23 year old 105kg powerlifter – also a new grad inpatient physiotherapist in Australia.
I have had L) anterior knee pain for approx 9 months. During this 9 months, I have done 2 competitions and decided to try my best to ignore the knee pain as it believe it has never affected my immediate performance i.e. my squats have kept getting stronger, but they just hurt a lot in the hole and the pain typically gets worse throughout my comp prep. I do believe it has slowed my strength progression as over the last 18 months I have progressed much faster in my DL (250kg – 292kg) compared to my squat (230kg – 253kg). I have just finished competing at Australian junior nationals and I am not planning on doing another competition until October or November this year.
So now, 1 week post comp I have decided to get into some knee rehab. I am going to keep going pedal to the metal on DL and bench as they are pain free.
Using BBM principals I have tried a number of different approaches:
Reduced weight on the bar: Using my comp style low bar squat. // still had pain whilst squatting the bar and w/ only bodyweight
Reducing ROM: I tried box squats and pin squats until they were ridiculously high. // same pain
Changing technique: Tried wide stance, narrow stance, more hip ER, more hip IR, pushing knees out, pushing knees in, flats, heels, safety bar, camber bar. //still had pain w/ bodyweight
Changing exercise: leg press, Spanish squats // Spanish squats w/ really short ROM and light leg press were only slightly painful, but the pain was still there and I just can’t see any benefit in doing movements this light and this non-specific to comp lifts.
Overall, I am feeling pretty lost, also disappointed as I am a physio who can’t treat my own knee pain. I am considering doing only bench, press, deadlift and accessories for 4-8 weeks. Would this be appropriate? Based on my experience w/ BBM I have never seen it recommended that somebody fully ceases training a particular movement, but I haven’t been able to find anything close to a squat that is pain free and not psychologically distressing. I’m also having a lot of difficulty clearing my head of negative expectations. I had a few different pains that caused a lot of annoyance during my basketball career, now I’m becoming concerned that I’m going to have to deal with L) anterior knee for the rest of my powerlifting career.
Aplogies for the long spiel, I’d appreciate any advice at all.
Hi Daniel, sorry to hear about your pain, a few things to look on with a positive outcome. First is that you have been able to train both the bench and the deadlift with no set backs which is really encouraging. Secondly and more importantly you seem to be a very strong individual and I think that it is vital that you know this, which is why I think it is not a great idea to stop squatting for such a long time. If the squat is what is giving you trouble it is actually best to continue to squat and not develop the idea that the squat is dangerous at all especially since powerlifting seems to be your thing.
i am sure mike and Derek would be better suited to give you specific advice here but I think that maybe trying some tempo squats of some sort may be beneficial. Keep a positive mindset, keep training and know that you are in control here Dan
Best of luck!!
One of my friends who works in a private practice had a look. He called it patellofemoral pain syndrome, suggested good things like changing intensity and ROM, I made an informed decision to not do those things at the time because I was ~7 weeks away from Comp. He also suggested that I work on my left dorsiflexion ROM (my knee to wall is 9cm on my L compared to 13cm on the R, which is from an adolescent ankle fracture)… I can confirm I did not do an stretches or ROM WODs.
I think it’s straight up tendon pain. The location of pain is more superior than tendon pains I used to get late in a basketball season, nonetheless it’s still most painful on palpation of the tendon and kneeling for ab rollouts. A lot of people at my hospital push isometrics for “pain relief”. I tried light leg extension isometrics and wall sits which hurt about the same as comp squatting.
Since posting this I have had an awesome win with some tempo, pause, squats in flats at ~30%of 1RM. The pain was still there but no increases after the session and same baseline mild pain w/ stairs and getting out of chairs at work the day after.
Gotcha. Yeah - whether we are discussing either of those issues (PFPS or tendinopathy) - the approach will be load management to return to baseline function prior to onset of symptoms. We’d be happy to consult with you on the matter to help guide the path or you may find use of a knee rehab template I developed - https://www.barbellmedicine.com/product/16-week-knee-rehab-template/
Glad to hear about the win since your OP - that’s awesome and sounds like you are on the right track. I understand these things can be frustrating but small wins are the name of the game in these scenarios. Keep us posted.