Knee pain, not sure how to advance

Pain & Rehab Forum [Moderated]
1

Hello,
About 4-5 weeks ago I started to have pain in my knee, at the quardriceps tendon just under the patella, I think. It feels like a regular tendinitis pain.
The pain starts immediately after squatting, and go away couple of minutes afterwards. No pain in the deadlift and no pain in daily activity, maybe sometimes when I go up the stairs but usually not.
It’s not very painful, but it’s disturbing and it’s there for quite a long time with no improvement and I don’t want it to worsen. In the last two weeks I kept my squat and deadlift loads the same and didn’t increase.
At the moment I do pause squats 3 times/week, Monday and Friday I squat a pyramid of ~8 sets, 15kg added every set, to a top set of 155kg, all sets are 5 reps. The last set is at about RPE 8, and the 140kg is about RPE 5-6 I guess. Wednesday is easier, I only go up to 110kg.
I switched to pause squats about 4 months ago due to an adductor pain, which is gone now, but I liked pause squatting after ~8 years of only regular squats, so I stayed with it for now.

Question is, is it possible to deal with it without going backwards in terms of weight? I thought about adding volume, and adding a 125kg back off set of 8 reps. Or maybe doing tempo squats with lighter weight of 3:0:3 for higher reps (~12) after the last heavy set. Or adding some tempo front squats. The overall load at the moment is not too huge, because the sets before the 155kg, 140kg and 125kg are relatively light even though there are lots of reps accumulated overall.

Any other option, of course, would be very appreciated :slight_smile:

Thanks :slight_smile:

2

Question is, is it possible to deal with it without going backwards in terms of weight?

Probably not.

I thought about adding volume, and adding a 125kg back off set of 8 reps.

Adding workload on top of an already sensitized area is typically not the best initial move to get symptoms under control. We have a lengthy discussion of tendinopathy here, where we explain that symptom onset and flare-ups often occur when the person/tendon are exposed to higher dose of stimulus (either volume or intensity) than they are prepared for at that time.

You may do just fine with tempo squats for higher rep-sets, and this would likely be our initial recommendation; however, if things are sensitive after doing your heaviest top set, that is the most likely modifiable culprit here.

3

Thanks for the reply,
The pain level is low, and after the last set I can (and do) deadlift with no pain at all. Actually, 3-5 minutes after the set there’s virtually no pain at all.
Does adding tempo squats for 2 sets of 12 reps after the last set account for more workload which is not recommended in this case, or is it a way to rehab?

If it won’t work, obviously at some point I would have to take weight off the bar, but I hope to manage it succesfully without it.

4

And thanks for the article, I have read it. In the second case study there is an option to reduce workload (squat twice/week instead of 3) and there’s an option to add tempo / isolation. So I’m not sure if I shall do overall more work (because I add tempo / isolation), or less.
This is where my question comes from.

Thanks again :slight_smile:

5

We can’t really predict your outcomes in advance. The risk of giving it a shot is low - go for it (you could similarly try the decreased frequency strategy outlined in the article) and see how you do. If it doesn’t work, then you’ll know you need to take weight off.

6

Great help,
Thanks!