Forums General Knee pain during/after squatting — what’s going on?

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    • #71458
      AvatarBen Dispoto

        Hi there!

        I’m experiencing some right knee pain during/after high-bar squatting for a couple of years. The pain is mostly right above the knee cap and I don’t think the issue is technique (here’s an old video of me squatting: ). 
        I’ve spent a lot of time recently doing mobilizations from Supple Leopard with special attention to hips and ankles and I’m just not seeing an improvement. I always thought it was probably lack of range of motion in my right ankle: my right foot tends to want to externally rotate at the bottom of the squat. Back when I was doing Olympic lifts, when I’d catch the bar after a clean or snatch, my right foot would often be severely externally rotated–much more so than the stance that I began the lift with. Here’s an (again, old) example:
        To further support this, if I sit upright on a chair and put my feet on the ground in front of me, I cannot move my right foot closer to me without the heel lifting off the ground (which again, seems like an ankle range of motion issue to me). I took a photograph to illustrate this:
        So in the photo I simply attempted to move both feet as close to my body as possible without the heel lifting off the floor. As you can see, my left side is doing much better.
        So what confounds me about the ankle mobility is that no matter how much I work on it, this issue doesn’t seem to improve. Additionally, I’ve had a few superfriends compare the mobility between my two ankles and they all say it looks about equal. 
        The final bit of information I have is that I often feel a bit of soreness right above my right glute (sort of at the junction of the glutes and lower back) after squatting. I had a pretty severe back injury in that location from a clean a couple of years ago (and that’s about when the knee pain started). I’m not sure if that’s a factor (I have tried resetting my pelvis multiple times but never hear/feel a pop).
        Any input would be really appreciated!
      • #76182
        AvatarNathan Richer

          Hmm that last bit of info seems very important. One diagnosis would be this.

          your injury resulted in the inhibition of your right glute. now when you squat, you rely on your quad to bring you up to compensate for lack of glute action. the quad’s overuse then tightens down all the structures around your knee and you feel pain there now.
          so if you want to test this diagnosis, i would:
          1. voodoo band around the knee. get those tissues around the knee to loosen up. continual squatting will keep tightening those up and result in pain. if this continues, it could develop into something far worse. smashing the quads and hamstrings wouldn’t be a bad idea either.
          2. how’s the back injury? have you done a recent MRI to check the status of your spine?  if there are discs still bulging, i would find a good clinician to address the disc first before squatting ever again.
          3. if the spine is ok, then i wonder about your posture. how good is it? you may be compensating in some way that is subtle.
          4. good torso stabilization is key. do you breathe diaphragmatically? that is the correct way to stabilize, which is to use the diaphragm’s descent to create intra-abdominal pressure to stabilize.
          5. your glute may need some retraining after so many years of being inhibited.  i would do right glute strengthening – ie. single leg glute bridges, single leg deadlifts, but also manage the right hip flexors – ie. couch stretch, gut smashing, smashing the rectus femoris, etc..
          also if you try squatting, maybe with a lot less weight, make sure you pay extra attention to squeezing the glutes (esp the right glute) as you come up, as well as driving the hip forward as you get erect.
          as for your disparity between the ankles, did this happen after your injury or was it like this before? it could be related to the lack of proper glute action if after the injury. 
        • #76183
          AvatarBen Dispoto

            Hey David,

            Thanks a lot for the informative response.
            My back is okay, I think. The soreness I feel is minor and actually seems to decrease with time (but I’ve stopped/started squatting again so many times that it seems like I often have it, haha). I agree that it would probably be prudent to get an MRI and I will when the time is convenient. 
            I like your glute theory. In addition to the exercises you mentioned, do you think a switch to the low bar squat would help due to greater glute involvement? I actually used to exclusively low bar squat and never had issues/pain whatsoever. It was only on the switch to high bar/Olympic lifting that issues started to develop. I haven’t switched back out of stubbornness

            I think the ankle disparity developed once I started Olympic weightlifting and then the injury happened a few months after.
          • #76184
            AvatarNathan Richer

              if your superfriends say your ankle mobility seems equal, then it is not a soft tissue or local problem but either a motor control or upstream problem.

              as MWOD likes to say, there are three things to check: 1) soft tissue 2) motor control 3) joint position in sockets.  and then do these things upstream and downstream from the problem.
              it sounds like once you started Oly lifting, the ankle problem was probably a sign of something wrong up stream and then the injury happened.  it could be the glutes that is causing ankle in-mobility.
              in the sitting pic above, it could be some residual tightness in the legs that is preventing you from moving the right foot closer without the heel lifting up. 
              ok so loosen up with smashing and banded hip openers. can you get your feet closer while in that seated position?  also, use the air squat as a test. how low can you air squat down before the foot wants to turn?  try generating torque (ie. screwing both feet into the ground ) *before* you descend. does that help?  how low can you go in air squat – ass to heels with proper back posture – it looks like from your squatting video that you can do this.
              this is a good read on the differences bet low and high bar squatting:
              the change in lever arm when you went high could have been enough to exacerbate an existing problem enough to flare…
            • #76187
              AvatarNathan Richer

                oops sorry the low/high bar squat link isn’t relevant here. was thinking about another post on this forum!

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