Dave suffers from intense knee pain when doing squats

March 3, 2016

Complicated situation.  I’ve had pain walking up stairs for years, but never down stairs.  Over the past 3 years I’ve lost 9.5 stone or more, and I had reached about 25 stone at my heaviest.

I have been regularly running (slowly) for about 2.5 years.  No pain on running on walking uphill, usually, on treadmill.  When I’ve tried to do squats on weight machine, the pain can be extremely bad–so that I have to stop.  Intense knife like pain behind knee or just under it to the left.

Tried physiotherapy over a year ago but this made pain worse (especially when flexing or contracting the quadriceps muscle, which made the knee pain worse).  MD then gave me steroids plus hydraulanic acid, even though my MRI is normal and I don’t have arthritis.  This made stair pain go away for 8 months to a year, but still unable to do squats.  About 3-4 months ago I started to do interval sprints, 30 seconds on and 1 minute off, about 8x up to my max speed (which isn’t very fast).  I’ve done this while weighing 98 to 105 kg.  Now I have pretty bad pain walking up stairs and for the first time ever, down stairs.  I’ve quit running for a month but pain isn’t any better.

I did buy and am using a decline board, but no progress to date.  My leg muscles are extremely tight and some of my leg muscles are very strong while others I’m sure are weak.

LIke I said, it’s complicated.


March 3, 2016

Hi Dave

Complex but not complicated – lots of differing symptoms when doing different tasks, but I’m sure you will have a simple cause of your symptoms.

It’s great that you’ve lost a heap of weight and great that you want to keep up the intensity work, but we need to be able to minimise the amount of force that’s being put through your retro patella surface (back side of your knee cap).

MRI for this type of issue rarely gives any tangible information. You don’t have a structural issue. You have an issue with how you make that structure function.

Minimise stress by knowing that pressure (pain!) is due to force (loading effect) divided by the area (how good your form is). The worse your form/function the greater the load the more pain you’ll feel.

The issue with the tissue at the back of your kneecap is that it’s extremely sensitive to load mismanagement – and when it’s stirred up it’ll remain like that for a while until you control the right amount of load being put through the joint. This can, and will take time with chronic conditions.

Have you tried taping your kneecap well? If it helps then keep taping. I think you need to stop loading your knee excessively (squat, sprints etc) It needs to be de loaded before it can be reloaded. Don’t see this as a backward step, more of a small step in the right direction.

You’ll also need someone to push your knee cap around – the structures on the outside of it become tight and stretch the structure on the inside causing an imbalance and associated pain.

And of course it goes without saying that your knee is merely the victim of what happens above (hip/pelvis) and below (foot/ankle) it – so these bits need to be fully assessed.

The biggest gains come from correcting lots of small, little errors.

Go see someone who can help manage your expectations and get you back on track – you’ve come along way, doing great but needs a little helping hand.

I’m sure I can recommend some people around the country.

The Guru

Guru Responded

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