Lateral knee pain & squats

Medical Q&A [Moderated]
1

Hello,

First, some background: 195 pound, 26 year old male with no background of knee injuries, training experience of around 10 years.

Over the last three years, I’ve had about five occurrences of severe knee pain on the lateral portion of my right knee, basically on the patella. This generally seems to happen each time when training is going very well, and I push my luck. Most recent occurrence was when I had programmed in a 405x3 set for back squats, felt good, so pushed a fourth rep, and on the way up, felt the intense stabbing pain again. It isn’t debilitating when it happens, but there is significant pain doing any squats (even with BW) for a week or two, and it hurts when I stand on it for too long.

Other information that might be useful. It’s hard to describe, but I can shake the lower leg on this side, and it almost feels like the joint pops in and out. The knee almost feels loose in a way. The other side isn’t like this at all. It does hurt worse when I drive for extended period of times, or if I squat down for an extended period of time.

I did see an ortho, and we had an MRI, and it ruled out any ligament or tendon damage, but he did say there was some ‘chondrosis’ on the joint. He advised PT sessions, which I chose not to partake in. Since then, I’ve continued squatting, and can still hit decent sets, but it seems to hinder me from making any big progress. I’m simply stuck around a 455 squat, as pushing the frequency or volume to get past this point results in another occurrence (past results).

Any other thoughts here? Seen anything similar?

I have no issues deadlifting. I can usually deadlift two days after an occurrence with minimal pain.

2

HITA,

Thanks for the post and for joining the forum. Glad to have you.

A few things tend to suggest against anything really wrong with your knee:

  1. Clean MRI
  2. No issues when deadlifting

That said, it appears that overfatigue may be an issue here and given your history…it may be ill-advised to play with fire on the squat in this manner, rather I would address this with form review (ruling out any varus or valgus components during your squat that is egregious) and adjusting volume/intensity/exercise selection to make your squat go up. It would probably be devoid of limit sets given the risk: benefit, you know?

At this point, I’d plan on returning to squatting provided pain doesn’t get worse throughout the set. Use knee sleeves and review your technique. I’d have one squat variation be belt squats or leg press- likely a tempo variation- once per week, and average intensity should be in the high 60’s-low 70’s for the first 2 weeks before going up to the low to mid 70’s.