I recently took about two weeks off from lifting mostly due to my hectic college schedule. Additionally, I was recovering from a back injury and I didn’t feel it was worth it to train.
When I came back, my back hurt much less and I was able to put a lot more weight on the bar without pain. When I began squatting, however, I felt an aching pain in my right shin. It then hurt for a few days when walking up stairs, getting up from the toilet, etc. It was another week until I lifted again (mostly schedule reasons like before), and the pain happened again when I squatted. The pain is around the tuberosity below my knee. I noticed a bit of swelling there this morning (I lifted yesterday). The squatting volume decreased slightly after I came back from the 2 week break. Upon brief research, the symptoms seem to match shin splints and stress fractures.
I couldn’t find a way to adjust the exercise to decrease pain. Any loaded range of motion with my knees bent hurts. It doesn’t hurt to unrack the bar or stand with it though.
I know that you probably can’t give me a diagnosis through the internet, but how likely are shin splints or stress fracturs in my situation, and what are the associated risks with continuing to train? Is there a structural issue with either of them? At what point should I see a doctor about the pain?
Being the curious sob that I am, I did just notice that I can load my leg without pain if I push my foot through the floor while sitting without using my quads, i.e. using my glute and hamstring. Don’t know if the added info helps, just thought I’d say it.
The symptoms sound more like patellar tendinopathy if the pain is around your tibial tuberosity. Also would make sense why it wouldn’t hurt if you load your leg using primarily glutes/hams.
If you took two weeks off and then got right back into squats with a heavier weight than usual, this is usually how these things pop up - load management errors.
That does make sense. Why would using a heavier weight be potentially harmful for the tendon? It certainly wasn’t a weight that I had any difficulty with.
For dealing with this in the future, would you suggest slowly adding weight, even if I “felt” comfortable with a heavier weight to avoid injury. This also brings up a related question I have about fatigue management. I know that fatigue is necessary for adaptation, but this would contradict the idea of fatigue management, since fatigue is a good thing in the sense that it drives strength increase. Is fatigue management about preventing the issue i described above - too much too fast increases the chance of an injury?
Tendons don’t respond well to loads they are not already adapted to. You may not have had difficulty with that weight before, but after taking some time off, it would have been better to gradually return to the weight you were using before jumping right back to it.
So yes. When recovering or training through an injury, it’s best to slowly add weight even if you “feel” comfortable with a heavier weight. This will promote both structural adaptation and psychological confidence.
Regarding fatigue management, you’re right in that it can be tricky with tendons. A good rule of thumb would be once the tendon is calmed down (with isometrics and reduced loading) you can train through about a 3-4/10 pain as long as it doesn’t cause a flare up 24 hours after. This is usually enough to cause a structural adaption and return to function.
When you say structural adaptation, do you mean that it is possible for a tendon to “de-train” that quickly? I was under the impression that, for the most part, my joints were well adapted to the load (except for the back injury). To clarify, I had no issues with my knees before and the tuberosity started hurting once I came back squatting heavy. My tendons were able to handle the weight several weeks ago, so are you saying that my tendons need to be slowly worked back to heavy weights, even if they are healthy? Say I were injury-free, but I just hadn’t lifted in a month, would coming back to the same volume and intensity leave me more prone to injury than if I had slowly increased them? Is weakened tendons one of the causes of this?