Training with Patellofemoral Pain - Is My Plan Sound?

Looking for a sanity check on my plan to work around/with patellofemoral pain.

Background: I’m 13 weeks into my SSLP and have developed an annoying case of patellofemoral pain in both knees. That started gradually as a general stiffness around week 6 (lifting 285lbs) and after week 8 (lifting 330lbs) things just straight up hurt. So, I figured some time off was needed. I stopped squatting for 3 weeks while running the rest of the program as is - though I dumped PCs for RDLs to keep that force and impact off the knees.

By week 11, the knees weren’t appreciably better or worse so I tried squats again. I did a big deload down to 200lbs to see how things felt. Knees still had pain during the movement but I continued squatting for another week. In week 12, I changed to doing pin squats within a pain-free range of motion. Sadly, this is currently about a 5-inch depth or roughly 1 stair-step height. Lifting 305 lbs at this setting now.

The pain is a pesky, ephemeral sharp pain right through the kneecap with no consistent intensity. 1 rep will hurt a lot and another one won’t hurt much at all. One flight of steps will hurt but another doesn’t. Eccentric movement hurts more than concentric. Walking is just fine and unloaded knee ROM is also pain free (i.e., just raising knee to chest while standing/lying down). Nothing is sore to the touch & no obvious swelling or discoloration.

Current plan: Continue to add load at current pin-setting. Retest pin depth (bar only) 1x/week. As ROM/ pin depth improves, recalibrate load and progress until next ROM/pin depth improvement.

Does that sound about right? Should I do anything different?

Other background tidbits:

  1. 48 year old male
  2. 20+ year rugby habit (15 years competitive but just social/tournament play now, 2-3 times a year)
  3. No running or other training outside of SSLP
  4. Grade 2 MCL sprain 15 years ago that healed nicely (right knee)
  5. Played around with dumbells last Sept (work gym – no barbells) and had a mild case of knee pain in both knees doing split squats after a few weeks – stopped that entirely and things resolved within 4 weeks
  6. No other knee pain/injuries.
  7. High-bar squat with wide grip since I can’t yet get my shoulders to cooperate getting into low bar position (slowly improving, though!)
  8. Train at home w/ no coach
  9. Haven’t had any form checks and no older video to share.
  10. Have knee sleeves but notice more effect if worn prior and after training rather than during (at least as far as knee pain goes)
  11. Bodyweight of 260lbs w/ 33% body fat, which doesn’t help my cause

Yes, that’s the plan that I’d use! (And get a form check if you can!)

Perfect! As soon as I can get to a decent depth, I’ll get that form checked. Thanks!