T Nation

Squat Mechanics and Knee Injuries

Hi all. For about two years now I’ve had incessant patellar tendonitis. I don’t know why it never occurred to me before, but today I realized that this condition roughly began around the time that I cut my squat ROM back from full to parallel. Now, I’ve always known that squatting to parallel was considered bad for the knees, but I thought that this was because of its effect on the ACL, not on the patellar tendon. Is it possible that all my knee problems (again, it’s patellar tendonitis right along the proximal edge of the patella) have been due to squatting to parallel? I really don’t know enough about squat mechanics to say, but if that’s the case, I’m ecstatic. And if anybody’s wondering why I cut back my ROM in the first place, it’s because I have trouble keeping my lower back from curling under when squatting all the way down, and I figured that cutting back on ROM would solve the problem. It seems that perhaps I just exchanged one problem for another?

It is more likely that your tendonitis results from one of two things: a) You lean too far forward over your toes when you squat (which is my guess since you state that your flexibility and/or lack of hamstring strength is such that you can’t keep your back from rounding) or b) your patellar tracking is off because of a muscle imbalance. BTW, squatting, and particularly deep squatting, is not hard on the ACL.

Hola, FB. I’ve thought of everything you mentioned, and though I think the tracking issue may very well be the problem, I don’t think that either lack of hamstring strength or flexibility is. I say this because I’m very flexible throughout my lower body (I can lay my chest flat on my legs in a seated toe-touch position) and I also deadlift considerably more than I squat. My back-rounding problem is weird – the rounding actually occurs in the lower thoracic portion of my spine, not in the lumbar portion. I think it’s due to an anatomical anomaly, because the same strange rounding is apparent when I just sit in a chair and lean forward, and I remember taking a dance class once when I was like 8 (don’t ask) and the teacher giving me shit because I couldn’t lean forward at the waist and keep my back flat. But assuming tracking is the issue, any ideas how I would go about assessing what’s causing it, i.e., tests that can help me determine what to do to fix the problem? I know a weak VM and/or tight IT band are usually to blame for tracking problems, but a)I don’t know how to test if my VM is weak and b)I doubt IT band inflexibility is the problem because of my general lower body flexibility. I know that my feet are very flat and that they pronate terribly, and walking a lot definitely exacerbates my tendonitis. Might that be the cause of the tracking problem?

It could be caused from many things. I doubt it would be caused from regular squats because the squat is a slower movement whereas something like jumping or anything done with a quick change of direction puts a lot more stress on the patellar tendon and causes much more stress on tendons and ligaments overall. In olympic lifting the jerk is actually responsible for more knee injuries than any other movement due to the quick dip and drive. Do you play any sports or do anything speed/power oriented that might stress this area? To test for v.m. weakness soemthing I learned from Charles Poliquin is to do a weighted lunge with the front leg slightly elevated. Set up in a position where the front knee just goes over the toes. Go all the way down until the hamstring makes contact with the calf. Have someone watch your form. Upon the ascent if your knee buckles in at all than your v.m. is weak. I think an even bigger challenge is to do a single legged squat sitting back below parallel on a box or stairs. Try to rise straight up and be observant as to whether or not your knee wants to move in on the ascent. If you can do this with no problem then I would doubt the v.m. is your problem. And yes over pronated feet can cause a host of other problems throughout the body. Try to get evaluated by a professional in this area or get your hands on a copy of the book “Muscles: Testing and Function” by Kendall and McCreary.

Squatting to paralell is probably a cause because it sounds like you know your stuff as far as anatomy and biomechanics, so you probably know about degrees of flexion and the corresponding increase of relative force applied to the patellar tendon as well as the patella. Stopping your squat at paralell forces the tendon to resist something like seven times your body weight plus squat weight, whereas a full squat allows for the full range of flexion, taking more stress off the tendon, while still a great deal is on the patella. as far as it being bad for your ACL, unless you are manipulating your foot placement so that you are drastically inverting your ankle, which in turn internally rotates your lower leg which places greater stress on the ACL, but after all that it might have been an acute injury that isn’t healing because your not resting it, I dunno, have a doc look at it I’m a lowly athletic training student at SDSU. HOpe I helped a little bit though.

Thanks for the input, guys. Kelly: I picked up the book you recommended, and it didn’t really tell me anything new. I also tried both the VM strength tests you suggested, and they were both negative; that jives with my intution, as my teardrops look well-developed and I’ve never had any problems with knee bowing-in while executing any squat-type movement. I guess I’m left with either pronation or simply the squat itself (done to parallel, that is) as the cause of my tendonitis. Of course, simply squatting to parallel doesn’t seem like it should be the cause alone, since all the powerlifters I know squat way more than I do (both in terms of frequency and weight), exclusively to parallel, and never have problems. Maybe it’s the pronation coupled with the squatting to parallel, maybe even coupled with an acute trauma way back in the day I don’t remember that I never let heal fully. I don’t do any sports-type activities other than lifting, so I don’t know what could’ve caused such a trauma, but oh well. For the time being I’m just going to see if switching back to full squats fixes the problem; if it doesn’t, I suppose I’ll have to find a qualified doc to figure out what the problem is.

Try doing some stretching of the iliopsoas complex. I’m betting yours are hypertonic, and may therefore easily produce instability at the thoracolumbar junction.

Man I hear you, Patella tendonitis is like the worst knee injury you can have (ACL tear may be the most painful though but tendonitis is probably the most stressful and takes the longest to fully heal), cuz I had surgery on mine in May and I’m still rehabbing. I’m sorry I can’t help you much because for now I can’t even do squats because I can’t bend all the way without me feeling a little strain on my joint.

Thanks for the continued feedback. SWALE: Thanks for the suggestion, but I’ve got the loosest hip flexors of any person I’ve ever known, so I don’t think that’s the problem. I mean, in a lunging hip flexor stretch postion I can put my rear thigh flat on the ground and pull my lower leg up until the sole of my foot touches my back.

Well, you’re giving me something to shoot for.