Knee issue nearing end of LP

[NS84]

Hi coaches, I apologize up front if this is a little long winded, but I’m a little bit at a loss with a knee issue I’ve been dealing with.

I am 33 and began my LP Back in April this past year where Squat progressed from 185 3x5 to 325 3x5 and Deadlift from 275 x 5 to 380 x 5 through June. I was thrilled about my progress and was probably nearing the end of my LP. I had posted form check videos here to make sure everything looked okay and never received any huge offenses on form issues, just to keep plugging away. Here is my latest squat form check with 320:

https://startingstrength.com/resourc...eck-320x5.html

Towards my last handful of sessions, I had begun to feel a little soreness/pain on the top of my knees (more so left) that would loosen up while warming up during squats. After my last squat workout in mid June hitting 325 3x5, I noticed the following day that the very top of my left kneecap hurt walking up stairs etc. With my leg laying stretched, it was sore when I dug around in there. I looked it up and thought it sounded like some Quad/Patellar tendonitis.

I decided to take a week off where the pain seemed to subside and began squatting again with lighter weight. Everything was feeling okay, and then at work (firefighter) I was training having to carry a downed firefighter up a flight of stairs which involved some deep squatting and seemed to have pissed my knee off more, right when it seemed to be getting better.

Since that day, it hurts going down past a quarter-ish air squat, and will hurt walking up stairs sometimes. It also aches if I seem to aggravate it. I was thinking I have just developed Quad/patellar tendonitis and it will take time for the tendon to heal. One thing that is worrying me is I notice when my knees are bent, my left seems to have more of a point/apex on the top left side around where it is painful compared to my right side that is more rounded in the same area. Here is a pic of what I mean.. I circled the point:

IMG_5251.jpg

Could this be some inflammation of the tendon? Maybe a bursitis or something? The little point or bump is very hard and doesn’t move around, but seems to be right in the area of where the pain is and where it will be achey.

I’m trying to figure out what caused this… I am flat footed and have been prescribed orthotics years ago that I don’t wear all the time. I had not been wearing them with my Ramoleos for squatting. I went to my podiatrist for another issue and he noticed I am much more flat footed on the left side which is where I am having the knee issue. Could my flat foot have been causing my knee to track wrong? I always consciously tried to open my knees by creating an arch in my foot. I also saw in my videos that when I reached depth, the barbell seemed to very slightly move inward on the left side, which is the problem side. I never knew why I did this. I also seemed to have slightly more inward knee movement on the left side in the hole, which I always attributed to weaker adductors from a groin strain I had the previous year. But this was nothing crazy to worry about in my videos.

Anyways, I am at a total loss of whats going on and how to address this issue. I was hoping someone had dealt with a similar issue or any advice at all. I’m pretty bummed out this has stalled my progress. Deadlifts seem to make the knee achey after session, so I have been focusing on rack pulls to get work in. Maybe time to see an othro or different specialist?

Thank you again for taking the time to help, I always appreciate it!

[Tom Campitelli]

I looked it up and thought it sounded like some Quad/Patellar tendonitis.

I suspect you are correct. My condolences. This can be a vexing problem, although you identified it fairly early, which is good.

Could this be some inflammation of the tendon?

Could be.

Maybe a bursitis or something?

Could be that, too.

Let's try a few things to see if they help. Don't squat for the next four days. Take a loading dose of ibuprofen (800 mg three times a day for four days). That is four 200 mg tablets at a time. Take it with food. See if that knocks down the pain and inflammation a bit. Cease the big dose of ibuprofen after that. I have a couple of ideas for how to train the squat after that using some eccentric work. Do you have a pain free range of motion, or does the tendon hurt pretty early into your descent?

[NS84]

Tom,

Having done more searching on the forum I realized this issue had been addressed many times before, I apologize if I sound like a broken record. I appreciate your help because I'm still confused about eccentric training and what amount of pain is okay to train through with tendonitis. I will give the ibuprofen a try and report back to see if that calms things down.

The tendon hurts pretty easily about a 1/3 of the way down into my squat. I tried putting voodoo floss on it and do some air squats and that seems to warm it up and enable me to squat down almost full depth air squatting without pain. But I find the pain relief doesn't last.

[Tom Campitelli]

Yeah, voodoo floss doesn't do shit besides provide some temporary alleviation of discomfort. You are not a broken record, either. Not may people get quad tendinitis from squatting, but a few do. Its causes are poorly understood as are its cures. Here is what I want you to do for your squats:

• Set the pins in a rack at the level where you would be doing a 1/3rd squat.
• Put a fairly light weight on the bar for the work sets. Probably 225 or 245. Warm up with the empty bar and move up as you would if you were going to squat this weight.
• Do a set of five to seven squats. Go down very slowly. Take about five seconds to get to the pins. This will likely hurt quite a bit.
• Pause at the pins for two to three seconds. Continue to produce about 75% of the force you would need to move the weight while you are down there. This is the isometric part of the movement. It will also probably hurt.
• Come back up.

It will feel strange doing partial squats, but we are less concerned about getting the muscles strong at the moment and more concerned about trying to produce a change in the connective tissues, so the stress will be different. After five reps, you may be out of air. You will wind up holding your breath and straining for at least eight seconds a rep. That will be the limiting factor more than the weight. That the weight is light is fine for right now. Finish the course of ibuprofen before you start the squats. Do these two or three times a week and move the pins down lower each week. Lemme know how it goes. I make no guarantees that this will cure you, but there is chance it will do some good.

Start with 3x5 or 3x7. Your warmups should be done the same way as work sets. Slow eccentric, a little pause, then back up. Try to have someone time you at the bottom. You will be surprised how long three seconds can be. Two seconds is fine, too. I am still playing with this to see what works and what is most important. Weight will not increase week to week, but the range of motion will. You may find that your knees feel fairly good after two or three sets of these, or they may hurt. Make a note of how your knees feel after a week of this. If they are beginning to feel better, you are on the right track.

[NS84]

Awesome, thank you for taking the time to write that all out for me. I'm on day 1 of the ibuprofen and will report back.