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Thread: Need Advice: Doctor/PT advised not to squat for a month during SS

  1. #1
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    Default Need Advice: Doctor/PT advised not to squat for a month during SS

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    Rip, SS Coaches, and other experts,

    I’m a 28 year old (5”10, 235 lb.) male with minimal previous weightlifting experience. I’ve been lazy and fat for about 12 years but started turning my situation around a year ago (running, bodyweight exercises, food habits), which eventually led me to SS.

    I'm into my 4th week of SS and everything was on track until I recently started experiencing a lot of pain in the lateral side of both my knees. The orthopedic specialist diagnosed that I had tight IT Bands and patellar tracking syndrome. The patellar tracking syndrome, in my case, is caused by muscular/biomechanical imbalance around my knees due to weak VMO (muscle strand of quad right above the knee). Doctor recommended that I go through 3-4 weeks of physical therapy before resuming any squat work. The Therapist identified that these issues are not rare and can be corrected through therapy quickly and assured that I'll be able to resume squat work in a month.

    My question to Rip, coaches, and others in the forum is that if I can't squat for a month, then for the next 3-4 weeks, should I:

    (1) Hold off on the SS program and resume only when I can start squatting again
    (2) Continue with the SS program without squats and then add the squats back again when I can resume squatting.

    Looking forward to your inputs, thanks,
    GatorATL

  2. #2
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    Quote Originally Posted by GatorATL View Post
    Rip, SS Coaches, and other experts,

    I’m a 28 year old (5”10, 235 lb.) male with minimal previous weightlifting experience. I’ve been lazy and fat for about 12 years but started turning my situation around a year ago (running, bodyweight exercises, food habits), which eventually led me to SS.

    I'm into my 4th week of SS and everything was on track until I recently started experiencing a lot of pain in the lateral side of both my knees. The orthopedic specialist diagnosed that I had tight IT Bands and patellar tracking syndrome. The patellar tracking syndrome, in my case, is caused by muscular/biomechanical imbalance around my knees due to weak VMO (muscle strand of quad right above the knee). Doctor recommended that I go through 3-4 weeks of physical therapy before resuming any squat work. The Therapist identified that these issues are not rare and can be corrected through therapy quickly and assured that I'll be able to resume squat work in a month.

    My question to Rip, coaches, and others in the forum is that if I can't squat for a month, then for the next 3-4 weeks, should I:

    (1) Hold off on the SS program and resume only when I can start squatting again
    (2) Continue with the SS program without squats and then add the squats back again when I can resume squatting.

    Looking forward to your inputs, thanks,
    GatorATL
    Post a video of your squat.

  3. #3
    Join Date
    Nov 2009
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    I've had these same issues and more. Several times I've tried physiotherapy, it does no more than simple rest would have done. This is what worked long-term.
    1. stop running
    2. foam roll ITB and quads each day
    3. once the pain is minimal or has passed, squat with good form
    4. foam roll again after workout

    Few problems since.

    #3 will usually require a coaching session or two, or following Will's suggestion.

  4. #4
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    I suspect you're squatting wrong. Post a video.

  5. #5
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    Quote Originally Posted by Kyle Aaron View Post
    I've had these same issues and more. Several times I've tried physiotherapy, it does no more than simple rest would have done. This is what worked long-term.
    1. stop running
    2. foam roll ITB and quads each day
    3. once the pain is minimal or has passed, squat with good form
    4. foam roll again after workout

    Few problems since.

    #3 will usually require a coaching session or two, or following Will's suggestion.
    Kyle,

    Foam rolling has been recommended by my therapist and I've been foam rolling my ITB ever since. Earlier I was only foam rolling my quads. To work on my technique, I watched Rip's DVD, re-watched, took notes, and tried to apply the instructions. However, I still feel that I'm not correctly applying his instructions properly or not being able to judge if I have applied them correctly. I'll post a video.

    I workout at a CrossFit gym, which has a separate Oly weightlifting area, and one of the instructors had looked at my form and helped me correct a few things. However, I feel I need a little more dedicated help and I have looked up the SS coach directory and will be scheduling at least 2-3 sessions to work on my technique. Any recommendations for a coach in the Atlanta area?

    However, my question again - should I continue doing rest of the lifts until my Therapist will let me get back to squats?

  6. #6
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    Atlanta appears to have several SS coaches, which you can see here.

    You can deadlift, press and bench without putting any pressure through the kneecap. Squats and cleans will tend to hurt it. This is why I say, wait until the inflammation has died down. You can also tape the kneecap, a strip across it pulling it inwards, and another strip pulling it down, your physiotherapist should have shown you how to do this since it gives instant relief from the pain, you're taking the direct pressure off the inflamed tissue.

    Practice squatting without weight a few times a day. I would, once pain-free for a full day, go back to barbell squats the next day, preferably that day would be your first coaching session.

    Patellar maltracking means that when you flex your knee, the kneecap slides up and down in the wrong place, and grinds against the structures there. With most people, they're sedentary, they do a little bit of damage, it heals, a little bit of damage, it heals, and so on. If the person takes up running, cycling or hiking, they do a lot of damage, it heals a bit, more damage, and so on. At some point the damaged tissue becomes inflamed, and inflamed tissue when further poked hurts. It's like poking a bruise.

    Thus, the pain from patellar maltracking is essentially an overuse injury. Doing zillions of knee flexions and extensions fucks it up. One time I had it someone suggested it might be the squats I was doing, however at that time I was cycling to PT school every day, an hour each way. A normal cycling cadence is 75 revolutions per minute, which is 4,500 each way, or 45,000 a week. My squat workouts usually had 3 warmup and 3 work sets of 5, for 90 reps a week. Which is more likely to cause an overuse injury, 45,000 reps or 90 reps?

    Thus, squatting will not bring on the inflammation and thus pain from patellar maltracking, however if the inflammation is already there squatting will "poke the bruise" and make it hurt. This is why I say, stop running, and once you're pain-free you can squat.

    Physiotherapists typically recommend activation exercises for the "VMO", the vastus medialis, which is the quadricep muscle innermost on the thigh, when you straighten your knee you can feel the muscle about 3-4" from the knee towards the groin. I tried those and nothing happened. I found that the vastus medialis is very well activated by a wide stance deep squat. As well, a wide stance deep squat tends to mean less pressure through the front of the knee, less kneecap being dragged back towards your body, and less "poking the bruise", compared to narrow stance squats, cycling, running, etc.

    Thus, stop running, foam roll, when pain-free squat properly, foam roll again. You don't have to wait a month to squat, just until you've been pain-free for a bit.

  7. #7
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    Steve Hill hosts regular squat camps in the ATL area, which would be a very cost effective option for you.

  8. #8
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    Atlanta
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    Quote Originally Posted by Kyle Aaron View Post
    Atlanta appears to have several SS coaches, which you can see here.

    You can deadlift, press and bench without putting any pressure through the kneecap. Squats and cleans will tend to hurt it. This is why I say, wait until the inflammation has died down. You can also tape the kneecap, a strip across it pulling it inwards, and another strip pulling it down, your physiotherapist should have shown you how to do this since it gives instant relief from the pain, you're taking the direct pressure off the inflamed tissue.

    Practice squatting without weight a few times a day. I would, once pain-free for a full day, go back to barbell squats the next day, preferably that day would be your first coaching session.

    Patellar maltracking means that when you flex your knee, the kneecap slides up and down in the wrong place, and grinds against the structures there. With most people, they're sedentary, they do a little bit of damage, it heals, a little bit of damage, it heals, and so on. If the person takes up running, cycling or hiking, they do a lot of damage, it heals a bit, more damage, and so on. At some point the damaged tissue becomes inflamed, and inflamed tissue when further poked hurts. It's like poking a bruise.

    Thus, the pain from patellar maltracking is essentially an overuse injury. Doing zillions of knee flexions and extensions fucks it up. One time I had it someone suggested it might be the squats I was doing, however at that time I was cycling to PT school every day, an hour each way. A normal cycling cadence is 75 revolutions per minute, which is 4,500 each way, or 45,000 a week. My squat workouts usually had 3 warmup and 3 work sets of 5, for 90 reps a week. Which is more likely to cause an overuse injury, 45,000 reps or 90 reps?

    Thus, squatting will not bring on the inflammation and thus pain from patellar maltracking, however if the inflammation is already there squatting will "poke the bruise" and make it hurt. This is why I say, stop running, and once you're pain-free you can squat.

    Physiotherapists typically recommend activation exercises for the "VMO", the vastus medialis, which is the quadricep muscle innermost on the thigh, when you straighten your knee you can feel the muscle about 3-4" from the knee towards the groin. I tried those and nothing happened. I found that the vastus medialis is very well activated by a wide stance deep squat. As well, a wide stance deep squat tends to mean less pressure through the front of the knee, less kneecap being dragged back towards your body, and less "poking the bruise", compared to narrow stance squats, cycling, running, etc.

    Thus, stop running, foam roll, when pain-free squat properly, foam roll again. You don't have to wait a month to squat, just until you've been pain-free for a bit.
    Thanks for your response. This is a lot of great information. I was definitely leaning towards continuing with the rest of the workout, but still wanted to check with the community if I was overlooking something. On that note, I went ahead and did Deadlifts and bench press today. I did some body weight squats and I don't feel any pain. I'll use the barbell in my next workout, before meeting with a coach for weighted squats.

    My PT provided a similar explanation of patellar maltracking and used a model knee to demonstrate it. I read up a bunch on it and now I understand what the injury is about. The quantitative analysis, explaining the overuse, makes a lot of sense and explains a little more why the injury occurred. I've been running for a year, until a month ago, and during the Aug-Oct period I biked 3 times a week (an hour per session). This explains a lot.

    My PT is definitely helping me in strengthening my VMO, and helping me with a lot of mobility and tissue work. I like the fact that he is a big proponent of StartingStrength type free weight, compound lifts. He insists that I do tissue work with the foam roller on non-workout days as well and I do see the benefit as I understand the science behind it. He also showed me some mobility work for my shoulder so that I can better position the bar on my traps for a low bar squat.

  9. #9
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    Quote Originally Posted by DRice311 View Post
    Steve Hill hosts regular squat camps in the ATL area, which would be a very cost effective option for you.
    I just reached out to Steve Hill and hope he can fit me in sometime next week.

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