Hello BBM,
A few weeks ago I posted about how to move forward with some lower back pain. I’ve since taken the advice given by Jordan and am feeling much better. I’m obviously not back to my previous working weights yet (not even close), but I’m optimistic about the future and very thankful for the suggestions.
In that post, I also mentioned some right knee pain, which unfortunately hasn’t improved in the same way my lower back has. I had a few questions regarding this.
• How would you differentiate something like knee tendinopathy from more general non-specific knee pain? Does the diagnosis even matter in this case, or would the approach be largely the same?
• What is an acceptable amount of pain to train through? I’ve had a few workouts where I pushed movements like sissy squats close to failure, or did ~30 minutes on the stationary bike, and noticed a mild increase in symptoms the next day. The baseline pain is also very mild, but I definitely “feel something,” if that makes sense. Is this something to worry about, or is some increase in symptoms expected even when the training dose is appropriate?
• I’ve noticed that knee sleeves seem to help, but I’d prefer not to rely on them. My current plan is to use them for accessories like leg press or sissy squats, but not for regular squats (which I’m progressing very slowly anyway due to the back issue). Does that sound like a reasonable strategy?
I understand that you probably can’t provide very detailed guidance without a consultation, but I’d appreciate any additional advice. Thanks again.
Glad that back pain advice has been helpful so far!
1- For most purposes, the specific diagnosis does not radically change our management approach, although it may change the expected timeline for improvement. Some things (like tendinopathy or certain post-operative knee rehab scenarios, for example, take longer to recover compared with other situations). We have a general article on tendinopathy management in case you find it useful for your situation, in addition to our traditional “non-specific” pain management article, and the important follow-up piece on common rehab mistakes.
2- We can’t really quantify this for you. As laid out in our articles, a mild, tolerable amount of discomfort that either improves with warming up, or that does not worsen throughout the training session, after the session, or into the next training session, is generally acceptable in the short term, if the overall trajectory is positive. If the pain worsens as you warm up and increase load, that would be a signal to stop and adjust/modfiy. Even if the pain remains the same throughout the session, but it is not getting better over the course of multiple sessions/weeks, that is another reason to adjust/modify.
I would note based on your comment: if I were experiencing knee pain, I would not be pushing sissy squats (or any knee-based exercise, for that matter) to failure. With that said, the symptoms you are reporting do seem quite mild – and it may be the case that paying attention to the advice in the “Common Rehab Mistakes” article may be all you need here – training a bit further from failure, increasing the exercise variation, and progressing more gradually.
Regarding knee sleeves, I don’t have strong feelings either way, as I just don’t think they have any meaningful impact on recovery compared with the more important variables we’ve discussed so far.
As you note, we’re happy to provide more individualized guidance via a consultation, if needed.
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