Dr. Baraki,
I am hoping to get your take on programming considerations and exercise selection you would consider for someone with injuries like I have. I’m 32 and I have a SLAP tear in my left shoulder and fairly significant OA in my right knee stemming from several injuries in my past that include 2 ACL repairs, partial PCL tear, meniscal tears (both lat and med but lat was the worst of the 2), and compound fracture of the right femur. For the last 5-10 years, I’ve been able to get away with just about any type of squat, deadlift, or jump without any significant pain or irritation and cycled through various programs with a max frequency of performing squats 2x/week.
It wasn’t until the later portion of a 9 week cycle running a 5x5 (madcow) and squatting 3x/ week where my knee began to swell to the point of needing to be drained twice and is now always in pain and fairly swollen towards the medial/posterior side. It really hasn’t improved despite reduction in activity, NSAIDS and icing. Recent X-rays showed formation of bone spurs and very little joint space at the distal femoral condyle and tibial plat.
My shoulder is more of a dull pain with a majority of the pain coming from supraspinatus tendinitis and I have cut out all OH pressing.
My questions are:
1.) Is there a squat form that is more “knee-friendly” that would benefit me more and allow me to continue trying to squat and if so;
2.) If squatting 3x per week was simply too much for my knee, is there a way to implement enough volume/intensity to drive adaptations and progress my squat? and;
3.) If I want to avoid labrum surgery (which I do), does this mean training the OHP is out of the question?
I appreciate any input you can share!
-Mike
M_Guinan,
Thanks for the post and for joining us. We’re glad to have you.
Judging by the anatomical specifics here, I think we’re placing too much emphasis on structural defects and would caution against doing so. To be brief, the symptoms you’re having can occur with and without the structural issues you have described.
From a symptom management standpoint I would not make special considerations based on the anatomy, rather I would see how you responded to a given change. Now, onto your questions:
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There are no more or less knee-friendly squats, in general, though some may tolerate one version over another. I think much of your symptoms can be chalked up to the programming. I do not think Madcow is a good program for most folks. I am not sure if your symptoms are are due to squatting 3x/wk or too high of an average intensity (or other fatigue factors). That said, I would recommend backing off the intensity and seeing what type of squat variation you tolerate best (if there is a difference). In practice, I would try low bar squats, then high bar squats, then front squats or SSB squats, and if none of those were suitable I’d start playing with paused squats, box squats, leg press, or altering the range of motion to find something more tolerable.
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See above.
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I am not sure that OHP is contraindicated with your pathology. I also want to know how your SLAP tear was diagnosed? Did you see an ortho? If so, what did they recommend? Additionally, a labral tear with instability in the shoulder may require repair and this - rather than supraspinatus tendinopathy- could be causing the pain (or something else entirely). How do Dumbbell Presses feel?
Thanks for your response Jordan, I’m glad I found this page.
Originally my shoulder felt “off” a few months ago…if I recall correctly I felt the injury occur doing cleans. At my initial visit with my ortho he prescribed PT before imaging it, which really helped and got me back to feeling 100% until about a month ago where I felt a slightly more noticeable pain doing something stupid like battle ropes. I got a MRI 2 weeks ago and that was when my ortho diagnosed the tear. He said it had been there for a while due to pockets of fluid and that it would warrant surgery if I chose to go that route but that it was up to me. He said since the first round of PT helped to maybe consider that again since labrum surgeries can have inconsistent results.
Currently OH presses, whether they be DB or BB, are possible but feel awkward/uncomfortable at about the 1/2 way point of the movement. This is followed by some tingling/dull pain of the area following but never exceeds anything more than a 2 unless I sleep on it in which case it can get uncomfortable.
Horizontal presses don’t seem to bother it as much though I haven’t been pushing it.
Thanks again
I would discuss surgical management with your orthopedist, as it sounds like this is significantly impacting your life in a negative manner.