New lifter; knee pain after squats

[Moxt]

I am coaching a new lifter. This is my third lifter to coach besides myself. She is having some problems with pain at the bottom of her knee after she squats.

She is doing the SS LP. Yesterday was her 5th day of training. Her knee felt a slight pain (1/10) about 10 minutes after completing squats, so we did the press but did not do deadlifts. 30 minutes after completing her squats, she had a knee ache (2/10 scale) that lasted about 20 minutes, then a shooting pain for 10 minutes (4/10 scale). Then it was gone and did not return the next day (today). We’re going back tomorrow evening to do the 6th day of the program (squats, bench, deadlift).

Her form is not perfect. She’s making it to depth 95% of the time and is sitting back well without her knees sliding forward very much. Her working weight on the squats are 70 pounds for 3 sets of 5 reps, which (in my opinion) should not be enough for these form issues to cause this pain without something else being wrong.

She is not obese or underweight, normal anthropometry, 5’3", in her early 30s, and sits at a desk professionally.

She has a history of knee problems, going back to her early 20s when she was diagnosed with osgood-schlatter disease. She did crossfit for a month or two in 2014 or so and had very bad knee pain from it. In response, she had an x-ray done and part of the bone had chipped off the growth plate. She had a follow-up x-ray on the knee and the chip had disappeared. She has not done strenuous training/exercise since then. Unsurprisingly, her doctor told her to not do squats again. She is ignoring this advice. She does not have knee pain in her daily life.

I’m not sure how to proceed here. My plan is to have her lift again tomorrow.

I don’t have any idea what physical thing is happening that would cause the pain. Any ideas on how to prevent the pain? Is this a “work through it and it will go away” thing or is it something that requires medical intervention?

Thanks for any insights.

[Austin_Baraki]

This is probably something that will improve with time. It is important to note that there is no weight that “should” or “shoudn’t” be enough to provoke symptoms. If she has a history of knee problems, make sure she isn’t coming into the training sessions with fear of knee pain or expecting that her knees will hurt. Keep training, and don’t be afraid to use other tools (like the leg press, for example) to desensitize her (from a physical and a mental standpoint) to that sort of loaded ROM on the knees.

[ericjspencley]

Before I started lifting, I had hyper extended both of my knees a few times from playing ice hockey when I was in high school. Parents made me go to a sports medicine orthopedic surgeon who said “you will need to get your knees replaced within 5 years”. Because of that, I was always terrified to squat because I have knee pain (rated 4/10 in my head). Once I started to squat and I saw that it did not make my knees hurt, I forgot about the pain and it disappeared. I know Austin says pain is very complicated, but I feel a majority of the novices that I train tend to have their pain disappear after about a month of actual training.

[Moxt]

@Austin_Baraki

This is probably something that will improve with time. It is important to note that there is no weight that “should” or “shoudn’t” be enough to provoke symptoms. If she has a history of knee problems, make sure she isn’t coming into the training sessions with fear of knee pain or expecting that her knees will hurt. Keep training, and don’t be afraid to use other tools (like the leg press, for example) to desensitize her (from a physical and a mental standpoint) to that sort of loaded ROM on the knees.

Thank you. That’s a good note for me re: provocation of symptoms. We will continue lifting. She definitely comes in with fear of knee pain, but I think it will get better as we keep working.