Very Mild to Acute Pain from Squats in Outer Quadricep (right leg only)

Medical Q&A [Moderated]
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Hi Dr’s.

After studying your podcast, and parts that deal with pain (awesome content). I hope I can be a good example of someone having a question to do with pain giving enough information to it be worth a doctors time and experience to provide a general direction I should go with it. I’ll go ahead and order me a bottle or two of GAINZZZ RX as a thank you in advance!

Yesterday, during my linear progression squats, third working set at 230#, rep 4 of 5, transitioning from decent to ascent, I felt what i would describe as kind of a static pain in my right quad. Initial pain origin id say was outermost area of outer quad muscle, up 5 inches from center of knee just about the outer most area of my thigh. To be exact, when I stand straight up with my arms at my sides my middle fingertip points to the exact location what appears to me to be the most sensitive part of the injury.

Stupidly, (im guessing) I just had to get my PR so I could go up in weight. So I went ahead and did the final rep. Im not sure the pain was any worse on the last one, but it was enough that i tried to slightly let my left side take some of the load on the way up, and Completed the rep.

History
Previously I have never had a pain in this area. I have had knee issues, but these have about completely dissolved by using squat shoes, following a SS squat, and ripping the carpet off the floor to provide a hard stable surface to work from. There is NO KNEE PAIN at all with this.

I still had to do overhead press and deads for the day. So I didnt panic and wanted to keep training. During this time the pain seemed to radiate from the bulbous lower point of the outer quad (near the knee joint), all the way to my lower right side of my back. Back pain more like a stiff pain (kinda like sleeping in a terrible foreign bed for a night)

As of today, the region of the pain has condensed back down to the fingertip area of my quad on my right side (arms hanging down sides of legs standing upright) with some slight glute pain on same side. Not sure if its related or just general pains of linear progression.

I have full range of motion.

I can do air squats (hurts)

There is no noticeable swelling that i am noticing.

Another description of where pain is localized. If you sit down in a chair, knees bent at 90 degrees. If you split your leg into four pie pieces, the piece that is aggravated, would be the top right piece. (from patients eyes of view) top of quad, over to the outer most area of leg (outside)

I feel no pain on the underside of thigh at all.

No visible bruising, although it hurts to touch as if someone elbowed you sharply in that area.

I work in a warehouse so I will be spending all day using my legs picking up things so I guess i’ll know more by end of day but it doesnt appear to be getting any worse and is very managable with a couple of ibuprofen, but still very apparent.

Any other information I may have left out to help I apologize and please let me know.

I want to get back to my LP as quick as Possible.

Sorry this is kinda scattered information.

Thank you so much!

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This is an exceptionally well-described history compared to what we usually get, so thank you for that.

The “stuff” in the area your describing do involve the vastus lateralis muscle and its associated distal tendon, as well as the iliotibial band. You may have strained some component of this tissue.

You report that doing unloaded “air squats” causes pain. Is this pain mainly in the bottom of the ROM, similar to when you first experienced it? If that’s the case, can you perform a partial rep and avoid the painful range of motion? Similarly, is it modified at all by adjusting your stance width and toe angle (i.e., narrow, toes-forwards squat versus wider, knees-out squat)?

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This may be a repost, but I wasnt sure if my last sent, and I copied and pasted this to make sure it came with the pictures.

Austin, thank you so much for helping me with this.

I am attaching a few pics of the area of concern. The X marks what appears to be the main area of aggravation, while the circled area represents the radiant pains domain for the most part. Im hoping you can click on each pic to see the detailed encircled area let me know if you cant see the area marked.

Q: You report that doing unloaded “air squats” causes pain. Is this pain mainly in the bottom of the ROM, similar to when you first experienced it?

A: Not at all. The two side pics posted represent the point at which the pain activates and stays constant throughout the whole decent. Id say a 4 out of 10 pain level. On the ascent, The pain level may increase slightly to a 5/10, and remains constant throughout until lockout at top.

Q: …can you perform a partial rep and avoid the painful range of motion?

A: No, I have tried starting and stopping the squat at all levels and have the same result.

Q: … is it modified at all by adjusting your stance width and toe angle (i.e., narrow, toes-forwards squat versus wider, knees-out squat)?

A: Sadly, no. I’ve tried every variation you have described, and even ridiculous feet positions just to see, and they all lead to the same result.

I’ve heard a wise man or two say that training is better than not training. I do have a high threshold for pain, And i’m willing to do whatever it takes to move forward. I have no problem working through pain, but I need to know if it is wise to do so. Completing linear progression and getting up to (and hopefully) a 300 pound squat for sets is something that I dream about every night. I have the drive I just need to get an idea of how to better get there.

Technically, I finished my fives and I am supposed to move on to 3 sets at 235, but i’m smart enough to know that would probably be a dumb move given the circumstances.

I workout from a home gym and I do have a cybex squat press (leg press) machine . Its been collecting dust, so I figured Id dust it off and see how that felt with my injury.
I can actually find some foot positions on this than I think could be totally doable to get some weighted work in. Just put 90 pounds on it and the pain is there, but way less noticeable that from performing air
squats.

Thank you so much Austin!

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I can certainly sense your attention to detail and motivation to accomplish your goals. I have no doubt you’ll get there (and far beyond, in the long term), but I would not recommend just pushing through this sort of pain at work weights.

Whether you want to or not, you’re going to start “anticipating” the pain and altering your mechanics to reflect that, which may ultimately be counterproductive. Rather than continue to piss off angry tissues, I much prefer the idea of finding a way to train that’s pain-free (or, at least, significantly less painful) and work up from there. In other words, doing exactly what you’ve found you can do on the leg press.

You’ll be OK, dude.

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Thanks for the great advice and assurance. We who aspire to be successful at Barbell training appreciate people at the top of this sport for support and guidance.

Btw, I hope some of your products come back in stock soon! Ill be sure to pick up a shirt and bottle of protein when it does so . I’ll also help spread the word for yours guys about Barbell Medicine and the great information.

I WILL be a success story for you guys in the future…

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