Training Legs with Knee Arthritis

It seems I’ve developed arthritis in both knees, mainly under my knee caps. My MRI shows deep fissuring and cartilage loss in one knee and just fissuring in the other, in both cases in the cartilage under the knee caps. I’ve been to see one orthopedist who basically told me I just have too much mileage on my knees (40+ powerlifting meets over 18 years) plus skiing, sports, running, etc. I’m working with a good PT and going to see another orthopedist in about a week.

I’m wondering if anybody else on the board has dealt with similar knee arthritis and continued training legs. From what I can tell, loss of cartilage under the knee cap is associated with knee flexion. Once I’m cleared to return to training I’m thinking I’m going to have to make some changes to the way I train to hopefully minimize further damage – I don’t want knee replacements when I’m 50 (nearly 40 now). Some obvious changes seem to be to drop the frequency of knee dominant movements and I think I’m done with powerlifting, at least for a while. I’d appreciate any feedback folks have.

Dam 39 and blown knees. Have you looked into knee stem cell injections?
What are your thoughts about peptides like BPC 157?

I prefer to think of them as “beat up knees.” :slight_smile: The stem cell therapies look promising. The peptide I hadn’t heard of but my initial look at it was that it doesn’t seem to rebuild cartilage.

You’re on the right track.

Something else to keep in mind is how much knee dominant movement you do outside the gym.

The most common way I first address this with my clients is changing how they sit. Rather than this:

I change them to this:

The most I have these clients squat is twice a week, and more often than not it’s box squatting, so they can sit back more, lessening how much knee flexion happens.

For the ones where the knees are really bad, we’ll start out going no lower than parallel, and I’ll have them go up maybe 5-10 lbs a week, starting at no weight. I take a very longterm view with them. To your point, avoiding knee replacements starts dominating the thinking.

(It might sound like too little weight, and for some I won’t take it that far, but regardless, if you kept that up, you’re at 250 lb squat in a year; 500 in 2 years, etc. With the longterm view, it adds up fairly quickly.)

If the person has been squatting regularly for a while though, like you sound to have been doing, I might just not have them do any loaded knee bending for a while. 3-6 months isn’t out of the question.

I’ll also encourage them to keep walking, if not running though. (Within reason of course.) Rationale being loading is critical to keeping cartilage healthy, but you want the right kind of loading.

These are some sources I commonly send to clients:

→ Good little book about a guy’s journey dealing with knee cartilage issues. Details research showing cartilage can heal.

→ Short article in the vein of the book. The author has a few articles out there detailing how running, to a point, can be helpful for preventing knee arthritis. The simple mileage argument doesn’t hold. Too little mileage can be as bad, if not worse, than too much. (A great way to destroy a joint / cartilage is to immobilize it.)

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I appreciate the info. I’ve learned a lot about my issues since I made the original post. It seems most, if not all of my problems, are due to improperly tracking knee caps (overdeveloped and tight outside of my leg coupled with underdeveloped VMO). I’m working with a physical therapist on fixing the tracking issues and day to day pain has improved substantially. I’m still not back to barbell squatting and deadlifting, but RDLs and goblet squats are on the menu, so that’s good.

Sure thing. Hope you’re making progress. Handling tracking issues can be tough. Let me know if you ever want more info on that. Good luck!