Hello everyone. I hope you are doing well during there hard times!
I have a problem almost for one year now.
Last summer, during a squat session, i caved my knees in the last rep of the last set. I didn’t feel anything at that time.
The next day, I started to feel a lot of pain when trying to squat, especially at the start of the ascent.
So, after some time, I went to a sports medicine. He examined me and told me I have chondromalacia patellae. He told me to go take an x-ray and come back again.
After seeing the x-ray, he told me that my patella has a diamond-like shape, and that irritates me knee.
Not sure what to do next, I went to another sports medicine.
He examined me and also told me I had chondromalacia patellae (didn’t ask for and x-ray).
He prescribed me some NSAID’s, a supplement with chondroitin and glucosamine and some weird exercises like leg raises to strengthen the guadriceps (he found out through measuring that one ise weaker and smaller). Nothing got better again.
So, I decided to go to a physical-therapist. He examined me and told me that I didn’t have chondomalacia patellae. He told me that the pain was caused by some maltraction of the patella. One reason, said, was that i had really tight feet. He told me to strengthen my calves, to use a spike ball and some stretching in order to relax my feet. Also, he urged me to continue training, but not squat ATG until my pain goes away.
So, almost one year later, I still feel pain.
Should I keep trying to loose my feet and just suck up the discomfort ?
I could send you the x-rays also to see.
Thanks !
If the only symptom is pain, then I personally wouldn’t get imaging, nor seek out a single biological pain generator. My layman’s understanding is that image findings tend not to correlate very well with pain. Additionally pain is a complicated human experience and seeking out a single pain generator is often a futile task, and may not change the treatment approach anyway.
Are you familiar with this article: https://www.barbellmedicine.com/blog…ining-what-do/ I think the approach laid out in this article is probably the approach you should take.
I think BBM pain and rehab consults are meant largely for people who have chronic pain (almost a year seems long to me) and if you feel as though you need a clinician to help you, a consult may be the way to go.
I have read the entire article. The think that bothers me is that I always feel discomfort in my right knee, during or not during training, and sometimes my left also.
I want to solve the problem not only because I want to train painless, but also to feel perfect in everyday life. To squat ATG whenever I want, and generally to not feel and irritation in everyday moves like sitting in a deep squat, jumping, running, riding a bicycle etc.
I am sorry that the discomfort is present so often. Perhaps you would benefit from slightly shifting your goals. If you are interested in increasing your tolerance to ATG squats, jumping, running, and biking then I think you should be working on finding a tolerable (not necessarily pain free, but a level of pain that you are mostly comfortable with and allows you to gain confidence and reduce fear) entry point for all these movements (or pick a couple to focus on for now). This means scaling down the dose and/or adjusting the formulation of stress. For example you may choose to focus on heavy ATG squats and long runs, but start with BW partial squats and short walks.
Additionally you may want to change your goal from being “painless” and feeling “perfect” to being able to tolerate the level of pain that accompanies these movements. This is important because overly ambitious goals can be frustrating and may make you miss the progress that you do actually make. Also, I don’t know anyone who is always painless and feels perfect.
It is great that you have identified movements that you want to increase your tolerance to. All that’s left is redefining your goals (such as: I want to be able to do 5 BW ATG squats without an intolerable spike in pain), finding entry point, and slowly progressing towards your goals without being deterred by any temporary ups and downs.
Just to reiterate, when you say you want to “solve the problem” my understanding is that the problem is low tolerance to movements you want to engage in, not a single pain generator that can be addressing by this one weird trick (like stepping on a spiky ball or eating chondroitin).
It may be worth looking into a BBM consult or the knee rehab template. I don’t have experience with either of these, but if you feel overwhelmed they may be useful.
I understand the theory behind the words you say. It’s basically the approach Dr. Barakis article about pain has.
My general goal is to be painless and, if there is a problem to fix like flat or tight feet, patella maltracking (meaning things that cause pain), to fix it.
Of course, as you say, on part of the problem is low tolerance and constant discomfort.
This is being kinda nitpicky with your wording, but the entire problem is low tolerance and frequent discomfort. If your arm gets crushed, the problem is that you have a low tolerance to movements that use that arm and you are in pain, the crushed bone is a factor that contributes to that low tolerance and increases your risk of severe pain. Honestly, I think you are doing yourself a disservice by worrying about tight feet or patella maltracking. If the most fruitful rehab approach is going to be directly treating tissue damage (without doing exercise specific to your goals), then I would expect that tissue damage to be obvious (think dislocated joints or bleeding). For the most following a well dosed exercise routine will cause tissue to adapt in a positive way. Identifying that you have tight feet would not change my recommendation, you still need to find an entry point and slowly build up. It’s possible that the tight feet could influence that entry point and your rate of progress, but it doesn’t warrant a different strategy.
I think you are on the right track and I’m glad you understand the article that I’ve been reciting to you. As far as I can see, there is no reason for you to delay putting in work toward your goals.
Edit to add one more thing: You mentioned that you occasionally feel pain in both knees. This makes me doubt even more that seeking out a tissue abnormality is going to be especially helpful. In fact, I’m somewhat inclined to think this is an example of sensitization (Central Sensitization: chronic pain can change how pain works) and that the exposure based approach we’ve been discussing is really the way to go.
I see your point. Just to clarify, I said I feel discomfort all the time in my right knee, like something is stuck in there, and sometimes in my left knee when training. But, nothing too strong to keep me off training.
I’ll read the article and try to change my perception about pain and discomfort.
Thanks again !
I see your point. Just to clarify, I said I feel discomfort all the time in my right knee, like something is stuck in there, and sometimes in my left knee when training. But, nothing too strong to keep me off training.
I’ll read the article and try to change my perception about pain and discomfort.
Thanks again !
Hey @GiannisKa - I’m inclined to agree with 4l3x - maltracking, chondromalacia patellae, nor “flat feet” give me a lot of concerns that your situation necessitates more than what is outlined in the article linked previously (Pain in training, what do?). However, I do think you’d benefit from a consultation with us so we can discuss any concerns and questions you may have while collaboratively outlining a game plan to return to your desired activities: https://docs.google.com/forms/d/e/1F…ilUWA/viewform
Unfortunately, sounds like in an effort to “explain pain” you’ve been led down some not so great paths.
Hello Michael. Thanks for seeing my post. I’ll surely give a thought about the consultation.
The thing that I can’t get in my head is this. Let’s say I start to build from an entry point, little by little.
Am I going to see myself, let’s say for example in half a year, without pain? I’m talking not only about the pain when training, but rather the pain I have even when I just sit on a chair or walking. I always feel this annoying discomfort inside my right knee, all day long. It is really frustrating. There isn’t a day almost for a year now that I feel my knees to be ok.
I would be really happy if you could just give me some answers.
I have to say also, there are times when, after squatting, my knees feel a little better, but that doesn’t last song.
I am waiting for your response Michael!
Another thing I forgot to mension is that my feet are giving me problems for a lot of years. I stopped playing basketball and running cause, after some time, I couldn’t bare the pain in my feet. I’ve had a physical therapist to try to loose my tight feet, but it didn’t help. I feel numbness whenever I push them. The weird thing is that, there are shows that had me pain free. Could this by a chronic problem like plantar fasciitis?
Yeah, I think there is likely a lot we need to unpack with your prior history and an internet forum likely isn’t the most ideal place with which to do this. With that said, it’s fairly rare I set the expectation we are aiming for being “pain free”, rather I tend to set the expectation as we identify related variables to your situation, discuss your beliefs about pain (potentially reconceptualizing your understanding of pain), and taking steps towards your valued life goals - we tend to see symptom regression. I’d rather help set you up for success in the future should you have a pain experience again, given the experience is human and we all deal with the experience at various points throughout life.