Squats and chondromalacia patella Squats and chondromalacia patella

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Thread: Squats and chondromalacia patella

  1. #1
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    Question Squats and chondromalacia patella

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    Greetings coaches!

    A friend of mine (female, 30 years old) is considering starting lifting weights and what better way to start than Starting Strength, right? There is, however, some concern regarding her knees. She was recently diagnosed with chondromalacia patella (CMP), most likely due to wear and tear from her job as a carpenter. She also did her fair share of cycling a few years ago, along with typical aerobic group sessions and spinning at the gym. CMP, as far as I can tell, is a problem with the knees that causes degeneration/arthritis of the patella that can cause problems/pain with certain movements.

    Her physical therapist say that squats are no good for her knees, and this does indeed seem to be the common advice from PT's from what I've gathered from googling CMP and squats. The PT would have her do partial squats, quarter squats, if not 1/8 squats instead of full squats. You know, the standard "toes-pointed-right-ahead-high-bar-partial-squat-for-10-15 reps" (or so I think it's called). This, of course, doesn't seem to be very productive considering the information on this site and board regarding squats and knee safety/health, and also the general tendency of PT's to tote bullshit regarding actual strength training. My friend is understandably a bit apprehensive on squatting, so I would very much appreciate some advice on the situtation and help her get started. The goal is simply to get strong(er) without jeopardizing her knee health, short and long term.

    I'm hopeful that correct full squats might actually benefit her knees, but I'm really not in a position to say. Do any of you coaches have any experience with starting strength training, and specifically squats, for people with CMP or otherwise shitty knees? Please feel free to move this post to the correct subforum if I've posted in the wrong forum. Thanks for your help, it's greatly appreciated.




    I'll include some possible relevant information I found during my web searching, in case it might come of use. (Apologies for the wall of text, feel free to skip/skim.) The problem for me is is that I don't really know if the cited studies on squats and knee health have any merit, as Sully's meticulous review of exercise science goes to show. I know correct squats are not bad for the knees, but I don't know if this is the case if there's a pre-existing condition with the knees. Here goes, don't kill the messenger:


    Because peak compressive forces generally occur near maximum knee flexion, individuals with patellofemoral disorders should avoid performing the squat at high knee flexion angles. However, performing the squat in the functional range between 0 and 50 of knee flexion may be appropriate for patellofemoral patients, because only low to moderate patellofemoral compressive forces were generated in thisrange.

    <snip>

    The low-bar squat technique may be desirable for athletes or rehabilitation patients who want to perform the squat but minimize patellofemoral compressive force. Moreover, the low-bar squat position of greater forward trunk lean has been reported to decrease potential ACL strain, in part due to greater hamstring activity and less quadriceps activity (47). Hence, squatting with greater forward trunk lean may be appropriate for those whose goal is to minimize ACL stress. Furthermore, greater forward trunk lean also minimizes forward knee movement, which has been shown to increase knee shear forces.

    Source: http://www.mlmixrun.com.br/artigos/K...he_dynamic.pdf


    I have found all of the above methods (planks under heels, wide stance, weighted squat for stretching) to be highly successful, even with some older men who could not squat as far as thighs parallel to the ground, yet after a few months of using these strategies at least twice a week, they have eventually managed to do overhead squats (snatch style) and full squat snatches without knee injury.


    Interestingly, three of these older men, a Masters tennis player, a former sprinter and a bodybuilder had all been receiving physio treatment for more than 3 months to resolve knee pain (chondromalacia patellae or peripatellar pain syndrome) and were warned against any form of squatting. Instead they had to do the usual isokinetic knee extensions to little avail - one even used transdermal anti-inflammatory patches to handle the pain. After following the above strategies, all of them managed to do full range squats without pain or any medical treatment and return to fairly vigorous competition, so, at least in their case, full range, pain-free squatting (with something like 50% more than bodyweight) not only became possible, but it enabled them to improve on previous sporting achievements without further recourse to medical treatment.
    Source: http://staff.washington.edu/griffin/squats98.txt

  2. #2
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    Sullivan may have some words of wisdom here, but chondromalacia patella, depending on its severity, is not some kind of death sentence. I don't know how much her knees are hurting right now, but this is not an uncommon condition. A properly done, full depth squat is safe for the knee and helps strengthen the musculature around the joint. Her PT is wrong on this one. There is one way to find out what she can do. She is going to need to squat and see how things feel. Her knee will not explode if she tries, although it is important that she do them correctly. If she finds her pain has worsened, maybe it is time to do something else. However, her knee may continue to hurt, or perhaps improve, and she will get stronger. Joint pain is a bitch and many times it comes and goes for reasons that are not always clear. Getting weaker, however, is unlikely to help anything. Check this out, too:

    http://startingstrength.com/resource...440#post645440

  3. #3
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    I have mild chondromalacia patella. If you put your hand on my patellae while I ROM them, they go "crunch, crunch, crunch."

    I squat. I slather on tiger balm, wrap my knees in elastic bandages, put on knee warmers, and warm up first. Stef and Rip grin and make good-natured fun of my "knee armor." I do it anyway. Usually my knees are fine. Sometimes they hurt. Then I take tylenol, and reflect on the First Noble Truth.

    If anything, squats have improved my knee pain, probably by stabilizing the joint and correcting innate mechanical imbalances in patellar tracking. The assertion that patients with this condition should not squat is, I'll warrant, based on absolutely no clinical evidence of any quality.

    YMMV, but I think TOM has it right on this one.
    Last edited by Jonathon Sullivan; 04-04-2013 at 03:14 PM. Reason: Senility.

  4. #4
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    Me, too. ^What Jonathon said.

  5. #5
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    Quote Originally Posted by Jonathon Sullivan View Post
    YMMV, but I think Steve has it right on this one.
    I see, Sully, give Steve credit for my post. Some kind of conspiracy here...

  6. #6
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    Steve, did you just hear something? It was like a lonely cry in the wind....

    (Post ammended to reflect proper attribution. Sorry.)

  7. #7
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    Other people's money and other people's credit - it's the best spending currency there is!

  8. #8
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    In my thirties, I lifted some, played sports and ran (not crazy distances like a marathoner, but for me, too much) and had moderately bad CP. I tried cycling, orthotics and other stuff, but quitting running was the best thing, and after that, squats seemed to make things better. Now at age 64, my knees are pretty darn good, if I warm up well, as Sully says, and use knee sleeves when I squat. I sprint, play softball and downhill ski, and the knees are mostly aok. )) So, it can get better and in my experience, correct squats are fine.

  9. #9
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    starting strength coach development program
    Great info, guys, I truly appreciate it. We'll have our first session in the gym next week, and we'll focus on correct squatting technique from the start. Maybe some knee sleeves to keep the knees warm, Sully's knee-armor doesn't actually sound half-bad. And besides "knee-armor" sounds pretty badass. I've had some knee issues as well, and going to a PT was a complete waste of money. I can come back with some updates if that would of interest. I'm optimistic now, time to get busy!

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