T Nation

Squats with bad knees

My husband has HUGE legs. A lot of it is genetic, he is quite gentically blessed. He also has very bad knees. He thinks it was from running on concrete when he was in the army. Now, whenever he does squats it kills his knees. He can get away with using lighter wights on squats without hurting his knees, but then he doesn’t even get sore. Does he just have to use a different exercise? Leg press doesn’t hurt his knees so he tends to favor that exercise. Sometimes the standing ham curl hurts his knees too, the sitting one doesn’t bother him. Advice?

If he squats with thighs and feet parallel and close together, have him try moving his feet farther apart and turned out in a semi-sumo stance. It’s a completely different movement for me and much easier on my back, especially when my thighs are about 90 degrees apart in the bottom position. Also, it is imperative that the feet point in the same direction as the upper thighs in the bottom position (turned out) to prevent twisting the knee joint. Hope this is of some help.

Ironbabe…sounds like your hubby and I have the same issue. I also have great legs, but bad knees…too much hoops, and martial arts. I use a lot of preexaust leg extentions so that I dont have to go as heavy on the squats. I also use knee wraps because they help me save my knees. Other than that, I just grit my teeth and deal with it.

This is pretty much an impossible question without more information on the injury… If it is a problem with tendinitis or poor tracking, sure I have some great advice. Go to an ART provider, and he’ll be feeling great in 3 or 4 weeks. If he’s got arthritis, start him on glucosamine and chondroitin, and possibly consider MSM and cetyl myristoleate as well. If he has considerable damage to his cartilage or bursitis, you may have to consider surgery. If you don’t even know what his medical condition is, well you just found your first problem. Out of the VERY limited information you gave us (leg presses don’t hurt, squats do, military running…), he probably has plain ole’ tendinitis. I’d also hazard a guess that he’s not too flexible and has an overly tight IT band from the concrete “army” running. (which usually means running in formation and doesn’t allow full stride or much hamstring activation). Here’s your plan of attack…

Take him to a doctor and figure out exactly what's wrong with him, but don't listen to the doctor when he says he'll have to take mega-doses of ibuprofen or whatever else for the rest of his life. Start him on a stretching routine, and get him a nice, painful sports massage once a week. Then write back with some more info, and we'll help direct you to the best treatment options.

If the doctor says he needs surgery, get another opinion. If the 2nd doctor recommends surgery too, go to a chiropracter that also practices ART (may be difficult to find but not impossible). If HE says he needs surgery, he’s probably going under the knife…

Fish oil helps alotem what about some glucosome and chondrium as well 9sorry if they are spelt wrongly don’t have much time tonight)

Well, we don’t know exactly what caused the injury, but when I read your responses to him, the running in military formation thing really stuck out to him, he is 6’4" and had to run with much less than his full stride. He is also very inflexible. His knees don’t bother him in every day life, only during squats, so I don’t see why he would opt for surgery. One more thing, he was diagnosed with bursitis in his hip, while he was in the army, it used to absolutely drive him crazy with pain. But the pain went away on it’s own and his hip never bothers him now. Maybe the pain in his hip was really from the running and not bursitis at all? I think the first thing we are going to try is getting him more flexible. He knows he is not flexible at all. I bet this will go a long way toward fixing his problem. Thank you all. If the stretching doesn’t fix it, we’ll try some of the other things you guys have suggested. Also, what is ART? Save me from an internet search that will probably just bring up paintings.

ironbabe art is active release technique but i don’t know much more about it other than that there was an interview with a guy who speciqalises in it in one of the back issues.

Hey I had the same problem due to formation runs with the Marine Corps. Also I’d developed bursitis because I was grappling with a wrestler while in boot camp and he slammed me to the floor right onto my kneecap. I favored the hurt knee for so long to complete the training that I got tendinitis in the other leg. Doctor told me it was tendinitis, he told me to keep squatting but to stop short of the reps I knew would hurt, warmup thoroughly before running, stretch thoroughly before running and he put me on an anti inflammatory as well as glucosamine and chondroitin. The massage thing hurt but I think that also contributed to my healing. I’m in the process now of recovering my strength in the squat.
Good luck to your husband.

Where is the pain located (more specifically than “the knee”)? In my long-distance running days, I had more than my share of knee pains.

Outside of the knee on the side of the leg? Probably ITB problems. I treated mine with stretches.

Knee cap? Most likely chondromalacia. Anti-inflamatories and muscle balance exercises can help mild cases, advanced cases may require arthroscopic surgery to repair the roughened cartilage on the kneecap.

Does it tend to lock up? Maybe torn cartilage (with a joint mouse). Not much can be done here other than surgery.

There’s also another condition called synovial plica (don’t know if that’s spelled right), and I don’t remember the specific symptoms. Basically it’s an extra ligament (genetic) that serves no purpose other than to cause pain.
Just some ammo that might help pinpoint a cause. Hope it helps.

He says it hurts at the bottom of the knee cap.

I’m not an expert, but I have had bad knee pain for quite awhile and I’ve been researching the subject a lot. There are literally hundreds of things that can go wrong with the knee joint, and to make matters worse, many of the problems mimic each other. From the sound of it, if the pain is right below the patella, it could be patellar tendinitis. It could also be a fat pad impingement (or impingement of other synovial tissue). I’ve read that MRI’s can often those issues. I hope this helps in some small way…

Ok, same place as my injury. I’d say it’s tendinitis. Anti inflammatories should do the trick along with the stretching and sports massage. It will hurt though. But I don’t think there’ll be permanent damage. Have him press on his tendon just below his kneecap, if it hurts there, it’s most likely tendinitis.

ART-Active Release Technique. It’s a method of soft tissue release, and it’s beyond me to really describe how it works. I can tell you what you’ll experience though… the practicioner will find certain spots along your husband’s hips, butt, all along the sides of his legs, and right in front of the knee. He’ll “release” these areas by pressing very hard against them while taking the joint through its full range of motion. It can be painful at times, but it sounds like it will really help your husband’s condition. Any tendinitis problem is pretty much a knockout with ART. Stretching should also be of great importance, and you’ll probably want to focus on his hamstring development and the length of his quads.

if he squats (or does hack squats, or leg presses) make sure that he takes a shoulder width stance, and points his feet slightly outward. also make sure that his knee tracks in-between his big toe, and his first toe. he can also try limiting the depth to which he squats. This might be a good time to experiment with 20 rep squats. Start taking condroitin as well. Stiff legged deadlifts recruit more hamstring muscles than leg curls, so he can substitute them. I would also steer clear of the leg extension. Especially the last few degrees of extension are very hard on the knees. FInally see a sportsmed specialist.

I had rice krispie knees (snap, crakle, pop) from years of squating heavy, but only going to parallel. Over the last couple of year I’ve gone to deep squats with less weight and the results have been great, no more pain, except soreness, and no more noisy knees. I especially like one and a half squats. But, I don’t know if I would take advice from anyone who said they like any kind of squats.

This could also potentially be Osgood Schlauter (sp?). Basically a bone spur at the attachment of the patellar tendon to the tibia (or is it fibula, no anatomy reference handy). X-rays or MRI should be able to rule this out.

excuse me…I may be missing the point here, but if his legs are HUGE already and he can maintain with leg presses, then why try and get him to do a potential painful and harmful exercise? Substitute another T-releaser like deadlifts if that’s your concern, or use the pre-exhaust method as was mentioned previously. Squats are excellent, but leg presses and deadlifts combined may be even more effective without causing pain…good luck

jonah