Knee Tendinitis from Squats

[BendtheBar]

Talking this over with Off Road and LtL this morning so I am tossing it into a thread.

Frequent 90% squatting is working wonders for me but I am also picking up a bit of knee tendinitis. I fear this will soon turn into major knee tendinitis. I understand this is from a form flaw. Here's the way I am looking at my current squatting situation. Feel free to correct me if I am wrong.

I think my squat form is very good. Not perfect of course, but good. I work on it every week, and have had several of you comment in person that it's solid. We all know that form is a work in progress.

In using frequent 90% squats I am bound to accumulate bad reps. This is simply the law of averages. I believe these bad reps are the cause of the tendinitis.

What I am trying to do is solve this problem before it gets worse. I am considering 2 options:

1) Wide (or wider) stance box squats.
2) Dropping my frequency of 90% training down to once a week, or once every 2 weeks.

Thoughts? Comments? Swift kicks in the ass? Free food?

[MC]

IMO, tendonitis is going to best be solved by anti-inflams, heat-ice treatments, and either (a) complete rest and/or (b) taking some of the pressure off the tendons/connective tissue with wraps and such while working with very sub-maximal weights. If the tendonitis gets bad enough, even good reps with light weights are going to hurt.

[Off Road]

I think working high frequency combined with high intensity just brings the pain, regardless of good form. Powerlifters that are really pushing themselves are always feeling beat up somewhere.

[5kgLifter]

Originally Posted by Off Road

I think working high frequency combined with high intensity just brings the pain, regaurdless of good form. Powerlifters that are really pushing themselves are always feeling beat up.

I agree. I've found that really high intensity (in relation to what I lift) done too frequently leaves me feeling like someone has smashed all the joints involved with a sledgehammer, after a couple of weeks solid rest or at least backing off, and all the pain dissipates allowing me to get back to it again.

[BendtheBar]

I had really (REALLY) bad elbow tendinitis for about 10 years, but was always using a push heavy program. I think this combined with years of hardcore bicep work and a bazillion pushups in the military didn't help things much.

The interesting thing is that the moment I started focusing on getting my back as strong as possible it went away. Nearly overnight. I assume this corrected some imbalance.

During the elbow tendinitis period my workouts were:

--No barbell rows
--Dumbbell rows 110s or 120s for 5-ish
--No straps
--No deadlifts
--8-12 sets of biceps per week

During the period of time it went away, and until now, my workouts are:

--very heavy barbell rows
--Dumbbell rows 210s x 10 reps
--Versa Gripps
--Deadlifts
--No bicep workout

I don't want to make this a thread about elbow tendinitis, but when I try to think through the knee issue I wonder if it is driven by a weakness. I have always had strong quads and (I believe) weak hammies.

Part of me wonders if I need to hammer the snot out of my hammies with frequent wide stance good mornings and see if this helps.

[Fazc]

No kick in the ass from me.

I agree with MC in that it can be treated with NSAIDS. A certain amount of inflammation will occur from any exercise, frequent exercise of course exacerbates that. However regular use of NSAIDS does bring it's own issues with the stomach lining and can cause potential problems if relied on.

What I would suggest, and what I am also doing as I'm not confident with my own Squat form, is to reduce the number of days that you actually Back Squat and fill in the other days with variations that do not hurt. For me that works out currently to Squat, GM and Partial Squat. As my form becomes smoother I will Squat more often and do less work on the main lift.

I don't believe form is the only contributor to pain in frequent lifting, exercise is of course damaging in the short-term, but form is certainly the one thing we could all stand to improve and that improvement leads to benefits in being able to squat more often. With that in mind a friend mine recently suggested Goblet Squat Holds as a good way to introduce weighted stretching which should improve form and lead to healthier knees.

Finally, and this is just conjecture based on experience, stronger hamstrings would lead to healthier knees.

So:

1) NSAIDS used sparingly.

2) Variations in the short-term.

3) Long term improvement in form, smoother execution.

4) Strengthening hamstrings specifically. This could be GMs taking the place of Squats on one day a week.

[5kgLifter]

Originally Posted by BendtheBar

I don't want to make this a thread about elbow tendinitis, but when I try to think through the knee issue I wonder if it is driven by a weakness. I have always had strong quads and (I believe) weak hammies.

Part of me wonders if I need to hammer the snot out of my hammies with frequent wide stance good mornings and see if this helps.

From what I gather, hammies are weak on most people, so I wouldn't imagine it would hurt any if you targetted them a bit more anyway.

It could easily be a combo of things going on as well, encompassing any or all of the following to some degree or other; weakness in one area, heavy lifting itself, high frequency itself, age, joint issues.

[Pull14]

I agree with MC and OR. Because of the high frequency, intensity, and volume, local tendons/muscles will become inflammed because of the workload. Errors in form can cause or exacerbate the issue, but isn't always the single reason for inflammation.

If you like the frequency and intensity of the lifts, I'd first spend some more time with the rehab/prehab methods MC mentions: message, heat/ice, anti-inflam before and after training, and some light compression/warmth during training (light wraps or knee sleeves).

I'd also look at other things such as strength/volume balances. Not only that but tight quads, tight hamstrings, glutes, or a lower back can all put more unneeded pressure on the knee. Greater strengths in one of these areas can create tightness in that muscle and/or increase the strain in the opposing muscle. Or poor mobility in one region can do the same.

Not saying that is the case, but just be open minded to the cause of the issue.

My bet leans more towards your total workload (frequency, volume, intensity) and given that you push it so hard that your 'dead' by your 3rd week (deload) says a lot about the demands training puts on your body.

The changes that can be made to minimize the issue are as open to interpretation as is the specific causes of the issue. Reduction of frequency, reduction in intensity, longer deload, shorter loading period, greater focus on mobility, strengthening a weakness, etc, etc.

Edit: Facz makes great points as well.

[jasonjduke]

Best way to train for squats is to train with squats.

I would stop thinking that you have errors in your form or "bad" reps or weak hamstrings - this is where the true weakness in your knees appears. Any rep made is never a bad rep. From what I see in your log you are too strong to think like this. Don't succumb to such; try replacing it with the thought that you use different form for means; such as more weight on the bar. What we think will affect our outcome much more than we can ever know.

There is no single way to squat. So there is no one particular form that is better than another, but there is a particular groove that one has - like a freeway as opposed to a side street. Some side streets have big hills that are hard as hell to climb, but the freeway is where you can open 'er up.

Sounds like you need to open 'er up.

There are many things I have noticed that seem to be true for others. We are mainly designed the same by being human with bone structure with only some minor variances. But we should never round our back on any squat - unless we are going for the gold or slaying a Dragon of Iron.

Toes pointed outward tends to drive the weight through the inside of the knee joint. Doing this generally allows us to go deeper. Feet parallel moves the weight onto the outer thigh and hip, but generally doesn't allow a deep squat.

Wide stance, of course, does the same. Although doing deep ones will move much extra weight into the lower back so that your knees won't wear out as fast. A shoulder width and narrow stance may make your upper body come forward and put nearly all the weight onto the lower back and remove much of the weight from the knee.

Therefore: shoulder width stance with parallel feet removes nearly all stress from the knee. But, alas, you may be only be able to squat to above parallel or if we have the particular leverages to parallel and maybe even below parallel.

I shall digress momentarily...

Having somewhat longer legs will cause one to "fold up" their legs more so that a deep (parallel and below) squat will cause more torque on the knee joint (the folding up part). This is very important to consider, for if you have long legs, squatting below parallel or even to parallel will place greater amounts of stress on the knee joint.

Back to action...

Squatting above parallel or to just plain ole parallel does not mean we are less than we could be. Nothing of the sort. We can simply prove ourselves when we find it necessary to go deep. This shoulder/close stance parallel feet squat is necessary to become more than we are. I believe it actually throws the weight down the center of the leg and directly though the center of the knee joint - where the joint is the strongest. We must train this joint here.

How?

Moderate weight (50%-70%) for good reps. Add a "light" squat day for at least 3 sets of 10-15. If you respond better to low reps than do high sets 10 sets of 3 should do a good job. Don't force yourself to go deep - never ever round your back on these. Just find that groove and pump the blood and oxygen through. Fatigue them legs a good amount so that all the muscles scream in unison like an army marching in ordered step. When the time comes you may, of course, "Cry havoc and let slip the dogs of war!"

You don't have to tell people about these, as they really don't count anyway - do they?

Find your freeway and simply open er' up and she will stay clean and lubed for performance when you need her.

[Fazc]

Originally Posted by Pull14

I'd also look at other things such as strength/volume balances. Not only that but tight quads, tight hamstrings, glutes, or a lower back can all put more unneeded pressure on the knee. Greater strengths in one of these areas can create tightness in that muscle and/or increase the strain in the opposing muscle. Or poor mobility in one region can do the same.

Yep, I'm finding this truer and truer the stronger I get. Good points Pull.