Vastus medialis - will it ever be 100% pain free?

Medical Q&A [Moderated]
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1

Hey guys,

I’ve been suffering with tendinopathy in the vastus medialis area of my right knee for around 12 months now. I can’t pinpoint a time it happened, I just remember feeling a stabbing/burning pain, which got gradually worse over time, when I got up from a crouched position or walked up stairs etc. It never seemed to hurt during squatting but a day or two afterwards. It coincided with and increase in squatting frequency and volume (Texas method) and when I started using weightlifting shoes. I had previously squatted for several years (although not seriously strength training), to depth, completely pain free and I still consider myself young at 34.

I initially backed off, focussing in on form which I believe now is good (as per SS guidance). I also went back to squatting once per week. I tried other things like different shoes, foam rolling and wearing knee sleeves. The pain seemed to subside after a number of months but as soon as I ramped back up in weight it reappeared, although less severe. During this time I have done loads of research and some similar posts Austin has commented on led me to what I have just completed which is tempo pin squats at 70% for 6 x 4, twice a week, gradually lowering the depth of squat then adding weight over 8 weeks.

I don’t feel the ‘pain’ anymore which was probably a 6/10 at its worst 12 months ago. However, usually a day or two after squatting I have a niggling ache above my right knee and in the vastus medialis area, which currently would be a 3/10. I am worried that if I start to push it too much I will go back to square one. Am I being overcautious, would you expect this pain to every completely go? Or does it sound like there may still be an issue?

BW - 90kg
Squat - embarrassing but…90kgx6x4 tempo pin squat in my last session (was 150kg a year ago)
DL - 190kg
BP - 115kg

This is doing my head-in, I just wanna squat!

Any advice appreciated.

2

It’s difficult for me to be sure that this is truly a “tendinopathy”, but I think you’ve taken a reasonable approach, and it seems like you’ve experienced significant benefit from it. However, as you’ve noted yourself, it’s “doing your head in”, you’re “worried about pushing too much”, and fearing whether the pain will ever go away. You are doing what you can from a physical standpoint, but we also need to address your understanding and expectations as well.

Expectations have a significant influence on the likelihood of improvement in these sorts of situations - we need to get you moving confidently and being less hypervigilant about that part of your knee. I’m guessing you squat every rep in the gym with your mind focused on that area, constantly wondering and evaluating whether it hurts or not. I suggest that you keep progressing the pin squats as you have been doing, and educate yourself more about our approach to pain/injury from our two podcasts on the topic, the ClinicalAthlete podcast on pain and tendinopathy, my articles at startingstrength.com, and over at painscience.com.

You will get better.

3

Thanks for the reply, I’ll keep grinding :)​​