better and I began slowly training again. I made the dumb mistake of doing some sled drags (forward and back) and hill sprints on one day, which made my knee a bit sore, and then I made the even dumber mistake of doing heavy back squats the next day for the first time in like two months.

My knee swelled right back up; the patellar tendon felt huge and inflamed. I was back in the States by then, and went to see a chiropractor (a former powerlifter who used to squat in the 800 pound range back in the day) who did a couple of adjustments and told me I was suffering from chondromalacia and a kneecap that isn’t tracking properly.

Since then, I’ve been really good about resting, not doing anything that would bother my knee, and trying to do hip stabilization stuff and some quad strengthening exercises my knee can handle, like leg extensions. The chiro told me my quads are weak in comparison to my glutes/hamstrings, my abs are weak in comparison to my erector spinae, and my right back/hip are overdeveloped and tight compared with my left side.

He thought my right leg might be slightly longer than the left due to some imbalance in the hip. I should note that, like 70 percent of the male population, I have anterior rotation in my pelvis, which I have been working to correct using exercises I’ve found in articles on this site.

At present, I seem to have hit a plateau. There are some days where my knee is pain free and not swollen, and feels 95 percent and I get the itch to squat (which I resist). There are other days when I wake up and the kneecap is sliding around all weird and clicking and hurting just from walking. I continue to work on exercises to stabilize the kneecap (single-leg quarter squats on a declined surface, at least on days my knee feels okay to handle it, leg extensions, some terminal knee extensions), exercises to stabilize the hips and correct anterior pelvic rotation, and exercises to strengthen the abdominals.

I just can’t seem to get past this issue, and I am particularly dismayed on days when the kneecap just seems out of control. What else can/should I do? Getting very discouraged.

For reference, I am in my mid-20s, have never had any real knee issues before (minor patellar tendinitis in the left knee when I was 17 and was running a lot), and I have been lifting seriously for a little over a year. If it’s relevant, I’m 5’9", 180lbs and lean. My 1-rep max back squat is double bodyweight, and my 1-rep max deadlift is 2.875 times bodyweight.

Thanks again to anyone who bothered to read this far. I would really appreciate any good advice you guys can give.

Rest until the swelling goes down. Try if you can working with experts on your exercises. If your knee keeps getting inflamed then it’s something in your technique. Now it’s more important than ever to build your legs, but you are going to have to work on doing everything correctly before going heavy again, you may need an MRI again if it keeps getting inflammed there will be no telling when you do finally do some damage to it.

Question are you pushing your knees out when you squat?

Hi Airtruth,

Thanks for the advice. Yep, I’ve been just resting it and only doing any activity when I know it’s not inflamed. What’s weird is that some days it seems close to 100 percent, and other days the kneecap is all over the place.

My knee was feeling good earlier this week when I decided to take a complete rest day; the day after completely resting, the kneecap was clicking and tracking wrong and causing discomfort when I walked. So it almost seems like it is no longer correlated with my activity or lack thereof.

And to answer your question, yes, I do tend to push my knees out both laterally and forward when I squat. Some people have knees that collapse inward when they squat, but that has never been an issue for me. I take a slightly wide squat stance, with my toes pointed just a bit outward.

My spinal and ankle mobility are both pretty good, and I tend to sit pretty far back and down with my torso upright as I squat, if that makes sense. I do think I need to focus more though on keeping my knees from going so far forward. For the time being, I’m only going to be doing front and overhead squats, which I think will help correct some of my issues a bit.

Check how you sleep. You may be doing something in your sleep, or how you sit. As I got older the way I sat made a huge difference in how my knee felt.

This is going to hurt but take Yoga from a good instructor. Just Yoga for a short time, it’ll give you the best understanding of how the knee should work in movement, as well as help heal it. Have you tried fish oil, cissus or glucosamine/chondroitin/msm?

I found this pretty helpful with my knee problems.

Albeit my problems werent as major as yours

There are braces designed to help with patella tracking. I haven’t bought one yet but am going to soon. Supposed to help chondromalasia pain. Called Cho Pat knee strap.

See a specialist to manipulate your knee back into track. You won’t progress unless this is addressed. Then get back to squatting (light to moderate weight), practicing keeping your knees and feet more straight ahead, possibly keeping a closer stance. You may need to work on ankle flexibility simultaneously.

I’ve had surgery on both knees as a teen due to chondromalacia.

Aslo, this is good advice:

[quote]dcm1602 wrote:
I found this pretty helpful with my knee problems.

Albeit my problems werent as major as yours

http://www.T-Nation.com/readArticle.do?id=4847546[/quote]

[quote]Airtruth wrote:
Check how you sleep. You may be doing something in your sleep, or how you sit. As I got older the way I sat made a huge difference in how my knee felt.

This is going to hurt but take Yoga from a good instructor. Just Yoga for a short time, it’ll give you the best understanding of how the knee should work in movement, as well as help heal it. Have you tried fish oil, cissus or glucosamine/chondroitin/msm?
[/quote]

I’ve had my share of knee problems and surgery due to overuse and abuse. Really consider checking out the comments on sleep and sitting. Also, I’ve been subbing fish oil for all the other joint sups and find it to be much better. If you haven’t really tried fish oil for this, get a sup HIGH in Omega-3 and take the recommended dose and then up the dosage each day until you are “a little loose” (you’ll know!), then back off a little on the dosage until you are back to normal. You should be filling your body with Omega-3. Sitting correctly and fish oil are working for me.

have had tracking problems before nothin major, allot of foam rolling usually sorts it although yours sounds worse,as for the pop when you turned around that sounds like a classic acl injury- would get another mri myself as obviously there is something serious goin on in the joint possible cartalidge damge- injury sucks

Hey, thanks everyone for the good advice. Just to give a little more background, I have been wearing a cho-pat strap and sometimes another sleeve thing over that to keep the joint really warm. It definitely helps keep the knee moving the right way, but it doesn’t seem like a great long term solution. I’ve also been taking a ton of fish oil, as well as glucosamine and curcumin extract. I’m definitely going to try and change the way I sit and sleep, and I think I will sign up for yoga as well.

Meanwhile, I’ll try and at least stay active doing upper body stuff and maybe swimming. And, Romanian deadlifts don’t seem to bother it. Frustrating injury for sure. Big lesson learned: If something hurts, take some time off to recover right away. Don’t try to train your way through it…

What’s good man? I wrote a post a while ago on dealing with elbow issues, but nearly all the suggestions I gave in the thread can be applied to your knees (just use common sense). I’ve applied all the suggestions to both my elbows and knees and have completely turned around my health. I’m too lazy to retype everything out, but again, almost all the suggestions will apply to your knee. Give it a shot and update this thread in a couple of months

http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding/training_triceps_without_heavy_weight?id=5288275&pageNo=0

One suggestion I forgot to mention was to buy some Blue Heat off of Elitefts or see if you can get it somewhere by you. Great stuff that Eric Cressey has spoken very highly of.

[quote]Iron Dwarf wrote:
See a specialist to manipulate your knee back into track. You won’t progress unless this is addressed. Then get back to squatting (light to moderate weight), practicing keeping your knees and feet more straight ahead, possibly keeping a closer stance. You may need to work on ankle flexibility simultaneously.

I’ve had surgery on both knees as a teen due to chondromalacia.

Aslo, this is good advice:

[quote]dcm1602 wrote:
I found this pretty helpful with my knee problems.

Albeit my problems werent as major as yours

http://www.T-Nation.com/readArticle.do?id=4847546[/quote]

[/quote]

ID! Are your elbows still causing problems? I replied to one of your posts in this thread ( http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding/training_triceps_without_heavy_weight?id=5288275&pageNo=0 ) and you never responded, so maybe you didn’t see it. Check out my post and try applying the info to both knees and elbows.

Take care

Knees are convaluted territory, I’m gonna go on the assumption that this can be fixed through coorective excercises and tissue mobilization. However if surgery is required the coorective work will be moot until the conective tissue in the area is repaired.

It sounds like you have looked into this and have a good idea of where you stand with risk factors. The two most common mechanical factors are instability/restrictions of the hip and instability/restrictions of the ankle. You said you are doing hip work but that can mean a lot of things, a hip bridge affects a different movement pattern than a band walk and so forth. Your focus should be control of the knee during flexion and extension. The muscles that facilitate that are the adductors and abductors, it is critical those two are balanced in strength.

You said your knees push out and forward, that doesn’t expalin everything because it can be an issue of weakness in an area, or tightness in the same area meaning it is overactive and its opposing muscle needs to be strengthened. Try a single leg squat test, have a coach or friend observe you doing an unsupported single leg squat (arms on the hips). Have him or her observe where your knee goes and where your foot points (more on that later).

If the knee colapses inward it is often an issue of weak abductors and tight adductors. If that is the case then strengthen through lateral band walking, wall squats with a theratube around the knees, and resisted clamshells using a theraband to name a few basic excercises. Learn how to do these properly as contoling the coreseponding adduction movement is just as important.

As your gain profieciency in those progress to excercises that incorporate such as the a bodyweight squat with a swiss ball pressed between your knee and the wall, press against the ball wit your knee as you decend maintaining core control so you dont lean into it. Combine this with target mobilty work on the adductors and medial hamstring.

If it doesn’t collapse then flip the script and strengthen the adductors with excercises such as squeezing your legs together with a swiss ball between them (used timed holds) and progress to doing this in a squat. Lateral band walking works to this degree as well, incorporate forward and backward as well. You can also try a reverse hip band squat with the band achnored to something and the opposite end looped around your thigh, squat like this and try to maintain normal form against the outside resistance.

If the foot turns out it means your ankle mobilty might be lacking in one plane. An excessive forward lean can also indicate this. Even if you have great forward flexion you may be tight in the anterior or lateral muscles. If this is the case start with three way ankle mobs ( all over youtube, including some specific to knne pain) and hammer trigger point work on the tibialis ( shin muscle) and peroneus region (outside of calf). Strengthen the ankle through resisted flexion/eversion/inversion (essentially moving the ankle each way it can go against resistance) and eccentric calf raises on one leg.

These are examples and there are plenty of other excercises you can use, these are a couple that make good use of my facility so they might not work for you, its not about the excercise per say, but the goal. Strengthen the muscles that control the knee during extension and the muscles that stabilze the ankle. You also need to have mobility in the hip and ankle to accompany this strength. This is all for the greater principle that if something doesn’t work right in the hip or ankle during force production into the ground the knee will wear the differnce.

A few final notes, you seem like a strong person which means you have the ability to place a lot of load on the knee, so even with a couple weeks off from squatting you have the ability to aggrevate the area with one set. Until you correct your imbalances you are playing with fire everytime you get under the bar. If you need to keep strenghening for competion try to at least do heavy loading in excercises like the RDL that at least are hip dominant.

Usually in athletes that have knee issues from the squat they are quad dominant so it is strange that you are the opposite the fact your knees move forward while squatting indicates quad dominace but doesn’t prove anything. Traditionally I would recomend avioding the quads and focusing on hip dominat excercises but if you need to start strengthening the quad at some point avoid the leg extension or any machine for that matter.

Controling the knee during extension is a huge priority and machines eliminate the contribution of the muscles that stabilize that region. Again this is all assuming there isn’t tramatic damage still causing the problem. Chondromalacia is cartalidge based so coorective excersices can’t affect it directly, just remove patterns that may inflame it. If you rigoursly stick to a coorective excercise protocal, stop squatting, and still don’t see improvement, it may be time to see a surgeon unfortunately.