Knee Pain

[JKuhl]

Hello - I was hoping to get a little advice here on knee pain. First a few background facts: 41 yo male, 5’10’, 185lbs, been lifting consistently for the last couple years, squatting, benching, deadlifting and pressing 2-3 days per week. Usually 3-5 sets of 5 at 70-80% of e1RM. Conditioning consists of running and assault bike. I have a history of back issues, but none after starting to lift over the last several years. No history of knee issues.

About two and a half weeks ago, I was warming up the squat to approach my working sets of 225, 5 sets of 5. I always start with the bar and work my way up. As I was working up in weight, I put 185 on the bar, and went down for my first of several warm up reps. Here’s how I’ve been describing what happened: imagine a rope attached across the knee from the top to the bottom, across the knee cap. When I got to the bottom of the first rep of 185, the ‘rope’ moved to the outside of my left knee. I was able to stand the weight back up and re-rack it with no problem, but it was definitely painful. I tried one more rep a few minutes later and it was painful, so I decided to stop squatting for the day and continued with my other lifts. That afternoon, I could not bend my left knee at all. The following day, I could squat approximately one inch before the pain level went up significantly.

Over the course of the last couple of weeks, it has slowly gotten better. The first week, I could not squat or deadlift at all. As of now, however, I am doing squats at about 30% of normal to about half depth with no pain. I am slowly bringing the weight up. Today, there is still pain when first getting up out of a chair or getting out of a car - but I can walk that off pretty easily. I have lost some range of motion at full flexion and there is quite a bit of tightness across the knee when doing that. Running is terribly painful right now, but biking is fine.

I have not seen a doctor yet for this issue, as it’s slowly getting better and my experience hasn’t been good in the past (for past ankle injury or back pain, they do an Xray; they give me a colored band and a worksheet to take home and stretch). I’m very thankful for the BBM pain podcasts and ended up here with a few questions. First - what the heck did I do wrong? Second - how do I prevent this in the future? The web states that issues like this could be a muscular imbalance and I should be strengthening certain muscles (VMO, quads, hamstrings?) - but that’s why I lift, to get strong. Should I consider some sort of brace while squatting? And lastly, as long as it continues to get better, do you see any reason to see a doctor for this?

I hope I have provided enough info here. I really appreciate your help and advice to get me back on track.

[Michael_Ray]

@JKuhl

First - what the heck did I do wrong? Second - how do I prevent this in the future? The web states that issues like this could be a muscular imbalance and I should be strengthening certain muscles (VMO, quads, hamstrings?) - but that’s why I lift, to get strong. Should I consider some sort of brace while squatting? And lastly, as long as it continues to get better, do you see any reason to see a doctor for this?

Hey JKuhl,

Sorry to hear you are dealing with a knee issue.
The good news, sounds like things are improving since initial onset.
What kind of symptoms are you experiencing at the knee (describe the pain)?
Where are you experiencing symptoms (front of the knee, back of the knee, inside of knee - towards mid-line, outside of knee - away from mid-line)?

Regarding your questions - difficult to say what, if anything, went wrong. Sometimes these things happen and there’s little we can do to prevent them. If you have been appropriately managing programming variables and loading as well as recovery (sleep, nutrition, stress levels) - then likely little could have been done to prevent this.

What did you look up on the internet (diagnosis) to find the muscle imbalance for “this”? Overall, this narrative is not supported.
Regarding bracing - no, I typically do not recommend bracing for these situations but perhaps with more info this recommendation may change.

Regarding seeing a doctor - completely up to you. If things keep improving and symptoms regress while performance goes up, then personally, I’d have a hard time rationalizing seeing someone. If you’d like, you can certainly consult with us if you need assistance.

[JKuhl]

Michael - Thank you for your response!

@Michael_Ray

What kind of symptoms are you experiencing at the knee (describe the pain)?
Where are you experiencing symptoms (front of the knee, back of the knee, inside of knee - towards mid-line, outside of knee - away from mid-line)?

Regarding your questions - difficult to say what, if anything, went wrong. Sometimes these things happen and there’s little we can do to prevent them. If you have been appropriately managing programming variables and loading as well as recovery (sleep, nutrition, stress levels) - then likely little could have been done to prevent this.

What did you look up on the internet (diagnosis) to find the muscle imbalance for “this”? Overall, this narrative is not supported.
Regarding bracing - no, I typically do not recommend bracing for these situations but perhaps with more info this recommendation may change.

Regarding seeing a doctor - completely up to you. If things keep improving and symptoms regress while performance goes up, then personally, I’d have a hard time rationalizing seeing someone. If you’d like, you can certainly consult with us if you need assistance.

As far as browsing around on the web to determine what happened, my hypothesis is my patella dislocated. I’m not a doctor, so I can’t say if that’s even possible at this point (I brought the weight back up and re-racked it), but seems consistent in my mind with the movement in my knee at the time (the movement of the ‘rope’). Muscular imbalance seems to be a big topic around patella dislocation/subluxation. Just seems like squatting is ideal for this. Regarding your mention of recovery, I was coming off a cold that lasted several days. I wasn’t feeling 100% that day, but was wanting to get back under the bar and felt good enough for that. Not sure that could have contributed to it, but it’s something for me to think about.

Description of Pain
At initial onset, the pain was primary on the outside of the left knee while standing. Almost no range of motion under bodyweight (could not squat 1"). Sitting on the left knee (like to tie your right shoe) was impossible due to the pain in the front of the knee and the pressure on the knee cap.

Today: Sitting on left knee (to tie your right shoe) is bearable but there is significant pressure across the front of the knee (bottom of femur, across the knee, to the tibia). After sitting for an hour, standing produces pain on the outside of the knee - but after walking for a few minutes, the pain goes away. Planting the left foot and turning my body clockwise produces pain on the outside of the knee and the back of the knee. Planting the left foot and turning my body counter-clockwise produces no pain. Both my knees have been ‘noisy’, but the left one now is more ‘noisy’ after this event.

Seeing a doctor: I have no desire to, as long symptoms keep improving - and they continue to improve. My initial response was panic, but after listening to the BBM Pain Podcasts, I calmed down. I didn’t know if you may have seen some red flags that I missed, however.

Again, thank you.

[Michael_Ray]

@JKuhl

Michael - Thank you for your response!

As far as browsing around on the web to determine what happened, my hypothesis is my patella dislocated. I’m not a doctor, so I can’t say if that’s even possible at this point (I brought the weight back up and re-racked it), but seems consistent in my mind with the movement in my knee at the time (the movement of the ‘rope’). Muscular imbalance seems to be a big topic around patella dislocation/subluxation. Just seems like squatting is ideal for this. Regarding your mention of recovery, I was coming off a cold that lasted several days. I wasn’t feeling 100% that day, but was wanting to get back under the bar and felt good enough for that. Not sure that could have contributed to it, but it’s something for me to think about.

Description of Pain
At initial onset, the pain was primary on the outside of the left knee while standing. Almost no range of motion under bodyweight (could not squat 1"). Sitting on the left knee (like to tie your right shoe) was impossible due to the pain in the front of the knee and the pressure on the knee cap.

Today: Sitting on left knee (to tie your right shoe) is bearable but there is significant pressure across the front of the knee (bottom of femur, across the knee, to the tibia). After sitting for an hour, standing produces pain on the outside of the knee - but after walking for a few minutes, the pain goes away. Planting the left foot and turning my body clockwise produces pain on the outside of the knee and the back of the knee. Planting the left foot and turning my body counter-clockwise produces no pain. Both my knees have been ‘noisy’, but the left one now is more ‘noisy’ after this event.

Seeing a doctor: I have no desire to, as long symptoms keep improving - and they continue to improve. My initial response was panic, but after listening to the BBM Pain Podcasts, I calmed down. I didn’t know if you may have seen some red flags that I missed, however.

Again, thank you.

Yeah, the initial description you provided would lean towards patella subluxation but at 41 it’s interesting if this is actually what is going on without a prior trauma to the area. Typically this involves the medial-patellofemoral ligament (MPFL). Usually in these scenarios you can observe the patella “jump tracks” during knee flexion and extension. This also could be patellofemoral pain syndrome. Either way, you seem to be on the right track with trying to improve your active range of motion and loading to tolerance. Has the initial incident re-occurred since onset?

[JKuhl]

@Michael_Ray

Yeah, the initial description you provided would lean towards patella subluxation but at 41 it’s interesting if this is actually what is going on without a prior trauma to the area. Typically this involves the medial-patellofemoral ligament (MPFL). Usually in these scenarios you can observe the patella “jump tracks” during knee flexion and extension. This also could be patellofemoral pain syndrome. Either way, you seem to be on the right track with trying to improve your active range of motion and loading to tolerance. Has the initial incident re-occurred since onset?

The initial incident hasn’t reoccurred - but I have admittedly been extremely cautious squatting and deadlifting. Can PFPS begin with an incident like this? What is the proper course of care for PFPS? For some reason, I’ve developed pain in my right knee now, but nothing like the pain that resulted in the incident in my left. It’s more of a dull ache at the moment.

Thanks for your help.