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Reader Ario asked:
I ran my 1st marathon in May of ‘07 and shortly thereafter, began experiencing pain in my right knee. Each time I ran, climbed up stairs, or squatted, the pain could be felt.
I found an orthopedic specialist & had MRIs done. The diagnosis was patellar tendinitis. I’ve completed 6 weeks of physical therapy. The pain is still there and I’m thinking about seeking a 2nd doctor’s opinion before I consider something drastic like surgery.
I want to start StrongLifts 5×5, but don’t want to miss out on Squats, the backbone to your training regimen. I can squat down with no weight on my back several times without knee pain.
My current thinking is to just start with the bar and go from there. With the hopes that the exercises will help (and not hurt) my knee situation. I have a computer job and sit for large chunks of the day, but keep an active lifestyle outside of work.
Patellar Tendon. Image credit: MMG
Patellar Tendinitis. Ario has pattelar tendinitis: the tendon that attaches his quad muscles to his shin bone is inflamed. It’s hard to say what the cause of Ario’s patella tendinitis is. It could be various things:
- Overuse. Intensive preparation the months prior running his marathon. But without proper recovery.
- Muscle Imbalance. Quadriceps & hamstrings aren’t equally strong. This could increase the shear force on his patellar tendon.
- Improper Posture. Ario has a desk job & sits for large chunks of the day. Bad postural habits can cause tight hip flexors, lordosis, etc.
- Other. Bad running technique, bad shoes, hard surface running, etc.
Treatment. The worst thing you can do is immobilization. Accelerate the healing process by increasing the blood flow to your knee. In the meanwhile strengthen the surrounding muscles to help the weakened joint.
- Stop What Hurts. Avoid running for now. Some of the rehab exercises will hurt. Rate your pain from 0-10. Anything above 3, stop.
- Stretch. Stretch your hamstrings & quads. Both legs. Hold the position & wait for the muscles to relax. No bouncing, take it slowly.
- Squat. Squat with an empty barbell for 2 weeks. Then add 2.5kg every workout. Knees out, don’t bounce on your knees & break parallel.
- Posture. Sit with your feet flat on the floor, not with your feet crossed under your chair. Check for lordosis.
Consult Your Doctor. It’s hard to know why you’re injured. It’s even harder to diagnose yourself without knowing what’s happening on the inside. Ario could have had a teared meniscus: similar pain, different treatment.
You’ve got some pain that doesn’t go away? Do like Ario: consult your doctor.
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I would definitely seek out a second opinion if your problem is not improving. What kind of work is your therapist doing?
I was training for a marathon last spring and ran into some debilitating knee pain. I went to a doctor who recommended me to a physical therapist. The diagnosis was illiotibial syndrome (http://www.itbs.info/). Before starting therapy, I could only run 3 miles before I had to stop, and walking up and down stairs was near impossible. As you know, this is definitely not the distance you have to be running for a marathon. After some *very* intense therapy sessions (my legs were bruised everywhere, and people thought I had been beat up), I was able to continue my training and finish off a half-marathon with no pain.
A year ago, I used to have pretty bad pain in my right knee, somewhat like what is described above. (Long hours at the computer playing video games and programming). Ever since I started weight training (and losing weight) it has all but disappeared. Originally I was close to 400 lbs and now I am at 325 lbs.
Recently, I started doing squats ala stronglifts 5×5 and now pain in both knees is starting to develop. I think it may be because of the shoes I wear, they tilt my body forward a couple degrees and I find myself pushing off of the balls of my feet instead of my heels. As soon as I have some money, I am going to buy a nice pair of chucks and hopefully they will fix the problem.
There is no way I am going to stop doing squats however, the benefits I feel from this one exercise alone has been extraordinary! The knee pain is very slight, but it is there. I am hoping the new shoes will fix it, I could always take my shoes off, but I am not sure about sanitation with the floors in this gym.
“Knees out, don’t bounce on your knees & break parallel” I just started squating and I have been trying to get as low as possible is this wrong or are you talking about just this instance?
Another important point with patella tendonditis that is usually ignored is the glutes. When your glutes aren’t functioning well, your knees have to take a lot more of the load. People miss the glute function point when addressing this injury, but I have found it really can take a lot of pressure off the knees. Get them a bit more active, and you will find squatting hurts a lot less as well.
@Demizer
Definitely learn to push from the heels. Curling your toes up helps. Note that weight lifters use shoes with a heel. Heels is not bad per se, but good shoes definitely helps.
@Young athlete
Never ever bounce of your knees. Going low is good, bouncing on the knees is bad, it destroys your knees.
@Lauren
Very very good point. Problems at the knees are usually caused by problems in the hips or ankles. Glute activation will definitely help, the lordosis article I pointed to in the article is a start. Great point, you know what you’re talking about
““Knees out, don’t bounce on your knees & break parallel” I just started squating and I have been trying to get as low as possible is this wrong or are you talking about just this instance?”
I believe Mehdi’s phrasing is just confusing you and he means:
1) knees out
2) don’t bounce on your knees
3) break parallel
It might be a good idea to look into the possibility of soft tissue restrictions in the quads, like myofascial adhesions and trigger points. All of my knee problems went away after a few weeks of daily self-administered massage to my quads. Now that I’m lifting regularly, sometimes they start to bind a bit again and massage always takes care of that tightness before the tendons can get painfully inflamed.
I started squatting in May of ‘07 with just the bar and am now at 225 for 5 reps, could probably go for 10. However, footwear is the most essential piece of equipment as it affects every aspect of your posture. Running shoes are the worst possible choice as the soles start to compress with even moderate amounts of weight. I found early on that this caused me to push from the instep of my foot during the positive part of the sqautting movement causing my knees to buckle inward. After some research, I decided on wrestling shoes as the appropriate footwear for myself. It feels as if youf feet are attached to the floor and pushing through your heals to complete the movement requires no thought at that point…
You may want to consider buying, or checking out at a local library, “The Egoscue Method to Health Through Motion,” by Peter Egoscue. I’m studying to become a physical therapist so I’ve been reading a few PT books for a bit. This is a great book to read and maybe even talk to your PT about.
It talks about how injuries occur, basically, due to misalignment in the body. If your body joints are completely aligned with each other, it causes injuries such as ones found in the knees, ankles, shoulders, etc. One thing to keep in mind is that it is possible to put your body into correct alignment through doing static exercises. It doesn’t require running or anything, just 30 mins of specific stretches before you go to sleep each night.