Hello BBM,
I have had right knee pain for the past 18 months.The pain is usually felt around the medial side of my patella and is accompanied by loud clicking. I feel pain when I do any sort of squat (except a high box squat) or lunge.
Prior to this pain I was running a basic block periodization program. Squatting/benching/deadlifting 2x weekly. This pain has not bothered my deadlift or bench at all and I have been continuing to train them.
I have seen 2 orthos and one diagnosed me with PFPS and told me I probably have some chondromalcia. The second (who I saw recently due to frustration) told me I probably have PFPS and has ordered me an MRI to look for chondromalacia and to rule out any other possible problems (he said meniscus tear). He also said I have a very slight patellar tilt based on the x-rays taken at his office. Based on the research I have done, I don’t know how valuable these diagnoses are in treating my pain, as it seems there isn’t really a good way to treat either of these conditions.
I have done physical therapy that mainly focused on glute med strength(this didn’t help). After PT I began doing isometrics, and recently began squatting to depth with an empty bar with the pain being tolerable. At this point, the pain associated with squatting with 135 lbs feels the same as doing a bodyweight squat. Overall, I would say I am a little better off as far as pain goes than I was 6 months ago, but I am still frustrated and want some advice as to what my next step should be.
Is an MRI worth getting? Can anything even be done with the results of the MRI? Or should I continue to keep squatting with weights that are somewhat tolerable?
Thanks!
Hey, sorry to hear about your knee pain. A diagnosis of PFPS probably did not do much to give you good peace of mind with how to address the issue at hand. If the current differential is PFPS vs chondromalacia I do not know what additional benefit advanced imaging would infer as the first line of defense for chondromalacia is also conservative care. The symptoms you are experiencing are relatively common in the lifting community and I’m sure if you searched around on the forum you would see some more instances of this. If the symptoms have been going on for 18 months it is highly unlikely that there is a quick fix to address the issue at hand. For both PFPS and chondromalacia the evidence does support focal quad/hip strengthening and working within a tolerable range. Often, for PTs working with lifters we can have a right exercise/wrong dose scenario in which there isn’t a big effect because the exercises were too easy.
Starting with isometrics and working to tolerable range is normally our first line of defense. Often I’ll have athletes start working on a leg press utilizing some tempo work as well. A slow cadence tends to be much more tolerable for establishing pain free range of motion than just repeatedly trying to force full range. You can also approach the problem from two different angles. I will often squat athletes to tolerable depth at their normal RPE ratings then run some back off sets at tolerable range through an increase range of motion. This can let you get that “training feeling” for squats in a range you can tolerate while slowly working on going lower. The article I’m going to link is for tendinopathy specific cases, but the overall heuristic between treating PFPS and tendinopathy is very similar.
https://www.strongerbyscience.com/squatting-with-patellar-tendinopathy/