Knee pain during squats (I'm sure you've seen this title a thousand times).

[RobLikesBrunch]

Hi!

I've been experiencing some pretty significant knee pain in my right knee exlusively over the course of the past year or so. I haven't been really able to train the squat (it's gone down) due to the pain. I'm going to go through this chronologically.

I started squatting with SS a few years ago. I did low bar as recommended. Here's a video I posted a long time ago to the form. At the time of filming, I had zero pain/knee issues (but I hadn't even been lifting for a full year yet, so that may be why).

https://www.youtube.com/watch?v=UVckwZ5t_a8

I think you actually looked at this set and said it looks pretty good.

I then decided to do Olympic weightlifting and switched over to high bar (I know you don't agree with this and I think there's a video out there where you say Olympic lifters should just low bar and front squat---you get bullied pretty fast into doing a high bar squat in an Oly gym). I didn't realize it at the time, but looking back, my high bar squats were sort of ugly. They sort of look like a high bar/low bar intermediate or something. And I had some pretty significant knee valgus on every single rep. They looked like so:

https://www.youtube.com/watch?v=U22tt83SFNg

At the time of the above video (Nov, 2012), I still wasn't experiencing any knee pain. The pain started to develop in early 2013. Interesting, only the squat and the front squat were affected as far as I could tell. I didn't feel any pain doing cleans, jerks, or snatches. Maybe the explosive/quick nature of these lifts muted the pain or something. I don't know if it's significant, but here's a clean well into the time-frame where my knee started to hurt (but I did not experience pain during that clean):

https://www.youtube.com/watch?v=Q0zCmx-ZpD4

By Summer 2013, I had stopped squatting entirely. I transferred back to my old school and also stopped doing Olympic weightlifting for the time being. After about two months, I had enough and tried to squat. I thought maybe I had awful patellar tracking and tried your recommendations in your Knee Wraps video (http://startingstrength.com/index.ph...orm_knee_wraps). I used some really light weight Eleiko wraps and tried to wrap as loosely as possible without the wraps coming undone. This had the following effects: 1) My pain was greatly diminished 2) The moment I finished my set and removed the wraps (I know you say in the video to wrap lightly enough that you can just keep the on---they were lightly wrapped, but I removed them anyway) my knee would immediately hurt and feel sore. It's almost as if the wraps just hid the pain or something. At one point, (and I'm sure you'll think this is ridiculous), I tried squatting with voodoo bands tied somewhat tightly just above my knee cap and I had the same result. Zero pain during the squat, intense pain upon removal of the bands (I only did it once).

At this point I decided rather than use equipment/find some workaround to my pain, I should address the issue head-on and fix my squat technique. I began being very strict about my knee collapse and ensuring my knees are always out. I also worked on ankle flexibility to help maintain a more upright position (my ankle flexibility still isn't great, unfortunately). This didn't fix the pain either.

At this point, I said maybe I just need to rest it a little bit and just doing some squats with an empty bar a few times a week for a few months and then start-up again. So I did that and started up. At first, I didn't have any pain (I'm guessing I gave my knee sufficient time for any sort of inflammation/tendinitis to go away for a bit). But once I started to creep back up, it all came back.

So that's where I'm sort of at now. At the moment, I think the problem is either hips or ankles (or both). I'm doing some pretty serious hip and ankle mobility stuff from mobilityWOD and other sources. Every exercise to open your hips up, I'm doing. I had a period where just doing some hip mobility work before squatted allowed me to squat pain free, but it only lasted for about 3 weeks and then the pain returned again.

So that's the time-line. I filmed myself squatting from many different angles today after doing a bunch of hip and ankle work. Here are the videos:

60 kg, behind
https://www.youtube.com/watch?v=U6oaSctytuw

110 kg, front
https://www.youtube.com/watch?v=1MFllDhHEJA

160 kg, side
https://www.youtube.com/watch?v=wfwGvGIdmN8

160 kg, behind
https://www.youtube.com/watch?v=nb3OZEDDfPc

In all of the videos, I seem to have a tendency to shift my hips to the left towards the bottom. It wasn't as prominent today as it sometimes is (especially sans hip work), but my ass is also often uneven in the bottom of the squat, where my right cheek sits far lower than my left. I've also noticed that when doing this ankle stretch:



depending on the day, the right side of the bar will be lower than the left and the whole bar will tilt by about 10 degrees. No matter how much mobility work I do, I cannot seem to correct this. It's also occurred to me that my legs may be of different length or something. I've experimented placing mats on either side (although I believe it would be my right side), but that offered no improvement.

I also noticed that my left elbow is farther back then my right (I guess my torso might be rotated a bit).

The pain feels like it's sharp and inside the middle of my knee during the squat. When I'm not squatting, the pain is a dull throbbing above my knee cap.

Sorry that this is so long. Part of the problem is that I'm just not educated enough anatomy/physiology-wise (I'm working to correct this!) and instead of saying what the actual issue may be I have to give a bunch of symptoms.

Anyway, is there some glaring issue here? What measures can I take to fix this?

Thanks for your time.

[BareSteel]

Hey Rob,

Lots of history for us to digest on this one. I suspect some sort of physical asymmetry. You suggested leg length and that's certainly a possibility. However, your recent high bar squat videos don't show me anything glaring regarding your lower body.

However!! I think I did find something relevant. Pause the 110 kg front video at 0:16 when you're in the hole. Look at your wrists and elbows. You will see that your right arm is somewhat rotated to place your elbow in a positon approximately under the bar. The left elbow is clearly behind the bar. If I were there in person, I'd try to get a beat on why this is happening. Is it an arm length discrepancy? A frozen shoulder (immobility)? Just poor positioning when you feel fatigue? Hard to say. I'd wager that this is definitely causing the bar to tilt slightly and thus load your lower body asymmetrically. What I can't tell you is if solving this would solve the entire issue or if there are other unrelated components.

I failed to detect what you refer to as the hips shifting (or one glute being lower than the other). A video demonstrating that problem more clearly may help.

Wish I could assist more on the knee pain, but that a tough one.

Take it easy, man. You'll get back on track.

[RobLikesBrunch]

However!! I think I did find something relevant. Pause the 110 kg front video at 0:16 when you're in the hole. Look at your wrists and elbows. You will see that your right arm is somewhat rotated to place your elbow in a positon approximately under the bar. The left elbow is clearly behind the bar. If I were there in person, I'd try to get a beat on why this is happening. Is it an arm length discrepancy? A frozen shoulder (immobility)? Just poor positioning when you feel fatigue? Hard to say. I'd wager that this is definitely causing the bar to tilt slightly and thus load your lower body asymmetrically. What I can't tell you is if solving this would solve the entire issue or if there are other unrelated components.


Take it easy, man. You'll get back on track.

Huh, I was completely unaware of that until this video.

Do you have any recommendations as far as specifically addressing it?

[BareSteel]

It may be as easy as cueing that right elbow UP. Now that you are aware of the problem, you may begin to feel that elbow start to point down. Force it back to the correct position. I notice that the problem worsens slightly as you attain depth. That's a clue to me that it's poor positioning on your part, since structural asymmetries are usually apparent throughout the duration of the rep. Plus, you look symmetrical at 0:11, but as the set starts this deteriorates.

If I suspected an arm length asymmetry, I'd look to see if the center of the bar is plumb with the center of your spine when you squat, If the bar is off center, but you grip is symmetrical, you'll have to move one hand out wider (or narrower) until the bar is centered.

[elVarouza]

I've had lots of knee pain from squats and it's always been related to not shoving the knees out hard enough, every single time. I've found even a small amount of inward deviation can cause pain. Sometimes you need to think about over-exaggerating it.

Btw, do you lift at crossfit flat iron?

[RobLikesBrunch]

It may be as easy as cueing that right elbow UP. Now that you are aware of the problem, you may begin to feel that elbow start to point down. Force it back to the correct position. I notice that the problem worsens slightly as you attain depth. That's a clue to me that it's poor positioning on your part, since structural asymmetries are usually apparent throughout the duration of the rep. Plus, you look symmetrical at 0:11, but as the set starts this deteriorates.

If I suspected an arm length asymmetry, I'd look to see if the center of the bar is plumb with the center of your spine when you squat, If the bar is off center, but you grip is symmetrical, you'll have to move one hand out wider (or narrower) until the bar is centered.

Alright, thanks. I'll look into this. I don't think I have arm length asymmetry.

[RobLikesBrunch]

I've had lots of knee pain from squats and it's always been related to not shoving the knees out hard enough, every single time. I've found even a small amount of inward deviation can cause pain. Sometimes you need to think about over-exaggerating it.

Btw, do you lift at crossfit flat iron?

I used to. I don't think my knee pain is due to knee collapse, since I used to collapse significantly on every rep and now I don't do whatsoever and the issue hasn't improved.

I used to lift at Flatirons Crossfit (well, Flatirons Weightlifting Club really). But I've since transferred out of CU so I'm back in RI for now.

[roundedback]

Don't have time to read through the details, but if you're doing low bar squats one thing that I notice keeps knee pain away is keeping your knees over your toes. This takes a conscious effort to push your knees over your feet on the way down. Also push up with your hips and not your legs.