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Old 04-10-2009, 12:02 PM   #1
Andrew Wilson
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Default chondromalacia patellae, knee bend, and muscles imbalances

So starting back in Oly, I've really began to discover the muscles imbalances I have developed from doing random workouts & body weight/ mono type training. This week I've come across a very minor case of chondromalacia patellae in my right knee. I should be able to recover soon, but the cause is very, very obvious, check out these squats:

http://www.dailymotion.com/coldsurf/video/15017067

I've always had this issue ever since I started Oly in high school, yet never really solved them. Being a wrestler then, weight cutting would always detrain the gains. Now out of college, I started Oly again and things like this are starting to be exposed. I figured the knee bend has to do with being quad dominant, so bought Starting Strength a few weeks ago and have been reading up on how to activate the hamstrings. Worked very well so far and continued to work heavy squats to fix it. Now, I've come across this chondromalacia patellae and have realized I need to put more focus in fixing this. There's definitely something going on with the right knee, I can see it in all squat, snatch, and clean videos...

Does anyone have an recommendations on how to rehab/fix this?

I'm going to rest it until I quit hearing the grinding noise in the joint, then starting doing pistols to retrain alignment. My leg strength right now is the strongest its every been. I've gained 7 pounds just this month...
Thanks AW
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Old 04-10-2009, 12:26 PM   #2
Dave Van Skike
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Quote:
Originally Posted by Andrew Wilson View Post
So starting back in Oly, I've really began to discover the muscles imbalances I have developed from doing random workouts & body weight/ mono type training. This week I've come across a very minor case of chondromalacia patellae in my right knee. I should be able to recover soon, but the cause is very, very obvious, check out these squats:

http://www.dailymotion.com/coldsurf/video/15017067

I've always had this issue ever since I started Oly in high school, yet never really solved them. Being a wrestler then, weight cutting would always detrain the gains. Now out of college, I started Oly again and things like this are starting to be exposed. I figured the knee bend has to do with being quad dominant, so bought Starting Strength a few weeks ago and have been reading up on how to activate the hamstrings. Worked very well so far and continued to work heavy squats to fix it. Now, I've come across this chondromalacia patellae and have realized I need to put more focus in fixing this. There's definitely something going on with the right knee, I can see it in all squat, snatch, and clean videos...

Does anyone have an recommendations on how to rehab/fix this?

I'm going to rest it until I quit hearing the grinding noise in the joint, then starting doing pistols to retrain alignment. My leg strength right now is the strongest its every been. I've gained 7 pounds just this month...
Thanks AW

I've battled a pair of knees with this condition., ultimately needing surgical relocation of both kneecaps and extensive cartilage "remoldeling" the rehab for this took more than 5 years. I'll dig out some stuff I have on kneehab but first a couple highlights...if you're smarter than me you'll do the following.

You will abandon the concept of quad dominance, Tom Platz, Dan Jansen and Eric Heiden were quad dominant. Unless you have 4 inch thick slabs of meat hanging over your knee, you're not quad dominant, you just have a weak ass and hamstrings.


You'll believe it when people tell you that little knee problems of this kind are included (along with Wu Tang Clan) in the overarching category of " things to not fuck with."

You won't rely on advice on the internet about a potentially crippling knee condition...yes it sounds like hyperbole, it's not.

If you value your knees you will abandon the theory that pistols retrain anything, and treat them along with olympic lifts as an amusing parlor tricks for now.

You will embrace the box squat, the romanian deadlift, the glute ham raise and TKE's.

You will see as many competent sports med doctors as it takes and work through aggressive and early PT rehab..you will do the silly little excercise they give you however preposterous because PT works...when people actually do it.
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Old 04-10-2009, 01:18 PM   #3
Andrew Wilson
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Interesting, how'd it originally occur? I've CrossFitted for 3 years and deadlifts, box squats, GHR never really helped the problem. There was a period of 12 weeks where all I did was Fran 3 to 4, 5 times a week on a medicine ball with additional wods on the in between days and it disproportionately trained my legs at certain angles. So I have a pelvic tilt forward when I push loads up.
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Old 04-10-2009, 01:42 PM   #4
Dave Van Skike
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Interesting, how'd it originally occur? I've CrossFitted for 3 years and deadlifts, box squats, GHR never really helped the problem. There was a period of 12 weeks where all I did was Fran 3 to 4, 5 times a week on a medicine ball with additional wods on the in between days and it disproportionately trained my legs at certain angles. So I have a pelvic tilt forward when I push loads up.
Mine occurred when I was a bike racer. The start was very subtle, almost an itch under the kneecap early in the pre season. I suspect it was squatting technique issue like yours, pronounced postural problems from cycling coupled with several months of 400 mile weeks on the bike.

Box squatting and heaploads of hamstring work done in the context of a bunch of sloppy metcons will only make matters worse.

I don't want to come off as a total ass but that squat vid is a horror show. if that were a max balls out squat I could see suffering through one of those reps but man alive, regardless of knee condition, it's time to take something off that bar and learn how to squat. Again. no offense intended, there's just no nice way to say it.
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Old 04-10-2009, 03:03 PM   #5
Andrew Wilson
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Yeah I know
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Old 04-10-2009, 03:04 PM   #6
Steven Low
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Stretch your IT bands HEAVILY....

Strengthen your VMO. TKEs work... squats with someone between your legs that you're squeezing (or wall squats with a pillow or something).

Basically get the medial side of the leg stronger and loosen up the lateral side. Strengthen the hammies.

The tendency of some patellofemoral syndrome is to have the knees collapse in when they squat.


Pretty much what Dave said though.
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Old 04-10-2009, 03:04 PM   #7
Andrew Wilson
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But that was prior to making the Starting Strength adjustments
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Old 04-10-2009, 03:05 PM   #8
Andrew Wilson
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Thanks Steve
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Old 04-10-2009, 03:29 PM   #9
Dave Van Skike
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Originally Posted by Steven Low View Post
Stretch your IT bands HEAVILY....

Strengthen your VMO. TKEs work... squats with someone between your legs that you're squeezing (or wall squats with a pillow or something).

Basically get the medial side of the leg stronger and loosen up the lateral side. Strengthen the hammies.

The tendency of some patellofemoral syndrome is to have the knees collapse in when they squat.


Pretty much what Dave said though.
as a starting proposition, jut strengthening the VMO and hamstrings may clear some stuff up.

here's a little routine I used to do do every night whilst watching Le Tube
requires one green band. I worked up to this over time and after PT had ended.
  • do about a 100 TKE's per side in sets of maybe 20-50 with a green band.
  • then stretch the hamstrings and IT bands super duper lightly for about 10 min with bands.
  • then foam roll the IT band lightly...very lightly, don'e go all aggro with the roller.
  • then stretch the hip flexors.
  • then do some band Good Mornings...this is the time and place for that "pumped up feeling" the BB guys talk about. you want to literally pump blood into your hamstrings, glutes and low back. if you have a super light KB this would be a good thing too.
  • then do quad sets, basically hold a ball, (soccer, basketball, foot ball) between your knees and lock you legs in extension and then flex your quads hard holding the contraction for a couple maybe 3 seconds. do 50-100 as a minimum.
  • then do the TKE's again, work up to a couple hundred.
at the end of the day, I really I believe that nothing is better for f'ed up knees and a screwy squat than wide stance box squats with a vertical shin. when you are able to return to regular squatting it will be terrible and slow, you might miss depth and the rack will feel all wrong, but your hips will be stronger and you'll have built a good foundation for squatting as you bring your feet back in.
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Old 04-10-2009, 04:29 PM   #10
Andrew Wilson
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Thanks Dave much appreciated
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