Doing squats after having a Petellar/Femural issue.

[Bacchus]

Mark,

First let me say that i'm a big fan - and have enjoyed reading your material and watching any videos you've released.

I come from a history of running induced knee issues, mainly tendinitis my IT band. Last year, I decided to take control of my fitness - and began strength training. 8 months later, I develop a petellar-femural misalignment, and also petellar tendinitis. Part of the issue as well was the Vastus Medialis was not firing with the other muscles.

After 3 months of physio work, i'm cleared to squat again. Last week was my first week back, and I didn't have any issues. However, my questions is as follows ..

Is there anything I should remember in my form, to ensure the Vastus Medialis continues to fire with the other muscles of the quad?

[Mark Rippetoe]

How is it that your paralysis has not more profoundly affected the quality of your life? I applaud your therapist for the great work she's done bringing you through whatever traumatic injury cost you the use of your VMO.

[Bacchus]

How is it that your paralysis has not more profoundly affected the quality of your life? I applaud your therapist for the great work he's done bringing you through whatever traumatic injury cost you the use of your VMO.

Mark, Thanks for your response

It wasn't a complete paralysis, but things were definitely not working in sync. the VMO was abnormally smaller on that (left) leg. The misalignment as a whole definitely effected my daily activities, from walking to using stairs.

The fist month was spent doing proper stretches, and strengthening supporting muscles in the hip, as well as as a flexing exercise. With leg extended, I would flex my quads, trying my best to concentrate on the VMO - holding it for 5seconds. This was done 10 times, each waking hour of the day for a month.

I spent over two months doing body weight squats, holding a 2lb plyobal between my knees - which my therapist said would force the VMO do more of the work. My therapist has suggested continuing this exercise as a warm-up, before doing any weighted squats.

I just wasn't sure if stance played a role in causing or preventing this issue.

[Mark Rippetoe]

You have a good therapist there. She's using some cutting-edge techniques that are sure to wake up that sleeping VMO. I'd keep her happy if I were you!!

[Beau Bryant]

Rip, we just discussed an issue similar to this at the NJ cert.

Another example of a PT fixing a "firing" issue with 3 months of who knows what. I would guess that one legged squats were involved.

Any quality strength coach would have had you squatting over 300 pounds for sets in that 3 months time and your VMO would have "woke up" at the same time.

My recommendation would be to go find a good strength coach.

[Mark Rippetoe]

But this would deprive the kind, caring therapist of her $185 sessions. How is she supposed to get by?

[Bacchus]

Rip, we just discussed an issue similar to this at the NJ cert.

Another example of a PT fixing a "firing" issue with 3 months of who knows what. I would guess that one legged squats were involved.

Any quality strength coach would have had you squatting over 300 pounds for sets in that 3 months time and your VMO would have "woke up" at the same time.

My recommendation would be to go find a good strength coach.

A poor guess. No one-legged squats.

I don't think squatting through the petallar tendinitis would have been a good idea, when my knee was mangled to the point i couldn't walk.

I squatted through the minor pain from nov-jan, before eventually seeking a sports physio therapist.

On the plus side, it was only 60$/session - and is covered my by health insurance.

I'd love to find a proper strength coach though - I live in Toronto Canada, any suggestions on where to look?

[Kyle Aaron]

Setting aside the usual "everyone who does things differently from me is a moron" spiel - which I hear from my physio and coach both, I think perhaps they should get a room...

I experienced the same problem. It doesn't seem that your physio explained this to you, so I will. Patellar maltracking is about your body's makeup, not caused by squats or whatever. The only question is whether it causes pain. What happens is that the patella is in the wrong place, so when you flex your knee, the little groove it's supposed to track up and down through - well, it doesn't. Instead it grinds on other bits.

Now, with an ordinary person whose life consists of sitting down at work in front of a computer screen, then coming home to sit in front of a tv screen and eat doritos, this isn't a problem. They flex their knees a few times during the day, do a little bit of damage, it heals up, no problems. But if that person then starts going for runs or hikes or cycles, they do a lot of damage, it heals a little bit... and it builds up. You end up with swelling and pain.

Patellofemoral syndrome is thus an overuse injury. You're not going to get it from 100-200 reps of squatting or deadlifting each week, you get it from - as I did - running 50km or cycling 250km in a week. After all, an hour of cycling is something like 3,600 reps, do that eight times a week and - it's a heap more reps than anyone would ever do with squats.

So if the therapy has removed the problem, and if your only physical training is weight training, it will probably not reoccur. If you're going to go for runs and stuff like that, you need tape. If you did the same McConnell programme as I did, part of the treatment was taping your patella, with the tape beginning laterally and brought in medially; the aim is to move towards the midline of your body and downwards. This generally gives immediate relief to any pain, but as well I have found that it helps prevent further damage.

I am no medical professional, I'm just someone who's experienced the condition, got better from it without it coming back, and who's also experienced therapists and trainers both berating me over the supposed idiocy of each-other, leading to my being confused, and not helped at all.

[Mark Rippetoe]

Right, right -- Kyle from AUS, PFTS, been there/done that/T-shirt/knows all about this, muscle imbalances, VMO, sleeping muscles, corrective taping, functional training, bosu balls, muscles waking up all refreshed and bright-eyed, all that shit. Let's talk more about your therapist. Is she hot? Post a picture. Please.

[tallison]

Wow, Mark, you seem to be having fun with this one and I kinda hate to break in, but I'm having a hard time following. The first response *almost* sounded sincere.

Can someone break this down? Has the OP and the have the other somewhat extensive responses which took him seriously been saying things that are that far out to lunch?

How does one become "a well-informed patient" without spending a lifetime in the gym and suffering through 1,000 rounds of bad advice from trainers, physios, doctors, etc?