Can I still squat? (what is this damn pain in my knee)

[Bodybeing]

Hi Mark,

I've had a really strange problem with my left knee that I wanted to see if you might be able to help me with.

The problem started at approximately the same time time as I started squatting starting strength (Jan 2011). I don't want to admit this but I think its probably healthy that I do. Initially the problem was some tenderness to the touch at the top of the Tibialis Anterior muscle region (lateral anterior of proximal tibia), it wasn't really a big deal but I did start to get pain more often when I stood up from a crouching position.

Initially I didn't connect this with squatting as I never got any pain or trouble when I actually squatted. This seemed a little weird – I could put a load on and squat with no pain but if I tied my shoelaces and stood up it was excruciating. The pain would be at the top of the tibia on the lateral side of the left knee. It wasn't a muscular pain but a sharp pain that went again straight away and couldn't be replicated even if I crouched down again.

I started keeping a record of the pain from 8th March 2011 onwards and recorded the pain every couple of days, mostly when standing up from a seated position on an office chair. I saw a doctor and a physio, both loaded the knee and couldn't identify any problem.

Recently I stopped and re-started training several times. I went to the gym approx 1 month ago and was re-setting my squat when I badly hurt the same left knee. I think that I set my squat stance wider than usual and then got the same sharp pain but this time with a loaded bar. I asked a trainer in the gym and he said that my knees came in when I squatted. My knee hurt really badly for the next two weeks so I took the time off the gym completely and started wearing a cheap elastic knee brace.

Since then I have got the idea that the problem may be that the knee is somehow too loose and is twisting when I flex and extend at the knee. I have really tight hamstrings and gluteals and I think that trying to work on my hips sometimes has pulled on my knee rather than the hips. Also the knee feels like it sometimes hyperextends now when I am walking and I can get a sharp pain.

This week I did some swimming (750m breast stroke) and have tried some bodyweight squats and felt ok so I went to the gym today and did empty bar squats. After about 4 sets of 5 reps my left knee started really hurting again. I had the idea that my adductors were weak and I tried to focus most on keeping my knees out throughout but this hasn't seemed to have helped.

I have seen another doctor and been told that a specialist assessment would cost £100+ and probably involve a subsequent scan or arthroscopy. The medical professionals don't seem to be able to help me.

Does anyone have any idea of what this pain could be and/or what exercises I should do to strengthen the knee and stop it being so loose? One option would be to just stop squatting completely but I really don't want to stop doing these. I have no problem whatsoever with my right knee, have never injured my left knee and have no clue what to do.

[Mark Rippetoe]

I think you have a fibular head problem from squatting with knees in and forward. The ligaments holding the fibular head in place at the proximal lateral tibia are inflamed. It happens in the front squat often. What happened when you took the ibuprofen?

[AndrewS]

I had the same problem (or atleast one with similar symptoms) last year. A few weeks rest, ice, and ibuprofen along with some "chopat" strapss around my leg just under the kneecap helped a lot with the inflammation. When I started squatting again I made sure to shove my knees out as much as possible and I haven't had any problem since.

[Bodybeing]

To be honest, I never took any ibuprofen for the pain. This was because it was typically a sudden sharp pain that didn't affect me the rest of the time. When I last hurt it badly, and now today as I am limping around I assumed that I had an injury like a tear etc so ibuprofen would be pointless.

I suppose that if I take ibuprofen and it helps then this would signify that it is inflammation and that at least will tell me something about what the problem is?

[Mark Rippetoe]

That's the first thing to try. Inflammatory things move between sub-acute and acute fairly quickly at times.

[deadlift addict]

I've had knee pain before. I tried to do parallel squats in a high bar position and it destroyed my knees. Make sure you're shins are fairly vertical and you're using your ass and hamstrings to come out of the hole. Also, buy knee sleeves! The blue rehbands from jackal's store if you've got the money! I always use them now for my low bar squats. You might be surprised at the comfort they provide. Also if the pain is not too bad, you might wanna try some light ATG high bar squats. They're good for your knees if you do them correctly.