Medial knee discomfort bottom of squat

[BareSteel]

Hi everyone,

I'm looking for a little advice for nagging knee discomfort at the bottom of the squat.

It started four months ago when I lunged in an awkward way to pick something up (not gym related). There was no immediate pain, but in the following weeks I had some grimace-worthy squat sessions where it started to act up at the bottom of the squat. A local PT took a look and said he believes the irritation to be Hoffa's fat pad impingement.

Oddly, the level of pain is not correlated to weight on the bar. It's not like I can deload to a pain-free lift and build back up. Instead, it gets gradually better just as I warm up, so the work sets tend to feel okay. In January, it seemed to be getting closer to healed, but I must have aggravated it once again. Another hint is that a toes-forward squat seems to be a little less irritating than a normal stance in which toes are out about 30 degrees and I shove the knees out.

Any tips for working through this? It's anteromedial pain that feels like a pinch in the bottom of the squat.

Thank you,

*I can confirm that I am shoving the knees out properly and that this is not a case of the knees caving in at the bottom.

[Mark Rippetoe]

Video?

[BareSteel]

Thanks for taking a look, Rip. Here's today's workout from the rear view: Squat 5 reps form check Feb 2022 - YouTube

The two glaring form issues I see are:
1. Right knee caving in (note - this is not the painful side)
2. Lack of upper back tightness throughout the set, including constantly fighting elbow flare

These are issues to address, but they don't seem injurious to the knee.

[Mark Rippetoe]

Goddammit. Required reading before posting

[BareSteel]

Goddammit. Required reading before posting

Sorry, Rip. I jumped to the conclusion that you wanted to see if the knees were caving in during the set, but I should have posted the correct angles, because there are other problems that can't be detected from a rear view.

This is from today: Checking knee position in squat - YouTube

I'm seeing some knee slide at the bottom - not necessarily a glaring amount, but something that I need to fix. Do you see anything else that could be attributed to anteromedial knee pain on one side?

Thank you,

[Mark Rippetoe]

This is the standard incorrect squat that produces knee pain. There are several videos on this website regarding knee slide/back angle. SEVERAL. Watch them.

[BareSteel]

Understood. I see the form faults and I can fix this.

Mad at myself, because I used to do these with textbook form. Brent complimented my form at an SS squat camp a few years back, but I let in too much form creep since then.

[BareSteel]

I made some improvements on my own with the TUBOW: TUBOW squat 03 2022 - YouTube although these still need a little more knee at the top, I think. Do you agree with that assessment? Looking forward to a session with Hayden Courtland, SSC very soon to finish cleaning these up in person.

[Mark Rippetoe]

If the very first part of the descent does not show a back angle change, it is wrong.

[BareSteel]

Rip, I think I made progress on this squat. Today was the first day they looked and felt a lot different. Would you mind taking a look to confirm? Today's main focus was using the hips and knees together to initiate the descent. Thank you. Side note: I noticed the foot shuffling after the last rep of each set and will try to cut it out.

Squat knee and torso position - YouTube