Knee pain while Squatting Think it's form.. Squat Check Anyone?

[crzipilot]

My 16 yr old son has started having some knee pain while squatting. He made great gains on Rips program last year and was starting back to lifting. He lifted some through football season, but took a hit to his knee, and any heavy squats bothered the knee so he dropped the weights way down on squats through the season. He took about 2 weeks off after the season to let his body have a small break before getting into his off season workouts. Even with the time off, as he moved up in weight on his squats (around 300 lbs), he has a knifing pain at the top of his knee cap.

I found a thread which kinda confirms what the trainer at high school says, and that's tendonitis at the quad patella attachment. I think his form has suffered quite a bit, from not concentrating on lifting during season. We have both learned what we know, from reading the forums here, and going by rips books. I video taped him, and now reviewing his form, and BBT, I see some glaring form issues, but wondering if anyone else could take a look. The video only has 135 on his back, but the items I see,
Bar to high, not a low bar position.
Hands to far wide, wrists bent.
Looks as though his knees are leading and not his hips
See some movement towards the bottom, of his heels, indicating his weight is shifting to the front of his feet.
Knees moving forward

So corrections needing to be made, Lower bar position, Fix his hands/wrists, Hips need to lead going down and up, keeping bar mid foot, which should fix his knees shifting forward and weight shifting towards his toes.

Any comments are appreciated....

http://www.youtube.com/watch?v=bva2J33npHk

http://www.youtube.com/watch?v=kZx78IO1hW4

[nisora33]

I'll just address the stuff that might relate to his knee problem.

I don't see any forward knee drift at the bottom, but I do see knees getting forward quite late in the movement. Not sure whether this could be causing him pain, but given that he injured the knee already, the more probable cause is prior injury, not the knees getting forward late. However, in order to rule this out as an aggravation, make sure he gets his knees forward EARLIER. Rip does not teach breaking with the hips first necessarily. He in fact teaches getting the knees forward to where they're going to be for the remainder of the movement by the first 1/3 of the movement. Review the section in SS that addresses the Terribly Useful Block of Wood and you'll see this.

It's difficult to tell whether he's getting sufficient depth from this angle--although I think that he most likely is--but shallow squats can lead to pre-patellar aggravation like the kind you're describing. Double-check this.

If the problem persists, and you're certain that every other form issue related to the hips and knees is polished (making sure that he gets the knees forward early, jams the knees out early as well, and gets sufficient depth), then you can chalk the pain up to scar tissue left over from his having been injured, perhaps. If he continues to employ linear progression on the squat using PERFECT form, and the problem STILL persists, then it may be time to use the Starr rehab protocol.

If all else fails, he may have to use a shins-vertical squat variation, which takes most of the quadracep out of the movement and uses primarily posterior-chain musculature, from now on. Not saying that it'll come to that. It's a less than optimal squat variation, but keep it in mind as a last result.

-Stacey

[nisora33]

Okay, I didn't realize there was a second video.

He definitely IS NOT getting sufficient depth. Take care of this immediately. Shallow squats can--without any history of knee injury or pain--cause aggravation of this nature all on their own. But it's very likely they're aggravating the existing injury, assuming that it has not healed correctly during the time since football.

And again, get the knees forward SOONER.

-S.

[confuzzl3don3]

As you said, there are some things he needs to fix. To add to your list, he needs to look down more so that he can utilise hip drive better because i don't see much hip drive (but don't know if this is also related to his high bar position = less hip drive than low bar).

In regards to the knee pain, i suffer from that as well and i don't really know why but it usually hurts the day after i squat and generally relieves by continuing to stretch the quads and performing bodyweight squats throughout the day. The main things i see that could be causing it, is as u said that his weight is shifting a bit putting undue stress on the knees. Also there is the whole knee wobbling thing, sorta looks as if they're caving in a bit. Tell him to make sure his knees stay out and fixed as you push out of the whole so it doesn't wobble around like that.

I know more experienced help will be on the way so i leave it to them :D

[crzipilot]

Thanks for the quick responses.

I'll definitely get the depth issue fixed. I'm reviewing the squat section of SS now (as I obviously have to clean out the cobwebs) These videos were of his first sets after not really squatting for most of the football season, and took the videos for him to see his form also.

He does know about keeping his knees out, and pushing them out, and I'll emphasize this more. As well as getting the wood out to demonstrate the knee position. Forgot we cut some planks last year to do just that.

Yes the head, will be corrected. The problem we both have is the workouts he's required to attend at school. Last year, there was a lot of "core strength" exercises and such. Had one coach pull me aside and explain that my son went too deep on the squat and he was going to hurt himself if he didn't fix it. (Looked around the weight room and saw LOTS of 1/4 squats, and wondering why they weren't being fixed) and have heard more than one time, a coach yell at him to look at the ceiling. So he has had to improvise to satisfy those coaches, while trying to maintain what we both have learned in the pages of SS.....

Also not sure if I mentioned it before, but the knee pain is not present in normal day activities. In fact at school today he was running, and was pain free. But with weight on the bar, is when the pain comes. So hopefully no scar tissue, and if we clean up his form, it will go away...

Thanks again.

[nisora33]

The unfortunate part of the football situation is that he could actually be hurt by the practices that his coaches enforce. The shear force along the knee joint surfaces produced by the quarter squats, multiplied by however much weight he will be squatting, could lead to long-term knee issues. Lots of knee tendinitis as well. And I'm going to venture a guess and say that the coaches are probably having him squat with the toes forward as well, which only deepens the risk of the above knee hazards. All in all, a terrible mix of conditions.

Another unfortunate part of all of this is that the squats they'll have him do will conflict with the motor patterns necessary for correct squatting. I'd give anything to be able to travel back in time to a point when I had never squatted and have Rip coach me to do things the right way. I had a lot of un-learning to do once I learned to squat correctly.

If football is an important enough pursuit for your son, I guess he'll have to make sacrifices, unfortunately.

-S.

[TomC]

It seems like there are several issues at work here, not the least of which is that your son's football coaches are teaching a squat that probably exacerbates his knee pain.

He's also performing something of a hybrid between a low bar squat and a high bar squat. The bar is up kinda high, his thumbs are wrapped under the bar, and his shoulders are mostly relaxed. This is what you would do for a high bar squat, but not the style that Rip advocates. His stance is too wide for either high or low bar, and he is not leaning forward quite enough. The hamstrings are not doing their fair share of work under this arrangment and this is not helping with knee pain.

Here's how low bar squats should look:

http://www.youtube.com/watch?v=FVKEl4Wxoqc

[crzipilot]

Football is pretty important to him, He's only a sophomore and already getting some interest from schools. I understand completely what you saying about the situation with the football off season workouts. Which is what I meant by he has had to improvise some to satisfy them. Not so much squat in their form, but to either go light on the workouts or skip them all together. To rectify the situation, We've put the power cage on the porch, with 600lbs of weights, a commercial GHR bench we picked up for 100.00 at a gym closing, and made our own plyo boxes.

The draw back is he hasn't been able to run SS the whole time, due to the school workouts, but last year we got enough free time, to put 50lbs on him, and take his squat up to 340x5.

[crzipilot]

Thanks for the video, after looking at a bunch of them, things start to get confusing. Hadn't seen this one, and it shows a lot.

Already corrected the bar, hand placement, and shoulders. We'll work on the width of his stance, he is fairly tight, and have been stretching to help with that problem..

[nisora33]

Tom, I didn't see any problem with his stance. How are you determining that? Rip says that even feet a little outside shoulder width is okay for some people.

I've included a side by side comparison of crzipilot's son's, Justin Lascek's, and A.C. from 70sbig.com's squat stances:

http://farm3.static.flickr.com/2764/4154604242_b264518e34_b.jpg

These all look roughly similar, although I admit that it's difficult to tell much from videos taken at various distances and angles.

-S.

[TomC]

Tom, I didn't see any problem with his stance. How are you determining that? Rip says that even feet a little outside shoulder width is okay for some people.

I've included a side by side comparison of crzipilot's son's, Justin Lascek's, and A.C. from 70sbig.com's squat stances:

http://farm3.static.flickr.com/2764/4154604242_b264518e34_b.jpg

These all look roughly similar, although I admit that it's difficult to tell much from videos taken at various distances and angles.

-S.

It's primarily a judgement call and I am certainly not infallible here. Based on the video, it looked like he was a couple inches wider than shoulder width, but I could be wrong. Justin has mentioned on occasion that his stance tends to drift wider than Rip likes to see and AC was training for a powerlifting meet where a slightly wider stance can be advantageous. They are both upsettingly strong, but that's an aside. There's nothing wrong with a wide stance, to be sure, but if we are going for Rip-approved model squats a wider than shoulder with stance is potentially a deviation from that. Once again, it was an impression based upon an oblique angle from a video.

Since crzipilot's son was carrying the bar up kinda high, a wide stance is less desirable. If you do high bar squats, you want to get as low as possible since full ROM on high bar is not limited by the hamstrings. To get to the bottom of a high bar squat your hamstrings touch your calves and you want a more upright torso. A wider stance makes this difficult and puts additional rotational stress on the knee when going below parallel. In most cases, a wide stance with a high bar position will get you the worst of both worlds: inclined torso with longer lever arm for additional low back strain and less than full ROM. Check out Greg Everett here demonstrating high bar squats:

http://cathletics.com/exercises/videos/backSquat.mov

His stance is just at shoulder width, or even a touch narrower. There is no bounce from the hamstrings, but a bounce does occur at the bottom due to the collision of the back of the thigh with the calves.

[TomC]

Rip just weighed in on this very topic.

http://www.startingstrength.com/resources/forum/showthread.php?t=13667

[jeremyfirth]

The one thing I noticed, and it's the same problem I had for a long time, was that not only do the knees come forward at the bottom, they come in just a little bit. Especially the left knee. When my squats started getting heavy, I started doing the same thing on the way back up. My left knee would come in (more than your son's) and I started really getting knee pain. I focused on pulling my knees out as I came up, and my knee pain magically went away.

[nisora33]

In most cases, a wide stance with a high bar position will get you the worst of both worlds: inclined torso with longer lever arm for additional low back strain and less than full ROM.




Agreed, this is my understanding as well.

However, slightly wider than shoulder width is optimal for some people, and I have not had the luxury of coaching this young man firsthand and, therefore, cannot make determinations about this based on experience or history. Seems like the least of our squatters problems here. Ultimately, a process of trial and error is necessary to determine optimal stance width, and this will be something that is entirely up to the squatter and his dad. As long as it is within reasonable limits, stance width should be left alone, IMO.

-s.

[crzipilot]

Great information guys. I'm out of town, but this weekend I'll work on it with him and get some more videos posted up, if we get any corrections.

Thanks

[crzipilot]

Ok guys, got back in town. Was able to sit with my son today and discuss what was pointed out on here, and a few other things. Anyways, I think we got his depth issue solved. His knees. The Bar, and a little on his head / what he was looking at. I've got 4 clips this time, two from the side, two from rear quater. first set is at 225 or so, last three are at 260 I believe. Hopefully some improvement from previous video.

Thanks


http://www.youtube.com/watch?v=bszFx3NS3Ms

http://www.youtube.com/watch?v=lYwTlThFQnY

http://www.youtube.com/watch?v=4P6MRdVvJHw

http://www.youtube.com/watch?v=EG3TBw8phks

[nisora33]

Depth is much better. On his heavier sets, he still needs to work on getting the knees forward to where they need to be sooner. And after seeing a couple more vids, I would now err on the side of saying that his stance is indeed too wide. Narrowing it a smidge will help with the knees-out.

All in all, a vast improvement, though.

Oh, and get that boy out of those squishy shoes. Squatting is hard enough already without having to balance on big pillows.

Good job and happy training.

-Stacey

[crzipilot]

Thanks for the reviewing of the videos. I'll bring his stance in a little more, and see what we can do with the knees. We put up a couple of 4x4's during his warm up to show him where to go forward to.

The shoes, I know, he didn't have anything else. He has a pair of nike frees he usually squats in, but they were at school. Looking at getting him a pair of shoes for xmass though.

Thanks again...

[nisora33]

Crzipilot,

Glad we could help. Noticed that Rip gave your son's videos a pretty decent thumbs-up. Keep up the good work.

-S.