Knee Injury - Not a beginner

[Tranceparent]

Hello everyone,

As someone who started NROL for Men about a two months ago, I have been lurking around this website. I am happy to say a lot of my questions have been answered from this resource.

I was hoping that I could get some insight on this knee issue that I am experiencing.

I am currently 24 years old, and have been lifting since 17. However, I have not seriously trained my legs before beginning the NROL book. No squats, etc.

December 2007, I developed tendonitis and bursitis on my left shoulder so I took about a year off the gym. I was in my senior year of college so I got tied up in finishing my thesis and proposals. This time off allowed me to reflect on my method of lifting. Previously I was pretty confident on my lifting methods since I do a lot of research on the topic, but the injury made me realize that I was doing something wrong and started to look for other methods of working out. Obviously something was wrong with isolation training although I got tremendous results on my upper body.

I found the concepts in NROL very interesting and decided to give it a shot. I am glad to say, the shoulder has taken care of itself, and touch-wood, it is as good as new. However, I have hit another road block after completing the Break-In and Hypertropy I programs.

I started to feel a subtle discomfort on my left knee during the last days of the break in period, I ignored it and worked through the Hypertrophy I program, during which the discomfort increased to slight pain. Now at Hypertrophy II, the pain is much more noticeable, and I am getting worried about what I might be doing to my knee.

The following are some details on my injury.

1. When did the pain begin?
The pain started a couple of weeks into my Break-In program. This was the first time I was doing squats and deadlifts seriously.

2. What were you doing at the time? Or did the pain come on gradually over time?
The pain came on gradually over time.

3. Where, anatomically, is the pain?
The pain is on my left knee, feels like it is under the top part of the knee cap.

4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
It is pretty sharp, but not unbearable.

5. Is the pain constant, or intermittent, or only on certain motions?
The pain is not present when my leg is resting. However I feel it when I move my left leg (take the stairs, press down the clutch pedal of my car, do lunges, squats, getting out of my car etc).

6. What motions make your pain worse?
Bending the knee under load.

7. What, if anything, makes your pain better?
Not moving the leg.

8. Does your pain radiate to any other part of your body?
It does not.

9. What things could you do before, that you cannot do now because of your injury?
Nothing in particular. But now I feel pain when taking the stairs, and doing other stuff I used to be able to do pain free.

10. What is your main concern regarding the pain and its consequences?
That I might be hurting my knee further by continuing to squat or lunge.

11. Have you ever injured that part of your body before? If so, how?
No

12. Is your pain getting worse over time? And if so, how much worse over what time period?
The pain has gotten worse over time, it started from a faint discomfort about two months ago to pretty concerning pain.

I would appreciate it if someone could help me out with this, as it is a little frustrating to return to the gym after a year of taking off due to one injury, only to develop another issue

[Aoife]

(I'm not one of the injury peeps, but…)

It sounds like it could be an imbalance and weak posterior chain. Usually quad dominance can give knee pain and often like you describe. So while you should definitely listen to someone like Julie who knows way the hell more than me… I'd wonder if better targeting and activating your hamstrings and glutes will fix your issue. Certainly, it won't hurt. So RDLs, glute bridges, birddogs, leg curls on the physioball… that kind of thing would help.

If you're doing lunges and you find it hurts more if you're leaning your torso forward rather than staying upright, it could be a clue that this is part of your problem. When doing squats, deads, lunges, etc work on using your glutes… your quads shouldn't be doing all the work of straightening your legs.

I actually find that when I start up after a long hiatus, I just don't do loaded squats, and start with posterior work precisely because I rather easily end up like this if I'm not careful.

But anyway, welcome to the land of posting and I'm sure someone else will be of much more help than I am.

[Cloud9Fitness]

I suspect you are experiencing quadriceps tendinitis (QT). The differential includes other ligament, bursa, or soft tissue injury, but your history is textbook for QT. Specifically the location, sensation, and going from not training to a new program.

The theory behind improving the symptoms include addressing muscle firing patterns/balance with the great suggestions from the poster above (Aoife), and acutely addressing the discomfort with anti-inflammatories (AIs).

I would like to make one keep point if you decide to use AIs. They can reduce inflammation, but there is growing evidence that reducing inflammation may interfere with soft tissue healing, so tissue is suseptible to greater training response while under the influence of AIs . Also training while using AIs may not inhibit recovery when compared to individuals who take time off from exercise while using AIs. So, focus on the exercise suggestions for Aoife, and others that will be posted, to ensure inhibition of quadriceps dominance and the development appropriate muscle firing patterns in the face of AI use.

[Tranceparent]

Thank you for your responses, Aoife and Cloud9Fitness. I had figured it might be a posterior chain issue, and had begun to add some hamstring isolation work along with my leg workouts.

For now I will stop lifting on the Leg day of the Hypertrophy II program and instead do the exercises you guys suggested three to four times a week. Hopefully that does enough for me to be able to get back to painless squatting and lunging.

I will report back on the results.

[UConnJulie]

I would focus more on GLUTEAL strengthening than hamstring.
Also, stretch your quads. I find that most people have very tight quads.

[Tranceparent]

Thank you for your response Julie, I have been concentrating on stretching my quads (standing up and bending one knee) and hamstrings (toe touches) as well.

I was reading up on Quadricep Tendonitis, and it appears that it may be what I have on my left knee.

The symptom that really hit home was a sensation of 'warmth' on the affected area -- which is what I feel right above and to the left of my Patella while working out.

To my knowledge the best practice to relieve Tendonitis symptoms is to rest and ice for 20 minute intervals twice a day, till the issue is gone-- then easing back into the excercises.

Thoughts?