The Bad Knee Curse

[frango]

Hey guys, how are you?
im here to discuss seriou stuff.

well, i have recently done X-ray from my both knees because i cant squat or deadlift. My right knee hurts and its on my way from having fun/gains.

The x-ray revealed the pattelar bone on both knees to be more prone to rub the bigger bone and cause pain. My condition was diagnosed as just tendinittis.

I have been receiving advices from "specialists" that it may be that i have damage in my cartillage or little cartilage left. The right knee is worst.

But these so-called specialists (ortopedists, pshycalteraphists) all say: "YOU MAY NOT WANT TO DO SOME EXERCISES, LIKE SOME MACHINES YOU MAY NOT WANT TO USE, WHEN YOU SQUAT DONT GO BELOW PARALEL..ETC ETC"


So...these people no know nothing about strenght training and lifting free weights. They insist in telling me about the super modern machines that wont hurt me. All i do is round my eyes on the inside.

Sherdoggers, tell me: is my career as a squatter/deadlifter doomed? if a have little cartillage is it better to train my core using other exercises and forget about powerlifting?

To hell man, i want to squat. I just started TRT and now i should progress well.
dammit.

Tell me, wiser lifters, what to do?

and as always: sorry for my bad english.

thank you.

 

[ripskater]

Do you have flat feet? Google overpronation.

 

[frango]

Do you have flat feet? Google overpronation.

as long as i know, nothing wrong with my feet.
i squat and deadlift in chuck taylor and vans only.
will google.

 

[frango]

oh, ok.
when it comes to my feet i always had the tendency to supinate when younger/kid.

but i guess it is pretty neutral nowadays.

 

[Badger67]

Frayed sub patellar cartilage is chondromalacia.
The pain occurs when joint angle decreases and the patella grinds against the femoral groove instead of sliding over it. Deep knee flexion will bother it a lot.
Deadlifting shouldn't be incredibly bothersome as the joint angle against the external load isn't too drastic whereas in the squat you are decreasing it and stabilizing it before the concentric phase. So the squat may bother you for a while. In the mean time, reverse lunges tend to hold well for most with chondromalacia and subpatellar/tendinitis issues. Avoid the fuck out of leg extensions.

Some simple self therapy you can perform is gentle patellar glides, some cross friction massage on the patellar and quad tendon. A good dynamic warmup prior to any leg activity, especially focus on soft tissue releasing rectus femoris at both the knee and hip flexor.
You may need to adopt a new squat stance in a pattern that is less bothersome.

You are not doomed, you just may have to adapt and train more carefully.

 

[selfcritical]

Badger, would trap bar deadlifts or box squats stopping just above the ROM that produces discomfort also be tolerated well?

 

[Badger67]

There's a lot of other ways to train your core, including some power lifting style variants such as good mornings, pallof presses, heavy squat lock outs at full extension and partial flexion, hanging leg raises and weighted planches, weighted planks, standing russian twists with a plate or KB.

 

[Badger67]

Badger, would trap bar deadlifts or box squats stopping just above the ROM that produces discomfort also be tolerated well?

Trap bar deadlift should be fine because there isn't much eccentric loading which is where the pain is caused. Most people who have these knee issues only report pain when bending down, squatting, tying shoes, and prolonged sitting.
I'd assume box squats would also be fine in principle. It's the knee version of performing a good morning and using chains to offset the spinal loading when transitioning from the eccentric to the concentric phase. So it will give the knee a good rest, allow for depth without becoming problematic also and increases a lot of core activation. Though i prefer reverse lunges for deep knee flexor pain exercises when people still wish to be active, power lifting is a different caveat, I've met a lot of old timers with shot knees who just still squat and ignore the pain.

Some people seem to think squatting below parallel and knees over toes is a myth, it isn't actually. It depends on how much the angles change and whether or not your knees are healthy to begin with: IE healthy knees and not too far over toes, don't worry about it. Very far over toes and unhealthy knees, it increases a lot of sheer force.

Here is a good picture that depicts what occurs as you go deeper into a squat.
As the angle of the knee decreases, the tension upon the quadriceps tendon and patellar tendon increases. If you have ever pulled a rope around a tree while your friend pulls from the other end, there is always more tension against the tree, especially if you change the angle to a shorter one. This drives the patella deeper into the joint space or femoral groove. If there is no cartilage, a lot of pain, inflammation and potential for lateral/or other maltracking can occur.

Taken from here.
http://www.mikereinold.com/biomechanics-of-patellofemoral/

@JauntyAngle any other suggestions? You're quite good with this stuff also and i'd love your opinion.

 

[MandirigmaFit]

To clarify, is it tendinitis or chondromalacia?

Have they performed specific orthopedic tests for differential diagnosis?

Does it hurt at a certain joint angle when squatting? Are you doing HB or LB? Have you tried isometric strength training? How is your internal/external rotation of the tibia? What do you do for work/majority of the day? Does it only hurt when squatting/DLing?

 

[frango]

To clarify, is it tendinitis or chondromalacia?

Have they performed specific orthopedic tests for differential diagnosis?

Does it hurt at a certain joint angle when squatting? Are you doing HB or LB? Have you tried isometric strength training? How is your internal/external rotation of the tibia? What do you do for work/majority of the day? Does it only hurt when squatting/DLing?

first of all, thanks everyone for the inputs. Thank you Badger.

Chondromalacia is just hipothethical or soon to be scenario. My x-ray revealed that the patellar bone on my right knee is too close to the bigger bone ( femur?) on the outside.

it is not possible to know how damaged is the cartilage or even if there is any damage because it might be just the angle in the x-ray.

sorry, i dont know what you mean by HB and LB.

i also dont know anything about the rotation of my tibia.

I am going to start training in a good place where i can get good advice about my squat and deadlift stance. I aint got no experts in squats to give me advice yet.

I spend the majoriy of the day laying in the couch with my laptop on top of me. Not putting any pressure on my knee.

i have been disagnosed by an orthopedist with tendinitis. I just started phisioterapy. Im taking meds, anti-inflamatory, that is being very helpfull regarding pain.

before i went to the doctor i tried to do some rehab exercises at the gym. I tried isometric holds at a leg extension machine. The hold does not hurt and i would only notice the injury performing the ROM.

It hurts using stairs, up or down. Better to avoid i guess.

 

[Badger67]

I'm hoping it's just tendinitis on your behalf.

 

[frango]

I'm hoping it's just tendinitis on your behalf.

badger, i was squatting twice a week with relative high volume and intensity plus doing two leg presses, lunges and leg extensions.

it got to be tendinitis.

the coach at the gym must be an idiot, thats it.
well, i rather follow a simple strenght routine than doing all this extra work.

he put me do to circuit training because i was a bit fat.
TRT will fix that by itself soon.

fuck that idiot moron.

 

[Badger67]

Well, it could be (and i hope thats only the case because it generally subsides with rest and eccentric exercise), but if you have specialists and a potential x ray reading that may indicate having damaged cartilage, then the eccentric loading will bother you most likely.

"My x-ray revealed that the patellar bone on my right knee is too close to the bigger bone ( femur?) on the outside." This sounds like maltracking. the natural pull of the patella is slightly lateral (outside) but it shouldn't be so noticeable during stance of an x ray as it should return to mostly neutrality. Is it rotated by chance?

The tibial torsion (internal and external rotation) of the tibia is what he means. During extension and flexion of the knee, the tibia undergoes some mild torsion. If this is prevented, popliteus (muscle behind the knee responsible for unlocking the knee from extension to allow flexion) can also be involved.
This slide show is incredibly informative for basic biomechanics and arthrokinematics of knee.
http://slideplayer.com/slide/6642972/

Mandarigmafit asked probably the most crucial question i hope your specialists asked, does it hurt most during the eccentric phase of the squat/deadlift, or concentric? Or both?

 

[cincymma79]

Just work around it
My left si joint is fused, left ankle doesn't work, and left elbow doesn't bend as far as it should. Never going to go pro, so I what I can do, and Ditch the rest

 

[JauntyAngle]

@JauntyAngle any other suggestions? You're quite good with this stuff also and i'd love your opinion.

I know next to nothing about kinesiology, I am afraid.

I don't really understand the "knees tracking forward" thing. As I understand it (in my semi-informed way) the degree to which the knees go forward seems to be determined mainly by the degree to which your hips track back and the depth of the squat, plus of course your particular limb proportions. So if you need to do a full squat in an upright position (e.g. you are on Oly lifter) then there's a good chance that at the bottom your knees will be over the front of your toes- depending on your limb segment proportions, as I said. If you do a low-bar squat and just break parallel it's possible that your knees might barely travel forward at all. So... the degree of forward tracking seems to be driven by your athletic requirement and your proportions. And if there is a lot of it, and that places additional stress on the knees, you have to accept it as the cost of doing business.

But I guess, maybe, if you are planning to do a sort of neutral squat, or a very PL-style squat, and the knees are tracking forward, it could be a sign that you aren't breaking at the hips enough (i.e you are doing it basically wrong). FWIW, I often see people in the various rubbish gyms I go to squatting straight down with their weight on the balls of the feet- their knees are usually *really* far forward.

I don't know anything about rehab either.. I guess my ACL and PCL tears were minor as rest and then working back into it very gradually was sufficient. I guess I did find reasonably heavy split squats very helpful- after doing them all sorts of uncomfortable crackling and tingling in my right knee cleared up. Neither regular squats nor lunges had the same effect. But whatever the issue was, if it even was one, perhaps there was no causal connection, and n=1.

 

[Demogoblin]

Hey guys, how are you?
im here to discuss seriou stuff.

well, i have recently done X-ray from my both knees because i cant squat or deadlift. My right knee hurts and its on my way from having fun/gains.

The x-ray revealed the pattelar bone on both knees to be more prone to rub the bigger bone and cause pain. My condition was diagnosed as just tendinittis.

I have been receiving advices from "specialists" that it may be that i have damage in my cartillage or little cartilage left. The right knee is worst.

But these so-called specialists (ortopedists, pshycalteraphists) all say: "YOU MAY NOT WANT TO DO SOME EXERCISES, LIKE SOME MACHINES YOU MAY NOT WANT TO USE, WHEN YOU SQUAT DONT GO BELOW PARALEL..ETC ETC"


So...these people no know nothing about strenght training and lifting free weights. They insist in telling me about the super modern machines that wont hurt me. All i do is round my eyes on the inside.

Sherdoggers, tell me: is my career as a squatter/deadlifter doomed? if a have little cartillage is it better to train my core using other exercises and forget about powerlifting?

To hell man, i want to squat. I just started TRT and now i should progress well.
dammit.

Tell me, wiser lifters, what to do?

and as always: sorry for my bad english.

thank you.

maybe you should go to a damn doctor get a prescription and get physcial therapy
i wouldnt listen to badger or frango they give very bad advice and might make your situation worse like they did mine
if badger is a certified pyschio then im the king of france

 

[frango]

hey guys just a quck answer because i have to hop on a bus (no irony here) to go see the phishiotherapist and start rehab.

i canr google now what the eccentric fase is but it hurts when squating goind up and down. Hurt when hopping on the bus.

see you guys later

 

[ripskater]

Good luck frango.

 

[MandirigmaFit]

Keep us updated.

@Demogoblin is there a thread with your issue? I would like to take a look at it.

 

[JimRussel]

maybe you should go to a damn doctor get a prescription and get physcial therapy
i wouldnt listen to badger or frango they give very bad advice and might make your situation worse like they did mine
if badger is a certified pyschio then im the king of france

You quoted frango in his own thread to tell him he gives bad advice?

Also, you're blaming someone on the internet for making something worse? No one forced you to listen to Badger's advice. Why didn't you seek help from a health care professional? Don't be a sour little bitch.