Front squats and knee pain

Nadia Shatila · 12-21-2006, 08:33 PM

Hello!

I'm hoping someone can shed some light on my knee situation. I work with a personal trainer (we do crossfit) and in August we did front squats for the first time. I warmed up properly, started with 45lbs and worked up to 85lbs. I felt no pain whatsoever, and my trainer watched my form closely. The next day I woke up and could not walk due to tightness in my inner left knee. This lasted over 3 weeks, and one day my knee was so tight it felt as though the muscles were being pulled and were moving my knee cap into the wrong place. It took almost 2 months for me to resume running, jumping and squatting again. The werid part is that pain felt muscular, two muscles that run from the inner part of the knee up the leg are what hurt to touch and felt as they were being pulled when i walked or even tried to stretch.

A month or so ago I was doing air squats down to a ball and the next day my knee/leg was tight in the same place, however it only lasted a day or two. Then yesterday I attemped front squats again with only 70lbs, and i didn't even go down past 90 degrees and have the same pain.

I'm wondering 1.) what could this injury be? muscular strain?
2.) why this could be happening on front squats in particular? I have no pain after doing back, overhead squats or squat cleans, even if i go past 90 degrees.

Any thoughts, or ideas what could be going on?

thanks!

Christian Lemburg · 12-22-2006, 02:22 AM

Hi Nadia,

some thoughts:

1) What could this injury be?

A recurring muscular strain/spasm (probably with trigger points in the muscles involved -> massage!) that is caused by incorrect form on the front squats causing re-injury of an existing problem site. The sensations you describe (feels pulled, hurt to touch) are commonly associated with "strains", that is, microtrauma to the muscle.

2) Why is it happening?

Very probably bad form. Look into a mirror and assess what you do differently in a front squat vs. a back squat.

Watch out for more leg spread in the down position, lateral tilt or torsion in the knee, feelings of unstability or tightness when moving into the position, and weight distribution on your feet (weight on toes, heels, inside, outside). Observe and write down how it feels/looks for back squat, then for front squat. If you can't do it yourself, get your trainer or a friend to help you. But best is if you do it yourself with mirror and feeling - only you can feel some differences (especially weight/balance).

As for rehab/prevention - try to massage the muscles that are hurting. For more info on why and how to massage, see http://www.crossfit.com/discus/messages/27/14941.html.

Good luck, and fast recovery,

Christian

Elliot Royce · 12-22-2006, 09:53 AM

Christian always has great advice to offer so I hestitate before disagreeing. However, I would lean more towards excessive tightness of some of the muscles and tendons around the knee. The fact that it took you two months to recover suggests tendonitis since muscles heal from a strain in a much shorter period of time.

In any event, I would not look at yourself in a mirror -- as they say, a lawyer who defends himself has a fool as a client and the same thing applies here. Go see a sports physical therapist and go through the ranges of motion with them. You may be tight in certain spots, you may have poor form, there may be a residual injury. Anything that takes more than a week to recover from needs some expert advice.

Jan Szyndler · 12-22-2006, 08:46 PM

Just to throw this out there...
I recently went through a stint where I was squatting in the lower 400's and, over the course of a month, was relegated to doing body weight squats. I had been working out for over 12 years, so imagine my surprise when the PT told me that my abductors were weak and I needed to train them. Why? So my knees would not track in. WOW!!! Came as a real shock, but I am certainly glad I am taking care of the problem now.
No idea if this is your problem or not...simply putting it out there.

Nadia Shatila · 12-22-2006, 11:32 PM

Thank you Christian, Elliot and Jan for your feedback and ideas! You all have made some very good points and offered some great advice.

somethings I forgot to mention, I have been seeing a PT since June. I had a minor back injury which was linked to drumroll....jan you nailed it...weak abductors! apperently i had been compensating when running and it caused my back to tweak out. I didn't even think my weak abdudctors would cause my knees to track in though. I've been doing excersises persribed by my PT to help strenghten, guess I need to keep doing more.
My PT did a lot of massage, and said she just felt tightness, but the tightness for 2 months is what concerned me, and the fact that only front squats irritated it is what baffles me. I guess for now I will just eliminated them until I can really strengthen the abductors.

thanks for the tips on massage too, it's painful but has been helping!

Elliot Royce · 12-23-2006, 07:55 AM

The front squat motion is what you're going to have in cleans and snatches so you need to figure it out. Are you getting the same problems with cleans and snatches?

Again, if something lasts for two months, I would escalate the problem. Perhaps an orthopedist and an MRI?

Nadia Shatila · 12-23-2006, 09:13 AM

That is the weird part. No pain from cleans or snatches! Also for cleans i am using the same weight as i front squat. I guess i should go see an orthopedist. augh, i was just hoping i tweaked it once and after it healed it wouldn't happen again. Between this and the tendonitis in my shoulders, I'm getting frusterated!

Elliot Royce · 12-23-2006, 10:33 AM

how about getting someone to video you and post it here (not that I'm qualified to opine on your form but others are). If you can go deep in cleans and squats without pain then maybe the front squat is leading you to lean forward or something strange, putting your knee in an unusual position.

If it's a technique question, I think doctors are of limited use since they don't really understand how bodies move under load.

Keith Wittenstein · 12-24-2006, 05:17 AM

Nadia

Lots of good suggestions here. Maybe I can help prioritize a little:

IMHO
1. go to doctor and get everything checked out.
2. rest, ice, compression, elevation
3. read starting strength and Rippetoe's advise on pushing the knees out and squeezing your butt cheeks when you squat.
4. go back and read every CFJ on squats especially #4 Squat Clinic.
5. start from the beginning learning and working on your air squats.
6. post video of air, front & OH squats (broomstick or empty bar) on digital coaching board.
6. get a foam roller or "the stick" and go to work on your thighs.
7. listen to your body and don't push through the pain.
8. do more pullups.

Jim Lark · 01-04-2007, 01:32 PM

Re. abduction and adduction with the knees, please correct me if I am wrong. Was your PT telling you that you need to strengthen your abductors, aka IT band or muscles on the outside of the leg, so that your knees don't bend in?

If this is correct, run, don't walk. When the IT band is tight, during a squat, it will cause the knees to bend in, not out. The band attaches below the knee and pulls the lower leg (below the knee) out which, in turn, bends the knee in. What you need to do is strengthen the adductors (the opposing muscle to the abductor). To do this, angle the toes out at around 30 degrees when you do your squat (see Rippetoe's Starting Strength).

I may have misunderstood the diagnosis, so please excuse the long post if I have.

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12-21-2006, 08:33 PM	#1
Nadia Shatila Member Profile: Join Date: Jun 2006 Location: seattle wa Posts: 120	Hello! I'm hoping someone can shed some light on my knee situation. I work with a personal trainer (we do crossfit) and in August we did front squats for the first time. I warmed up properly, started with 45lbs and worked up to 85lbs. I felt no pain whatsoever, and my trainer watched my form closely. The next day I woke up and could not walk due to tightness in my inner left knee. This lasted over 3 weeks, and one day my knee was so tight it felt as though the muscles were being pulled and were moving my knee cap into the wrong place. It took almost 2 months for me to resume running, jumping and squatting again. The werid part is that pain felt muscular, two muscles that run from the inner part of the knee up the leg are what hurt to touch and felt as they were being pulled when i walked or even tried to stretch. A month or so ago I was doing air squats down to a ball and the next day my knee/leg was tight in the same place, however it only lasted a day or two. Then yesterday I attemped front squats again with only 70lbs, and i didn't even go down past 90 degrees and have the same pain. I'm wondering 1.) what could this injury be? muscular strain? 2.) why this could be happening on front squats in particular? I have no pain after doing back, overhead squats or squat cleans, even if i go past 90 degrees. Any thoughts, or ideas what could be going on? thanks!

12-22-2006, 02:22 AM	#2
Christian Lemburg Member Profile: Join Date: Jan 2005 Location: Aachen NRW Posts: 308	Hi Nadia, some thoughts: 1) What could this injury be? A recurring muscular strain/spasm (probably with trigger points in the muscles involved -> massage!) that is caused by incorrect form on the front squats causing re-injury of an existing problem site. The sensations you describe (feels pulled, hurt to touch) are commonly associated with "strains", that is, microtrauma to the muscle. 2) Why is it happening? Very probably bad form. Look into a mirror and assess what you do differently in a front squat vs. a back squat. Watch out for more leg spread in the down position, lateral tilt or torsion in the knee, feelings of unstability or tightness when moving into the position, and weight distribution on your feet (weight on toes, heels, inside, outside). Observe and write down how it feels/looks for back squat, then for front squat. If you can't do it yourself, get your trainer or a friend to help you. But best is if you do it yourself with mirror and feeling - only you can feel some differences (especially weight/balance). As for rehab/prevention - try to massage the muscles that are hurting. For more info on why and how to massage, see http://www.crossfit.com/discus/messages/27/14941.html. Good luck, and fast recovery, Christian

12-22-2006, 09:53 AM	#3
Elliot Royce Member Profile: Join Date: Mar 2006 Location: Inowa KS Posts: 922	Christian always has great advice to offer so I hestitate before disagreeing. However, I would lean more towards excessive tightness of some of the muscles and tendons around the knee. The fact that it took you two months to recover suggests tendonitis since muscles heal from a strain in a much shorter period of time. In any event, I would not look at yourself in a mirror -- as they say, a lawyer who defends himself has a fool as a client and the same thing applies here. Go see a sports physical therapist and go through the ranges of motion with them. You may be tight in certain spots, you may have poor form, there may be a residual injury. Anything that takes more than a week to recover from needs some expert advice.

12-22-2006, 08:46 PM	#4
Jan Szyndler Member Profile: Join Date: Nov 2005 Location: Cleveland Ohio Posts: 112	Just to throw this out there... I recently went through a stint where I was squatting in the lower 400's and, over the course of a month, was relegated to doing body weight squats. I had been working out for over 12 years, so imagine my surprise when the PT told me that my abductors were weak and I needed to train them. Why? So my knees would not track in. WOW!!! Came as a real shock, but I am certainly glad I am taking care of the problem now. No idea if this is your problem or not...simply putting it out there.

12-22-2006, 11:32 PM	#5
Nadia Shatila Member Profile: Join Date: Jun 2006 Location: seattle wa Posts: 120	Thank you Christian, Elliot and Jan for your feedback and ideas! You all have made some very good points and offered some great advice. somethings I forgot to mention, I have been seeing a PT since June. I had a minor back injury which was linked to drumroll....jan you nailed it...weak abductors! apperently i had been compensating when running and it caused my back to tweak out. I didn't even think my weak abdudctors would cause my knees to track in though. I've been doing excersises persribed by my PT to help strenghten, guess I need to keep doing more. My PT did a lot of massage, and said she just felt tightness, but the tightness for 2 months is what concerned me, and the fact that only front squats irritated it is what baffles me. I guess for now I will just eliminated them until I can really strengthen the abductors. thanks for the tips on massage too, it's painful but has been helping!

12-23-2006, 07:55 AM	#6
Elliot Royce Member Profile: Join Date: Mar 2006 Location: Inowa KS Posts: 922	The front squat motion is what you're going to have in cleans and snatches so you need to figure it out. Are you getting the same problems with cleans and snatches? Again, if something lasts for two months, I would escalate the problem. Perhaps an orthopedist and an MRI?

12-23-2006, 09:13 AM	#7
Nadia Shatila Member Profile: Join Date: Jun 2006 Location: seattle wa Posts: 120	That is the weird part. No pain from cleans or snatches! Also for cleans i am using the same weight as i front squat. I guess i should go see an orthopedist. augh, i was just hoping i tweaked it once and after it healed it wouldn't happen again. Between this and the tendonitis in my shoulders, I'm getting frusterated!

12-23-2006, 10:33 AM	#8
Elliot Royce Member Profile: Join Date: Mar 2006 Location: Inowa KS Posts: 922	how about getting someone to video you and post it here (not that I'm qualified to opine on your form but others are). If you can go deep in cleans and squats without pain then maybe the front squat is leading you to lean forward or something strange, putting your knee in an unusual position. If it's a technique question, I think doctors are of limited use since they don't really understand how bodies move under load.

12-24-2006, 05:17 AM	#9
Keith Wittenstein Affiliate Profile: Join Date: Jun 2004 Location: New York New York Posts: 945	Nadia Lots of good suggestions here. Maybe I can help prioritize a little: IMHO 1. go to doctor and get everything checked out. 2. rest, ice, compression, elevation 3. read starting strength and Rippetoe's advise on pushing the knees out and squeezing your butt cheeks when you squat. 4. go back and read every CFJ on squats especially #4 Squat Clinic. 5. start from the beginning learning and working on your air squats. 6. post video of air, front & OH squats (broomstick or empty bar) on digital coaching board. 6. get a foam roller or "the stick" and go to work on your thighs. 7. listen to your body and don't push through the pain. 8. do more pullups.

01-04-2007, 01:32 PM	#10
Jim Lark Member Profile: Join Date: May 2005 Location: Newark CA Posts: 58	Re. abduction and adduction with the knees, please correct me if I am wrong. Was your PT telling you that you need to strengthen your abductors, aka IT band or muscles on the outside of the leg, so that your knees don't bend in? If this is correct, run, don't walk. When the IT band is tight, during a squat, it will cause the knees to bend in, not out. The band attaches below the knee and pulls the lower leg (below the knee) out which, in turn, bends the knee in. What you need to do is strengthen the adductors (the opposing muscle to the abductor). To do this, angle the toes out at around 30 degrees when you do your squat (see Rippetoe's Starting Strength). I may have misunderstood the diagnosis, so please excuse the long post if I have.