Knee Pain

[RickBarker]

Age, Gender, current training status: 27yo male, 6’, 170lbs (I know, I know…), intermediate programming; 4 days/week, with 5x5 on squat, bench, press, and deadlift one day each week. Deload week every 4th week. For the last 6-8 weeks, I haven’t been squatting heavy. Before I get too much grief about my weight, my pain started when I weighed 210, and I'm stronger at 170 than I was at 210. Also, I’m gaining weight.

- Chief Complaint: My knees ache badly, mostly medially, bilaterally, starting anywhere from 24-48 hours after a heavy leg workout (squat or deadlift), and lasting anywhere from 48-72 hours or more after that workout. None, or very little, pain during sessions. I also have a very deep aching pain develop in the distal medial thigh, sort of between the vastus medialis and medial hamstrings. Very tender to palpation if I dig "under" the VM on the medial side. If I foam roll the medial leg, everything from vastus medialis to the medial hamstrings is extremely tender. Also very tender to palpation (bruised feeling) in the distal hamstring/pes anserine tendons, especially where they first meet the bone and all along the posterior/medial border of the medial tibial plateau and femoral condyle.

- Narrative describing the mechanism of injury: My knee troubles began in August of 2012. The previous summer, I was doing a lot (6x/week) of Olympic lifting and deep, loose bouncing front squats and high bar squats. I didn’t feel pain then, but I took a short break and then started graduate school and began sitting all the time. I kept training, and I developed anterior knee pain in the left knee first, then bilaterally, at the inferior pole of the patella. I kept Olympic lifting for about 6 months then quit. I have tried various things since then, including a stint of only box squatting, which helped a lot, and I recently cut out heavy squatting, which helped a little, but not as much as I hoped. The pain has changed over time. The initial anterior knee pain is barely noticeable anymore, but the symptoms I’m reporting now have taken its place.

- Pain: At it’s worst, probably 7/10
- Describe the pain: Already described above, but a deep aching pain throughout the medial, distal thigh, knee, and sometimes into the medial calf.
- What makes it better? Ice, rest (sort of), caffeine, sometimes compressing the calves seems to help
- What makes it worse? Standing in the same place for a long time, prolonged sitting is what brings on the most aching, especially into the calves, deep knee flexion (full squat) causes a stretching type pain in the anteromedial knee (medial to the patellar tendon), forceful open chain knee extension (just sitting, not on a machine) causes a pinching type pain that’s hard to localize, but mostly medial or deep to the patellar tendon.
- How do your symptoms behave throughout the day? Usually better at night unless I’ve had to sit all day

- Signs and Symptoms: No swelling that I notice. The skin over the patellar tendon gets red with exertion, and I have lost hair over the area, especially on the left. I have a large varicosity starting lateral to the patella and going down and laterally about 6 inches on the left side. I can do almost anything in the gym with no pain as long as I warm up properly, but if I’ve done a heavy leg workout, I’ll get extremely achy in the areas described above 1-3 days later. It is different than DOMS, I have enough experience to know what that feels like. Especially around the knee, the pain feels deeper than DOMS and has a more persistent quality. It feels more like it’s coming from the joint.

Sorry for the wall of text. I’ve been dealing with this for a while now, and I’m sure it’s made me more than a little crazy. My main confusion is that the pain is now much more medial, as opposed to lateral and at the inferior pole of the patella like it was in the beginning. My guess is that it’s volume related, and I need to back off the squat and deadlift volume (and maybe intensity too), gain weight, and progress as pain allows. I just thought I would post about it to see if anyone had any similar experiences. I have had my squat and deadlift form checked by a couple SS coaches, but I could post more video if that would help.

Thanks for taking the time,

Rick

[Mark Rippetoe]

MRI? What is the diagnosis?

[dws]

I hate to mention it, but it sounds familiar. I finally went to the doc, and was diagnosed with osteoarthritis. I hope yours is something else, especially at your age.

[RickBarker]

Never had one. The only doctor I talked to about it said quit lifting so heavy and take some NSAIDs.

[Mark Rippetoe]

Your knees are inflamed. How did you lose 40 pounds? What limited life experience would lead a person to say that inflamed knees were 10-level pain?

[RickBarker]

Haha, I meant to hit 4 on the number pad and hit 7 on accident. My bad. I meant 4/10 at the absolute worst also. Usually only 2-3. Anyways, I have no significant swelling or loss of ROM, so I didn't think OA. I lost the weight on purpose, though I know that's not a popular answer around here.

So, ice, NSAIDs, control volume, gain weight?

Also, I think there may have been multiple layers of confusion. My initial post read "7/10" for pain, which to me means 7 OUT OF 10, not 7 THROUGH 10. On top of that, I meant to type 4/10. I've had a testicular torsion; I know what 10/10 pain means.

[Mark Rippetoe]

Again, your knees are inflamed. How did you lose 40 pounds? Running? Are you still running?

[RickBarker]

I never run if I can avoid it. I haven't run for exercise in over 5 years. I lost the weight through dietary manipulation.

[Mark Rippetoe]

Post a video of your squat.

[RickBarker]

Here's some recent stuff.

https://www.youtube.com/watch?v=V4IZYRTp8ow
https://www.youtube.com/watch?v=aWYDLtFgOcs
https://www.youtube.com/watch?v=8t2JNTV2aRg

Like I said, I haven't been squatting heavily recently, but I could get video from a different angle tomorrow if it would help.