Another quad tendinopathy

Most likely beating a dead horse for many on here, but I just want to confirm my thoughts and process to fix this.

I’d say I’m a intermediate lifter from a form/time under the bar but due to schedule and life I’m floating around the SS 3x5 routine. The routine fits well with my life schedule.

Background:
We had a Cabo vacation for a week end of October. Plan was get big and then “cut” in a healthy manner for vacation which worked. Plan went as follows:
Oct 8 started doing “bulking” 3500cal/day and SS 3x5 (I had been on SS 3x5 for months before this, I really just changed my diet focus)
I did this up to 3 weeks prior to vacation
Reduced calories and did more specific lifts and more volume for “tone” 3 weeks before vacation
Went on 1 week vacation (no lifting)
Took 2 weeks off after vacation (no lifting)
Picked up SS 3x5 program on Nov 15 at reduced weight from where I left off and worked my way back up.

I noticed my left knee feeling “fat/swollen” and just a little off like maybe there was fluid? Nothing that kept me from squatting. I assume this was the beginning of my knee being “shocked” by the new/different load/rep routine after being off.

Dec 1st during my first working set and first rep I was halfway down into the squat and felt like someone stabbed the front of my kneecap with a knife. It was one singular stab pain and then I finished the rep. After this my knee felt sore and slightly painful to walk on but it subsided. I did not squat anymore that night.

Since Dec 1st I have not been able to squat to full depth even body weight. As of Dec 6 I have been doing box squats for sets of 6 at RPE 6/7/8 respectively at a depth right before I can feel the pain start. Doing this I have no issues/pain during the workout (bench press irritates it with knee 90*). I am also rolling my quad and taking ibuprofen as needed thinking it is a “tight quad” issue pulling on the tendon.

Symptoms:
Constant upper knee/quad tendon soreness/ache (sitting at a desk with knee @ 90* for extended times does it or being on my feet for long times). Flexing quad with a straight leg I can feel it. Pain increases with more knee angle (depth).

My assumption is a tight quad led to pulling on my quad/patella tendon? The sharp singular pain was unnerving as I have never felt something like that before and now just a constant ache/soreness. I also assume that doing a higher volume/less weight program then being out of the gym for a month then going back to a low volume/high load program over stressed my knee? I have not felt that sharp pain since even body weight squats all the way to depth (but quad tendon is VERY angry).

So, just curious what some more knowledgeable than me may think. I feel this is a ROM based issue (ie depth) since even sitting down or standing up from a chair with body weight is a less than pleasant feeling in my quad tendon. I was about to buy the “knee rehab template” listed in this forum, but thought I’s ask if some thought that is the right approach.

Thank you for any advice. “Rehab” is new territory for me and cautions on how much “pain” is “good for you” during this process.

Hey man! I’m sorry that you have had this experience with your knee and quad- it sucks getting injured. Have you familiarized yourself with any of our free content on pain in training? It sounds like you have found a decent entry point into activity by doing box squats at a lower RPE- it’s certainly reassuring that you can tolerate this.
I will say there is a lot to unpack here, and I don’t think that the forum is an appropriate place to address all your concerns. It does sound like maybe you did too much too soon after being out of training for a period of time, which could have increased your likelihood for injury. We would be happy to consult with you remotely to talk through some of your questions and provide more in-depth and individualistic advice. If you decide to forgo the consultation, I think you would definitely have success with the knee rehab template!

Thank you for the reply.

Since Dec 1 I have been doing the SS 3x5 3 days a week and doing limited weight and ROM box squats. It wasn’t until last night that I may have made a lot of progress. I kept the same weight but was able to get a couple of inches from full depth.

Prior to the workout I made sure to roll my IT band/quad/inner thigh area which seems to offer immediate relief. During the workout I felt no pain as long as I kept my butt back and slightly more on my heels. I also widened my stance slightly and everything seemed to go well.

My weight/reps have been 215/225/235 for 3 sets of 6. I’m trying to get back to full ROM at that weight/reps and when I do I may “restart” at 235 for 3x5 full ROM but repeat each weight for two workouts (assuming full ROM is met and no pain) Thought process being to slowly work back up to adding weight each workout basically doubling the time to get back to full weight/workout routine.

Glad to hear that you feel like you were able to make some progress last night with increasing the depth of your squat without significant increase in symptoms.

Overall, it sounds like things are moving in the right direction. Like I mentioned above, there are many different ways to approach this, but know that it’s perfectly fine to reduce the weight on the bar in the short term in order to find a tolerable load in which you can squat to full depth on. I would agree that this should be a gradual progress and would advocate for auto-regulation in your training. If you do not already use RPE, you may consider in order to gauge intensity of your training, check out this article here.

I do not think it’s worthwhile to foam roll. There is no evidence that foam rolling changes tissue structure or improves performance. If you have time and it feels good, you can do it, but it’s certainly not necessary and we do not recommend it.

As of Dec 24th I have been able to hit full depth with 195/205/215 for sets of 6. Overall the area and level of pain has been reduced. Previously it was highly concentrated in the quad-patella tendon and would span roughly 4-6 inches in length. Lately it is maybe 1/2" in length and some discomfort at the very front of the patella.

From a medical standpoint, what does it mean if the pain is mostly gone DURING the workout (which I’m pleased with), but a hour after a workout my knee has a constant ache? It is as if my knee gets sore/stiff if it is in one position (straight or bent) for too long.

I have been considering buying the knee rehab template to take me one step further but does anyone know what equipment is needed? I have a power rack, barbells and 300lbs of weight, some bands and dumbbells from 5 to 25lbs. So fairly minimalistic.

Happy to hear that you have been experiencing an overall reduction in your symptoms and that you have been able to successfully implement some of the strategies that were discussed above.

I wouldn’t spend to much energy worrying about a medical reason that the pain might be happening mostly after your training vs. during your training as defining a specific reason will likely not impact the management of your symptoms. If you are experiencing significant increase in symptoms 24-48 hours after your training, specifically ones that interfere with activities of daily living, I would say that you probably need to make an adjustment to one of more your training variables.

The equipment that you have access to should be sufficient for completing the knee rehab template!

I just wanted to give another update. Through doing more stretches and isometrics (focusing on upper quad and my left glute area) things seems to be better. I am suspecting that the issue is stemming from a tight/non-firing left glute/hip area.

Most of my pain is gone and I have been able to work up to Bulgarian split squats and getting my thigh to parallel. Slight discomfort(very localized) begins maybe 1-2" above parallel and the discomfort is less in the quad tendon but more in the front of my patella. I’ve also incorporated Spanish Squats

Doing isometrics and single leg squats has REALLY shown how unstable/weak my left leg is on it’s own. Makes me wonder how long this has been going on for.

I plan to continue isometrics and try for full depth movement with varying loads and reps. I’m going 3x10’s for anything single leg related.

I have also come to realize doing barefoot squats is more tolerable than with lifting shoes for now.

Leg workouts are now:
Foam rolling/stretching
Spanish squats 5x45sec
Sanding banded lateral leg raise (focus on glute/hip contraction)
Bulgarian split squat 3x10…adding weight dependent on how my knee feels.