I was planning on starting the 12 week strength template after my current block of training, however I’ve run into an issue. I am currently on week 6 of the 3 week hypertrophy template.
My issue is that my left patella tendon pain has flared back up again. Growing up, I was diagnosed with Osgood Schlaughter disease. From my understanding, this shouldn’t be an issue after growth has stopped, but it has always been a nagging problem. I have typically always just taken time off from the gym when this happens, but through BBM, I’ve learned I don’t have to do that. I’ve read the Squatting with Patellar Tendinopathy article on Stronger by Science, and I believe i have an alright understanding on how to tackle the issue.
I can typically get through squat sessions with only a moderate amount of discomfort, but the next day will be a gamble on how much it will hurt, ranging on a scale from 2 - 6.
My question is, should I start the 12 week strength template and just modify the squat sessions to address the issue, or should I wait to start the program until it feels healthy and run the hypertrophy block again?
Sorry to hear you are dealing with knee issues. You are correct, the Osgood Schalughter (despite if a bony prominence is still present) shouldn’t be a factor. Typically OS is self-limiting and self-resolving with appropriate activity modification upon occurrence. At your age, that is unlikely to still be a major component in what you are experiencing. Even if you are making it through sessions and then experiencing symptom above baseline, then it is likely you are not tolerating load appropriately. The typical heuristic here is 24 hours. If symptoms spike during the session to a tolerable level (individualistic) but regress at the end of the session then no cause for concern and you likely tolerated load well. However, if the symptoms spike during session and stay elevated or spike post session and stay elevated for 24 hours then it is highly likely you didn’t tolerate loading well and need to adjust accordingly.
I am not familiar with the template you are wanting to run but I’d imagine you can run the template and modify loading for any squatting patterns. Typically the recommendation is to run high volume and low intensity with tempo (3 second eccentric, 3 second concentric = Heavy Slow Resistance), 3 days per week with a 24 hour rest period between sessions (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday). You are building to a 15RM for a week, then 12RM, etc. Not sure if this would apply to you but it is also recommended to remove dynamic loading of the area for the first several weeks (jumping, running, etc). If you need assistance with program modifications, let us know.
This is a great post, thanks Travis and Michael- I’m a 43 year old man who has quite a large osteophyte below the patella due to teenage Osgood’s and I have had quite a bit of tendon irritation in that knee since getting my squat up past my own weight. I was curious about whether such a large lump would impact on the knee once starting squatting low bar. My knees have perhaps not been perfectly positioned during the LP but I do suffer with tendon issues historically, it’s inevitably always an injury of this nature that causes a plateau rather than a struggle with the weight. As a runner over the last few decades my achilles, for example, has been the regular barrier to progress. Same with my Dad, who has run many more miles than me over the years. No doubt in my mind it’s a bit of a family weakness.
I’ve trawled the web for this kind of simple advice and owing to the recent nature of some of the research on tendon problems I have found much of it a little technical for a swift takeaway to go and implement in the gym.
Most recently I have tried pin squats (to lower the intensity and nail the correct depth as I think I may have been going a bit low and compressing the knee ligaments) but I was doing fives (slow and heavy) rather than upping the reps and lowering the weight and bringing it up incrementally as you suggest above.
So I guess I will deload and start again tonight, with a 15RM, eventually working up to a 5RM I guess and then resume the LP. I think I might keep the pins for now and try and get that depth nailed in the muscle memory.
I’d caution against searching for family correlations as it relates to pain. Easy way to nocebo yourself into thinking this is your normal and out of your control. I’m not aware of any evidence supporting long term tissue detriment due to juvenile OS (despite a remaining ossified area on tibia). Your last line of the post sounds like a solid approach.
Reading my post back, all that stuff about family tendon issues is more or less a personal narrative isn’t it, you are quite right. Thanks for the reassurance on the long term outlook for OS.
Most of the reading/googling I have done on treatment of tendinopathy suggests a reasonably long wait for recovery (2-3 months?) using this type of “lower the intensity, increase the volume then titrate upwards” protocol.
I will be back on fives within six weeks at the above rate, so I am perhaps going to stretch the duration of how long I spend on each RM setting to two weeks and slow it down.
Sets of 12 seem to feel really good (15s were making me see stars as a tempo squat I can tell you) so I am tempted to LP a little on reps of 12 and see how it goes.
Am I right in thinking there is no exactly right or wrong way of groping my way through self treatment of tendinopathy?
Well, there are nuances to this approach that we cover during consultations. You are correct that there isn’t necessarily a right or wrong. I am actually gearing up to release templates on tendinopathies, but my usual approach goes like this:
Week 1: 3 x 15
Weeks 2 - 3: 4 x 12
Weeks 4 - 5: 4 x 10
Weeks 6 - 8: 4 x 8
Weeks 9 - 12: 4 x 6
That is absolutely spot on. Thanks very much, it really makes a big difference to how much I can get stuck in the more certain I am that the direction I’m travelling in is correct!
I’ll be very interested to see your tendinopathy templates when they are complete.
Hello, I was going to create a new post about OS but I’m glad I found this one!
I bought the BBM Knee Rehab Template and wanted to give it a try for my OS who is giving me lots of trouble again lately (I’m 26 and it’s been the same pain for 12 years, with 3 last years pain free).
The main issue I have at the moment is that I can’t do anything below the semi-squat or even quarter-squat some days. Parallel squats is a 8/10 pain with bodyweight and I can’t even get into position with the Spanish setup.
I’ve tried it a couple times with pain ranging from 5 to 8/10 but the next day the pain has been aggravated and I get the feeling that I’m not on the right track. Same for Single Leg Decline Squat, no pain until 90° of knee flexion at best but then it’s that same really sharp pain. Same for Bulgarian-Split Squat where I can’t get deep enough without experiencing that really sharp pain.
My doctor suggests I consult a knee surgeon to remove the ossicles at the distal part of the patellar ligament, but being aware of all the BBM content on pain, I don’t like the idea for now.
What’s my best plan of action here? Should I skip the isometric part of the template and start with 15’s 3/0/3 tempo squats but only in quarter/semi squats, see how it goes the next 24h?