Four years ago I experienced severe patellar tendinopathy, self-diagnosed but given what I’ve learned here, there is little doubt in my mind that’s what it was. Anyhow, it took a good 6 months of painful training (believe I ultimately stumbled upon Greg Nuckols’ guidance and that sent me through) but I got through it and am today stronger than ever.
In recent weeks I’ve noticed some of that familiar pain in my right knee. It’s insignificant and does not hurt while squatting, but outside the gym it’s present in certain circumstances (extending knee after sitting, for example).
For training context: I’m squatting 3x per week, following a self-developed program that is analogous to the old Barbell Medicine 12-week 4-day strength template. So, 2 primary squat days and a 3rd day of belt squats or beltless squats on deadlift day. I only get minimally sore so don’t believe I’m overdoing intensity like I was four years ago on Texas Method (ugh).
The basic question is this: how do I adjust my training program to mitigate the supposed tendinopathy without undermining training volume (too much)? Or is that the appropriate question to ask?
Thank you!
I just want to chime in and say that I had constant (self-diagnosed) PFPS for 2+ years and after reading the ebook on painscience.com I made some minor changes to my habits and training and have been squatting pain free ever since. Basically I never sit with my knees bent and I take 3 seconds in my squat descent (including variations).
Thanks. Eccentric squatting is one of the things that helped me through originally.
That is actually the perfect question to ask as tendinopathy is most often related to training volume. We all have a capacity for which we can train and sometimes when volume starts increasing we can butt against the edge of what that capacity is. This is going to be contingent on each individuals training history so unfortunately there isn’t an “x” capacity that we can all tolerate. The first recommendation I would have if you currently have two comp squat days would be to make one of them comp squat and one of them a tempo squat. While this will take absolute tonnage down some, tendons tend to adapt better to higher magnitude slow loading. If symptoms are minor I think just adding in one day of this for a comp squat should help some. You can also make a case for some single leg work here, i.e. split squats, bulgarians, lunges, etc as sometimes some variation of movement helps. Tendon adaptation is very load specific so sometimes we may be better off working around a problem as well as through a problem. It also can help to add some of the overall tonnage lost from switching from a comp squat to a tempo squat.
Thanks so much for the help, Derek!