Pain at the bottom of my knee

[RP89]

I'm experience a nagging pain at the bottom region of my left kneecap. If I apply pressure to the bottom of the bone i feel a pretty sharp pain, and it's uncomfortable when I'm walking around and sometimes even just standing. Just some backstory on this. I first had this pain in the 6th grade when running track (100m).

It would come back periodically. It would go away for awhile when I wasn't doing any hard activity, but when I would play basketball a lot when I was younger it would come back. When I was in 11th and 12th grade (I'm 20 now) and playing HS basketball it was pretty frequent I'd ice it regularly to lessen the pain. During 12th grade basketball season I also got "shin splints" and I had a feeling this may have had something to do with my knee pain, which caused me to alter the way I move on the court..I lost all my explosiveness and was practically useless.

After the school year I stopped doing any hard activity and it went away. Prior to now, the last time this pain occurred was about a year and a half ago when I played a game of pickup basketball and about 3 minutes in went up for a layup hard off my left leg. I started doing SS in late January and have seen great gains thus far (+35 lbs). My legs were feeling GREAT. I was feeling as explosive as I've felt in years. Unfortunately when I was doing my 305 workset less than a few weeks ago I asked someone for a spot. I told him not to give me any help unless I was stuck, but did not specify to spot by lifting the bar...so in turn he ended up spotting me from my chest.

The dude - who happens to be one of the strongest guys in the gym and squats 500 lbs High bar FWIW - was lifting me up almost every rep. Immediately after this set I felt that familiar pain in my left knee. Since then it has been on and off, but mostly on. When I squat now it's uncomfortable but isn't really that painful, however after the set I definitely feel it and it usually lasts throughout the night, gets a bit better the next day, then comes back my next workout after my 1st set of squats.

This is extremely annoying cause everything was going great and now this has put a halt in my training, with squatting at least. I haven't done 3 x 5 worksets since this injury. I don't know forsure if that spot on that particular set caused this nagging pain to reoccur but I'm pretty sure it did...lesson learned when it comes to getting a "spot" in the gym. My shins have also felt.."old" for lack of a better word since this happened. It feels like I have Larry Bird like legs, a huge contrast to the strength and explosiveness I felt in them just a few weeks ago. But this is the same type of stale feeling in my legs that I experienced during 12th grade basketball season which I referred to earlier, it's just not as bad cause i don't actually have shin splints this time. This type of pain has also occurred in my right knee in my lifetime but 90% of the time i've had it it's been in my left leg, I'm guessing it being my dominant leg may be part of the reason.

Sorry for the longass post but hopefully someone can help me out and let me know what I should do if you're able to identify what the heck this annoying nagging pain is. Oh yeah forgot to add in 12th grade I did "physio therapy" I think it's called and they treated my knee and shins massaging it with gel and doing some other things. Went for a couple weeks, it didn't do shit.

[RP89]

anyone...? The pain is still persistent. Friday it was worse than ever on my warmup sets. Honestly I'll never be able to do a 3 x 5 workset if this pain doesn't go away or lessen. Friday night I went out downtown and it was bothering me just walking around. Should I see a PT? what do I do? Someone help..

[blowdpanis]

Videos of you squatting would be extremely helpful here. Minus that, there's not a lot to say, since e-diagnosis isn't terribly easy. To me it sounds like some basic patellar tendinitis, but it's impossible to say from way out here.

[JT in MD]

Osgood Slaughter (sp?) syndrome? I'm not a doc and I really know next to nothing about basic anatomy. However, since you said you first had it in 6th grade.. - OS is usually related to growth in adolescents. I had it 6th-7th grade. If you push the bony thing that sticks out just below your kneecap it can be excruciatingly painful. Just a thought...

[RP89]

I don't have a camera and don't have any video capabilities on my phone. I go to the gym alone as well. If I can get a buddy to train with me who can record me I'll get something up. For what it's worth I've asked for about 3-4 different form checks from people who appeared to be squatting with good form who were also moving quite a bit of weight and they said I was sitting back on my heels well and keeping my back in extension fine. Then again I also wouldn't consider my form perfect and it would probably be like an 8/10 if critiqued on here as I'd still trust form checks here over guys who look like they know what they're doing at my gym.

But remember, I've had this exact same type of pain numerous times throughout my life long before I've ever done a squat. The time it comes back after about a year or so without it was coincidentally the time I get an improper spot squatting heavy. And isn't patellar tendinitis right above the kneecap? Do you think wearing a knee wrap might help ease the pain?

[allyn703]

I had a similar pain. just under the knee where it feels like the muscle connects with the bone? I found this to be tight quads and after stretching them out every day the pain went away. Hope this helps.

[Jeff Horner]

Yeah, I was diagnosed with Osgood-Schlatter as a kid. I had to quit the travel soccer team because of it. I also went to the doctor a few times back then because of soreness under my kneecap. O-S went away because I quit soccer and I grew into an adult.

I still have issues with my left knee swelling.

If you ever find a fix then you better let me know!

Check your leg lengths and see if they're different.

[Tom Campitelli]

Some questions:

Are you using ice or heat on your knee?
If not, try one or both. Do they help?
As the weight has gotten heavier on the bar, are your knees sliding forward at the bottom of the squat?
At the bottom of the squat, do you shoot the hips back and open the knee angle forcing more of a good morning motion on the squat?

I'm not a doctor and you were pretty vague about where your pain is occurring. However, it's probably best to start simple. This sounds a lot like patellar tendonitis, or tendonosis. Resting a bit might be initially useful, but as you have seen, it will just come back anyway. You probably need to find a way to manage the pain and train around/through it. I have had patellar tendonitis on and off. I no longer suffer from it. The solution? Gain weight, get stronger, and squat with good form. You may not have tendonitis, in which case the above advice may not apply.

[Tom Campitelli]

One other thing, if you are particularly inflexible, this may be an aggravating factor. Foam rolling, PNF stretching, and aggressive massage can be of help.

[RP89]

I had a similar pain. just under the knee where it feels like the muscle connects with the bone? I found this to be tight quads and after stretching them out every day the pain went away. Hope this helps.

Yeah right there. What type of stretches were you doing? I never stretch fwiw.


Some questions:

Are you using ice or heat on your knee?
If not, try one or both. Do they help?
As the weight has gotten heavier on the bar, are your knees sliding forward at the bottom of the squat?
At the bottom of the squat, do you shoot the hips back and open the knee angle forcing more of a good morning motion on the squat?

I'm not a doctor and you were pretty vague about where your pain is occurring. However, it's probably best to start simple. This sounds a lot like patellar tendonitis, or tendonosis. Resting a bit might be initially useful, but as you have seen, it will just come back anyway. You probably need to find a way to manage the pain and train around/through it. I have had patellar tendonitis on and off. I no longer suffer from it. The solution? Gain weight, get stronger, and squat with good form. You may not have tendonitis, in which case the above advice may not apply.

1 and 2 - no, because when I have in this past it never did anything to aid the pain.
3- I don't believe my knees are sliding forward and I've had no problem with knee caving since like 225.
4- Yes, I have been doing this recently I've been good morning' a lot of my heavy squats that I've done the past 4-5 workouts or so.

Again, isn't Patellar tendonitis above the knee cap? Shouldn't the source of the pain be there? Maybe it is tendonosis, I'm seeing a PT soon I'll see what he/she says although I'm not too sure how much I should trust their word.


One other thing, if you are particularly inflexible, this may be an aggravating factor. Foam rolling, PNF stretching, and aggressive massage can be of help.

I am definitely inflexible. When I do air squats I can't keep my back in extension. When I deadlift, you know how a lot of people stretch their legs all the way back before bending their shins to the bar? Well I can barely do that halfway. Will PNF stretching and foam rolling help me fix these problems? Is this a hamstring flexibility issue?

Oh and WRT my knee pain, I was doing air squats like 20 minutes ago and the pain was sharper and worse than ever before. I'm talking a lot worse than when I was squatting 300 or so monday and sessions last week. It was the first time the pain was actually excruciating and it happened abt halfway down in the squatting motion.

[allyn703]

Yeah right there. What type of stretches were you doing? I never stretch fwiw.

http://www.exrx.net/StretchImages/Quadriceps/Standing.jpg

Do these after your workout.

[Tom Campitelli]

1 and 2 - no, because when I have in this past it never did anything to aid the pain.

Understandable. Ice sometimes helps and sometimes doesn't.


4- Yes, I have been doing this recently I've been good morning' a lot of my heavy squats that I've done the past 4-5 workouts or so.

I found that breaking myself of this habit helped me a lot with knee pain.


Again, isn't Patellar tendonitis above the knee cap? Shouldn't the source of the pain be there? Maybe it is tendonosis, I'm seeing a PT soon I'll see what he/she says although I'm not too sure how much I should trust their word.

The patellar tendon's proximal insertion is above the knee and its distal insertion is on the tibia below the knee. The pain can occur anywhere along that. In my case, it was right near the base of the knee cap toward the tibia.



I am definitely inflexible. When I do air squats I can't keep my back in extension. When I deadlift, you know how a lot of people stretch their legs all the way back before bending their shins to the bar? Well I can barely do that halfway. Will PNF stretching and foam rolling help me fix these problems? Is this a hamstring flexibility issue?

I cannot guarantee that PNF stretching or foam rolling will fix these problems, but being diligent about regularly stretching will be of use to you. What is diligent? Stretching your hammies, calves and quads four or five times a day for about 90 seconds a piece. It sucks. It really does and it is difficult to find the time and remember to do it. However, flexibility does play a role in knee pain. Also consider getting a massage from someone who doesn't mind hurting you. If you have a friend or significant other than can help you to PNF hamstring stretches, this is very effective. I can't do PNF stuff more than once a day because it makes me sore.


Oh and WRT my knee pain, I was doing air squats like 20 minutes ago and the pain was sharper and worse than ever before. I'm talking a lot worse than when I was squatting 300 or so monday and sessions last week. It was the first time the pain was actually excruciating and it happened abt halfway down in the squatting motion.

This is probably because the air squat is a more quad dominant movement. If your knees are hot, this will irritate them further. A good low bar squat is more neutral for the knee than an unweighted air squat.

Once again, I am assuming that you are running into common tendonitis here and not something weirder. If it is tendonitis, a brief break might be in order supplemented with aggressively going after your mobility and form issues on the squat. Make sure to hit your IT band with that roller, too. I have worked with a guy at my gym who was suffering some serious knee pain, although not as localized as yours. He's seen significant improvement through squats, mobility work, and painful foam rolling. The potential is there for these activities to help so do give them a go.

[Tom Campitelli]

Two other things to consider.

Check out San Francisco CrossFit's blog (http://sanfranciscocrossfit.blogspot.com/). Kelly Starrett, the head coach, is also a gifted physical therapist. He's written some articles about loading and tensioning as well as PNF stretching. I think he calls it contract-relax stretching. Both topics will be of interest to you.

Play with a wider stance squat. This may relieve some tension on the knees, although it will require additional adductor flexibility.

[LimieJosh]

and painful foam rolling.

Does the pain ever subside? I've been going fairly consistently for about a month (min 15 mins a day 5 days a week) and have progressed far less painfully to balls of various sizes and hardness for the soles of the feet, calfs and hamstrings, but on my original foam roller I'm still going as gingerly on the IT band and lateral part of the quad with excrutiating pain today as I was on the first day.

[Tom Campitelli]

Does the pain ever subside? I've been going fairly consistently for about a month (min 15 mins a day 5 days a week) and have progressed far less painfully to balls of various sizes and hardness for the soles of the feet, calfs and hamstrings, but on my original foam roller I'm still going as gingerly on the IT band and lateral part of the quad with excrutiating pain today as I was on the first day.

I don't know that it ever feels good, but as you've seen, improvement does occur. It just hasn't been occurring for your quads. You might benefit from an IT release/massage that others have done. I've never had an IT release performed on me, but some of those that have claim marked improvement.