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Adrian Miles
12-16-2009, 02:31 AM
I've recently started regularly doing squats (3 x 10 @ 70kg and trying to increase load) as part of a rehab program for ITB issues (on top of my normal Crossfit) but have noticed a kind of soreness down the front if my knees. Its not painful or uncomfortable really, just like DOMS but in what I think is the patella tendon.

Just curious to know if this should be happening or if maybe my knees are tracking to far forward and therefore taking more load than they should be?

any advice/opinion would be greatly appreciated.

thanks!

Steven Low
12-16-2009, 06:11 AM
Read this... especially sections 3+4 and evaluate yourself:

http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/

If you have any questions feel free to post them here. BTW, sorry it's long.

Dave Van Skike
12-16-2009, 08:38 AM
I've recently started regularly doing squats (3 x 10 @ 70kg and trying to increase load) as part of a rehab program for ITB issues (on top of my normal Crossfit) but have noticed a kind of soreness down the front if my knees. Its not painful or uncomfortable really, just like DOMS but in what I think is the patella tendon.

Just curious to know if this should be happening or if maybe my knees are tracking to far forward and therefore taking more load than they should be?

any advice/opinion would be greatly appreciated.

thanks!

should not be happening. i've blathered on about knees and squats on this board too much already. ITB problems and knees. not unlike the Wu Tang Clan: NTFW.

voice of experience. fix that problem now

Adrian Miles
12-16-2009, 12:07 PM
Thanks guys!

Just to clarify - the ITB is not being aggravated or caused by squatting. The squats are to address many of the issues in the EMI article. (addressing glute strength etc). I am trying my absolute best to maintain correct form and have been given coaching at my affiliate. I am seeing an A.R.T therapist - (but I haven't spoken to him about this yet)

My main issue is this 'soreness'. Its not pain - its like having a sore muscle, but it feels like its in my patella tendon.. It does not affect my ability to squat or run or anything, just a bit annoying the day after squatting. And I'm hoping its not a precurser to some evil tendonitis.

My A.R.T has prescribed squats with feet out at approx 45 degrees to activate the vastus med more I think. Would that have anything to do with it?

Thanks again for the input

Dave Van Skike
12-16-2009, 12:39 PM
Thanks guys!

Just to clarify - the ITB is not being aggravated or caused by squatting. The squats are to address many of the issues in the EMI article. (addressing glute strength etc). I am trying my absolute best to maintain correct form and have been given coaching at my affiliate. I am seeing an A.R.T therapist - (but I haven't spoken to him about this yet)

My main issue is this 'soreness'. Its not pain - its like having a sore muscle, but it feels like its in my patella tendon.. It does not affect my ability to squat or run or anything, just a bit annoying the day after squatting. And I'm hoping its not a precurser to some evil tendonitis.

My A.R.T has prescribed squats with feet out at approx 45 degrees to activate the vastus med more I think. Would that have anything to do with it?

Thanks again for the input


ITB screw ups are usually indicative of something, so even if ITB doesn't get worse there is still a hip function thing to sort out.

my opinion about the foot angle and VMO may be ill informed but I think prescription sounds like utter BS. if you have a sleepy VMO you have tracking problems, if you have tracking problems they start as a soreness in the p. tendon..it is subtle at first. it goes downhill if not attended to. knees and squats are like certain advanced sexual practices..if it hurts, you're doing it wrong.

i'm not a doctor but here's something i would try and see if it works for you. as an interim squat technique to build some hip drive and flexibilty.

try to squat in a wide stance to a medium high box. when i say medium I mean you're right at parallel, not below, not really above. when i say wide i mean heels fully an inch plus outside shoulder width, and by shoulder width I mean the outside of your shoulders, not heel in line with shoulder socket...i mean wide. at first you may have a hard time gettign to eh box without plopping. like all regualr squats drive your knees apart going down and on the way up.

start by doing these unweighted. shins should be perpendicular to the floor or even knees behind shins. develop some hip drive and hip mobility. you should be able to do this without aggravating either knee or hip (ITB)...

try and see. look up "terminal knee extensions" for another VMO option.

Adrian Miles
12-17-2009, 02:57 AM
Thanks for the ideas. I'm definitely going to give them a go.

The A.R.T guy did have me squatting in an almost sumo-like stance, much wider than I normally would - but with toes pointed outwards up to 45 degrees like I mentioned previously.

Really want to get the knees and hips super strong. I'm aiming for a 100km trail run in about 4 mths. Overshooting probably at this stage.

But like you said- if it's hurting, it's wrong.

Dave Van Skike
12-17-2009, 07:42 AM
sounds like the ART guy and I are coming up with the same thing. so maybe we're both full of it....

do try the box, will help teach you to open your hips and use hips to drive up.
good luck

Steven Low
12-17-2009, 12:47 PM
Wide is good for now get all of the tissues moving correctly.

Work on your mobility/flexibility so you can do closer together sooner rather than later though.

Brandon Oto
12-17-2009, 03:06 PM
I posted a bunch of stuff recently on what worked for me on the knee issue, but if you're at an early stage I'd probably just say: be absolutely 100% certain your knees always always track over your feet.

People think they're good but in reality when they come out of the hole their knees dive in, whether a lot or just a wriggle. Do not allow this. "Knees out" may become your primary cue when squatting.

Adrian Miles
12-17-2009, 09:44 PM
Brandon do you have a link to where you posted what worked? You have an awful lot of posts on here and I can't seem to find it. Apologies.

My ITB is getting better from the strength work (squats) that I'm doing. My two constant cues are: knees out and maintain lumbar curve.

The last ITB issue I had, I believe, was from not managing it properly, had tight glutes, lower back and hamstrings from deadlifts the day before. But now this strange patella 'stiffness/soreness' - very strange, can't seem to find anything much about that part of it.

Brandon Oto
12-18-2009, 04:37 AM
http://www.performancemenu.com/forum/showthread.php?p=66400#post66400

I can't swear we're talking about the same problem, of course. For me it's patellofemoral syndrome, aka runner's knee.

Steven Low
12-18-2009, 05:08 AM
Do the soft tissue work I mentioned in section 4 of the above article.

Most of that stuff was written with PFS and ITBand in mind along with the other valgus disorders

Dave Van Skike
12-18-2009, 07:58 AM
http://www.performancemenu.com/forum/showthread.php?p=66400#post66400

I can't swear we're talking about the same problem, of course. For me it's patellofemoral syndrome, aka runner's knee.


sounds exactly like it to me...that's how my knee disfunction started.

might also add, doing a lot of other stuff (crossfit) on top of a knee rehab routine might be a problem...use soem restraint until your knee is worked out. if you simply must breathe alot, alternate between KB swings and pullups for as long as you can stand it in placce of your @fit stuff. neither should aggrevate a knee prob. and both are good for you.

i suggest those two things becuase that's what worked for me way back in the very beginning before i could bench or pull or squat at all., kb swings and pullups

Brandon Oto
12-18-2009, 11:22 AM
Thanks, I really should've mentioned that. Despite all of the above remedies I mentioned, none of them REALLY "fixed" the problem all the way -- to the point where I'm pain-free now for the most part -- until I pretty much took three weeks off training (due to relocating) and just rested everything completely. That was the critical point.

Steven Low
12-18-2009, 01:32 PM
Thanks, I really should've mentioned that. Despite all of the above remedies I mentioned, none of them REALLY "fixed" the problem all the way -- to the point where I'm pain-free now for the most part -- until I pretty much took three weeks off training (due to relocating) and just rested everything completely. That was the critical point.
I'm sure professionally done soft tissue manual work would've helped significantly. Self massage tends to be somewhat limited especially if you don't know what you're doing..

But yeah, when in doubt rest is 99.999999% never a bad thing.

Adrian Miles
12-18-2009, 04:30 PM
Just got back from the A.R.T and he seemed to think it was probably quad tightness that could potentially develop into chondromalacia if left. Got my quads released (painfully) and they feel much looser - will start on all the new suggestions that everyones given me here.

Steve Shafley
12-18-2009, 04:56 PM
Adrian, it is also worthwhile to make sure both your hip and your ankle have sufficient mobility. Inappropriate stiffness in either area often results in sore knees as well.

Brandon Oto
12-18-2009, 05:54 PM
I'm sure professionally done soft tissue manual work would've helped significantly. Self massage tends to be somewhat limited especially if you don't know what you're doing..

But yeah, when in doubt rest is 99.999999% never a bad thing.

Yep, not sure if I mentioned it in the other post, but a good working-over by a massage therapist was the other turning point for me. Like Shaf says, mobility from hip to toes, fix your form, and rest as needed.

Frankly none of the stuff like TKEs or other "isolate x part of your quad" training did shit for me. But YMMV. Theories abound on this stuff.

Steven Low
12-19-2009, 08:08 AM
Just got back from the A.R.T and he seemed to think it was probably quad tightness that could potentially develop into chondromalacia if left. Got my quads released (painfully) and they feel much looser - will start on all the new suggestions that everyones given me here.
You coulda done this yourself if you read sections 3 & 4! Albeit probably not as effectively but every little bit helps..

Adrian Miles
12-19-2009, 02:45 PM
I promise I read it Steven! Thanks! I'd actually read it a few weeks ago too when someone from my box had linked to it on our forum. And I just read it again for good measure.

You're definitely being heard. I've been seeing the A.R.T for a few months now. I think I had some really serious adhesions in my quads because I've rolled quite a lot and its never loosened up the way it did yesterday. (or I've not done it correctly)

I will be utilising a lot more of the stretching that you have links to because I know that is a major deficiency in my maintainance/rehab.