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Suggestions for working around knee pain

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  • Suggestions for working around knee pain

    Hello, I’m looking for some advice. I’m a 36 year old male barbell training for over 3 years. For the past 2 years I’ve had left knee pain when squaring. It started when I was running the TM and grinding out sets at or near @10.

    The pain is at the top of the patella where the quadriceps tendon meets the patella. Its manageable or even negligible until pivot weeks when I do singles @8 and reps @9. It flairs up and I can’t make progress after that. It’s most painful when I break parallel especially in the eccentric phase. Squat variations are usually are tolerable depending on the previous squat set.

    I want to make progress with my squat, so what would everyone recommend? I can’t decide whether to start by eliminating singles in favor of triples or doubles, limiting the range of motion to slightly above parallel, or sticking with the developmental work sets rather than changing programming at the pivot week.

  • #2
    If the pain is only present during and immediately after these pivot blocks, can’t you just not do them?
    Last edited by JonnyRockets; 07-15-2019, 07:14 PM.


    • #3
      Thank you for your response. Yeah that’s definitely an option, but is it the best option for progress? My knee responds poorly to heavy weights, relative to my strength at the time. I just did a 5 week block where I was doing sets of 6 @8 and I was feeling great. Lots of sets (6-7), lots of frequency (including variations), and very little pain. First single @8 and it’s sore and a week after that I can’t finish the prescribed sets due to pain...

      So don’t pivot is an option, but so is sticking to the pivot and replacing the movement with another one that I can tolerate at heavy weights, which may be a 3/4 squat. Which is preferable to make progress?


      • #4
        In the context of RTS/BBM style programming a pivot week or block is usually a period of lower stress training that allows some fatigue to dissipate before continuing with higher stress training or changing programming.

        Reasons for using heavy singles ([email protected]) include:
        • Training the skill of lifting heavy singles
        • Displaying strength already built (For fun/PRs)
        • Having a gauge for the rest of the RPE work to follow
        • Training the mental aspects needed to lift a heavy weight
        • Maintain strength during a period of low volume
        • Can be a low stress option during a period of reduced volume (I'd guess this is the reason they are included in your pivot week, however, they are clearly not low stress for you.)
        Why are you doing pivot weeks?
        Do you need to do the heavy singles?

        If you do want to continue with both, then choose something (thinking about the reasons for using heavy singles) that doesn’t have a negative effect on the rest of your training.

        Also, what is the rest of your training? And what are your goals?


        • #5
          I would still perform a "heavy single" but perform it at a lower intensity instead ie 5,6,7. I know that doesnt sound very heavy but in the long run this is worth doing.
          Also i would consider including tempo work into your program for 6,7,8 reps at low intensities so you can both load tendons and muscles without a high intensity.


          • #6
            From my own experience (torn meniscus RHS / ACL sprain LHS) an initial reduction in load and range of motion, then gradually building back up has worked fine. The will be some weight / range of motion that lets you squat (relatively) pain free. Find it and build from there.
            Unless you're getting paid or laid for max effort singles, I'd give them a break, at least in this context.


            • #7
              Great advice everyone, thank you. I also took some time to dig deeply into pain science related to knees. I found an excellent ebook on about Patellofemoral pain syndrome PFPS. My symptoms are consistent with that diagnosis. The ebook was written for runners but the models it uses to explain pain and recovery appear to be consistent with what is being used by the BBM community.

              Based on the advice here and the concepts of that book, I now feel confident in programming around this thing.

              What was so helpful to me was the concept that this pain is rooted in disrupting the homeostasis of the joint, and that upsetting that homeostasis effectively shrinks the threshold by which it can be further disrupted. By avoiding stresses that cause disruption the threshold can be increased, and these stresses often include things outside of the gym like sitting with knees bent.


              • #8
                I wanted to post a follow up for future reference. I’ve made some really good progress after reading that ebook and taking the advice posted in this thread. The general strategy that I’ve adopted is to limit stress on the knee both in and away from training, which has been made possible by the understanding that I’ve gained from that ebook about PFPS.

                One key stress that I’ve nearly eliminated is sitting with knees bent. Another big stress is fast or normal descent of the bar during squats. By using a 3 second descent on all squats including variations I have seen a big reduction in pain. I got this idea after following Dhruv4’s advice on tempo squats and finding they felt great.

                Thanks again for the helpful advice!