Hello Docs,
Thanks for your hard work and good content you put out. I watched most of your videos.
Age: 26
Height: 5’9
Weight: 185
Body Fat: 14%
Years lifting: 8 years
Powerlifting: 2 years
Ended linear progression :
Squat 4205@9 Bench 2955@9 deadlift 460*5@9.
Actually on 4 days split undulating periodisation.
I’ve been Powerlifting since 2 years I started with LP and end up on Texas method. I’ve been dealing with knee pain since 1 year it started intermittently on my right knee around the patella and ended up being constant. I took 8 weeks off of squatting and deadlifting after I read Pain science patellofemoral Syndrome and the Art of rest. The pain didn’t go away i still felt that burning pain around my patella I decide to gradually start squatting.
After my first training session i noticed that my left knee started hurting as much as my right knee. I decided to get an appointment with a orthopedic Doctor he sent me to get X-ray’s and couldn’t see anything wrong on x ray.The pain was constant even at rest. He sent me to get an MRI and told me it was Patella femoral syndrome.
MRI Results:
Left knee:BONE MARROW/OSSEOUS STRUCTURES: There is a small focus of subchondral diminished signal associated with the posterior non-weight-bearing surface of the medial femoral condyle, likely a small focus of sclerosis that may be related to subacute or chronic alteration of biomechanics or variant anatomy. No significant edematous signal is seen in this region to indicate an acute process. There is patchy marrow edema at the medial and lateral femoral condyles and lateral tibial plateau, and prominence of hematopoietic tissue is noted. The finding is likely of incidental note related to patient’s young age.
At the patellofemoral joint compartment, no chondral defects are seen.
1
No subchondral bony signal alteration is seen
No meniscal or ligamentous tears.
- Prominent hematopoietic tissue is seen, incidental finding related to patient’s young age.
Right knee: BONE MARROW/OSSEOUS STRUCTURES: There is an irregular lesion seen at the distal diaphysis of the femur that is only partially visualized. It roughly measures approximately 52 mm in length and demonstrates lobulated contour. It is suspicious for an osseous lesion. Recommend x-ray correlation for further characterization. When compared to the opposite extremity, this is seen only on the left side and is not identified on the opposite extremity. There is also osseous edema of the medial and lateral femoral condyles suggestive of contusion. There is also osseous edema of the lateral tibial plateau suggestive of contusion. At the patellofemoral joint compartment, no chondral defects are seen.
1.No subchondral bony signal alteration is seen. Suspicious osseous lesion is seen at the distal diaphysis of the femur. Recommend x-ray correlation.
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Edema of the medial and lateral femoral condyles and the lateral tibial plateau is seen suggestive of contusion.
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No meniscal or ligamentous tears.
I don’t feel the sharp pain often when squatting but a constant burning feeling even while walking. It makes it complicated to find what exercise Or Range of motion causes pain and which does not lol. What can you advise me and or what is the best method I can do/use to get back on a routine? Thank you in advance, Doctors
What have you tried so far?
When you went back to training, what was the first thing you did in the gym? Specifically, what did your programming look like?
Hi Doctor, thank you for your fast response.
I started doing (Some stretching and foam rolling lol) box squat with a barbell once a week then twice a weeks And gradually adding weight. No particular training program at this point but rehab exercises. I did that for 4 months. The pain was still there so I decided to start squatting anyway. I started doing a 3 days split Texas method modified . I also implemented RPE training to manage my fatigue level. I think my issue was I didn’t take in consideration my fatigue level when I was running LP progression.
Day1:Squat 11@8 + 55@8 and bench press 11@8+ 55@8 Def deadlift 11@8+55@8
Day2: Rest
Day3:High bar 28@6 and close grip bench TNG 28@ 6
Day4: Rest
day5: Squat 11@8+ 25@8. bench press 11@8+ 25@8 deadlift 11@8+ 15@8.
i add 2.5 to 5 lbs about every week. My intensity days change every 3 to 4 weeks followed by a deload week. The next cycle would be triple then double and single.
Thank you for your help i really appreciate it, it has been frustrating.
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Hey Rudy, PFPS tends to be a rather vague diagnosis for general knee pain. That being said, we typically have some good heuristics with which to address the symptoms. I would recommend starting with the linked article. It is on patellar tendinopathy, but Jason does and excellent job of laying a framework with which to address anterior knee pain when squatting.
https://www.strongerbyscience.com/squatting-with-patellar-tendinopathy/
Hey Derek. I checked the link you sent to me thank you .I’m already doing this type of protocol but it don’t seems appropriate for my type of knee pain because I feel the stinging feeling even at rest while walking. What would it be my pain baseline? Should it be stinking/pain just a little more after my rehab exercise? Or be the same type of stinging/pain like I usually have? Do you think my diagnosis would still be a type Patellofemoral syndrome base on my MRI finding?
My case seems stubborn lol.
Thank you Guys.
Hey Rudy, it is not uncommon to have symptoms while walking. The overall theme is building capacity in the tissue of this is an instance of finding the tolerable capacity and building from there. One of the big keys to implementing heavy slow resistance is the emphasis on “slow.” Often people will experience symptoms if they are running a normal tempo on the exercises but if they switch to either a 3-1-3 of 5-1-3 the symptoms will decrease and allow them to work. It is also okay for a slight increase in pain while performing the exercises or afterwards. Your pain baseline is your pain baseline, the goal is to change that baseline over time. This still sounds like a typical presentation of PFPS.
I (literally) feel your pain, Rudy! I’ve been dealing with a dual case of PFPS myself since March. I didn’t/don’t have resting pain but stairs, sitting in a car, and just going to the can were dreadful experiences. I moved to pin squatting in a pain-free ROM, but could only hit a depth of 4" , or about my knee ROM for deadlifts. Since then, my pain free ROM hasn’t improved, but the intensity of the pain in all ROMs has gradually subsided. It still hurts ~ 5 months later but its significantly better.
The best impact / relief for me came when I walked for 22 miles over a 4-day holiday in July. My knees have been noticeably better since then. Not sure if the constant motion or the lack of sitting that pushed the needle that far. Probably both.
I’ve also noticed less pain at the end of my workout, so I’ve moved squats there instead of the beginning when everything’s cold.
Stick with it!