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Comment by sofal | Hacker News Reader

Now just hold on a second there. As long as we're throwing out anecdotes, let me say that I've been lifting for a few years now and squats completely devastate my knees. I've tried over and over again and no matter what, my knees get a stabbing, debilitating pain when I squat, even at lighter weights. Physical therapy doesn't help. X-rays show no problems. Obsessing about correct posture doesn't help. Squats are just plain bad for my knees.

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If it doesn't hurt when you do body weight squats with zero weight, then you can make it not hurt when you do heavier weights. The trick is to start with body weight squats, or an empty bar, and build slowly. At every step, keeping proper form. Adding only 5 lbs each workout. So many people make the exact claim you're making, without actually going through the painstaking process of starting from no weight on the bar and moving up over a period of a year. You may actually have a real problem in your knees, but if you can do body weight squats without pain, you can work up from there. If you can sit down in a chair without your hands, you can probably work up from there too.

I can do body squats fine (lots of popping, though). I've worked up in weight (though not quite from empty). One week I'll be able to do semi-heavy squats (not even my bodyweight) with no problems and then the next two weeks I can't even add much more than the bar before the knife-in-the-knee. Both knees have the issue, and not simultaneously. The physical therapist says I'm a bit pronated, so I try to account for that in my posture. I tried all the stretches and exercises I was given. It's not like I'm doing things that my legs aren't used to. I'd been doing leg exercises, including squats for a long time. It's just that when I get to about 85-90% of my bodyweight on squats, it'll only be a week or two of no problems and then for the next two weeks I won't be able to do anything.

I do deadlifts, and they usually go just fine except when I've messed up my knees with squats, in which case then my knees will die during deadlifts too. Every time I tell myself I can get back into squats gradually I come back demoralized, and it poisons my other workouts too.

Can you do lunges, band work, step ups/downs, etc... without pain? How are your DLs, core work and glutes? The problem with the knee is that all sorts of other imbalances can show up as knee pain. Also, see if you can find a PT that specializes in sports.

Read this for some things to try to protect the knee: http://www.t-nation.com/free_online_article/sports_body_trai...

I've found, from painful experience, that most physical therapists aren't particularly oriented towards strength training.

If you can find an FMS certified strength trainer, there's a good chance they could help diagnose your situation. http://www.functionalmovement.com

I had problems with my knees after I gained a heap of muscle and then levelled out on my weight and stopped squatting for a while. My knees were now sore all the time.

At some point I read an article called "Everything you know about fitness is a lie" (which has been posted to HN several times), which has a section entitled, "You're only as strong as your weakest muscle". It talks about strengthening stabiliser muscles and exercises to rehabilitate weakened muscles.

The section also illustrates some of the better exercises you can do to alleviate injuries. In particular, there is an exercise for strengthening the knees - I can only describe as a straight leg lift while lying on one's side - which I tried for a couple of weeks, despite the flak I copped from my weightlifting compatriots.

I believe it works the quadriceps, and from my research, the exercise alleviates the difference in strength between the hamstring and the quadricep (don't quote me on this though), which seems to be the cause of my particular joint problem.

However, I've found I can't just go up to a certain point and stop the exercise. I need to continue with it as long as I'm doing squats. It's annoying, because none of my weightlifting crew have this problem, so I think it's got to do with the particulars of my genetics, but whatever works.

I used to have patella tendinopathy in one of my knees from heavy squats. I was able to eliminate all pain in about a week or two using these "Voodoo Floss Band" things.[1] They don't seem like they would work that effectively, but calling them magical is as justified as it was for the iPad. I had tried other strategies such as decline boards and negatives for several months which are commonly prescribed by physical therapists but they didn't make much of a difference. After my knees were 100% from the bands, I began squatting heavy weights again and focused more on keeping my knees out and my butt further back. This seems to have resolved my issues and I no longer experience knee pain squatting (my 1RM is >350).

1: http://www.mobilitywod.com/2012/05/voodoo-band-your-patella-...

Yeah I had pain around the patellar tendon last year and doing this helped. But you don't need to buy that thing for $24, you can do it with a cut-open $5 bicycle tire tube and it works equally well.

If it goes away when pressure is applied, it might be trigger points. Find a physio who does dry needle therapy and see if that helps.

I hurt my back rowing in 2009 in the L5-S1 area. Many physios diagnosed it as different things and many of them tried different treatments. None of them worked and it hurt for three years. I tried lots of different core exercises, some physios tried manual and manipulative therapy (which helped for a bit) but after a few months of sessions of dry needling my back hasn't bothered me with that injury in over a year.

I would much recommend dry needling, it's not the same thing as acupuncture.

I feel like I should say something in-jokey here.

I'm pretty keen on dry needling of trigger points, given how many things it's fixing for me. But I'm wary of seeming like a new convert -- I think people should consider it as one possible cause of pain, often undiagnosed because it's not a commonly taught concept.

In the absence of pre-existing knee issues I would wager that there's something wrong with your squat form. Do you squat below parallel? Do you sit back with your weight on your heels and spread your knees apart when squatting? Have you tried taking a video (from the side) of yourself barbell squatting and posting it to one of the major lifting forums for a "form check?" You can get a lot of good form/technique feedback that way.

I try to go down to parallel, and I do sit back on my heels and spread my knees apart. I have not done the video thing but I have researched it and had it critiqued by people at the gym and by physical therapists.

The amount of time I've spent trying to refine my form and then have it do nothing for me is demoralizing. I understand that's the only suggestion people can come up with, and I understand why. I mean, I'm just some random guy on the internet and from that perspective the likelihood that I'm just cluelessly doing it wrong is high. But there comes a point for me at which I can no longer be satisfied with that answer. I've got better form than hundreds of thousands of noobs who successfully do heavier squats than me every single week. I feel like I'm chasing a holy grail of form religiously, like if I could just find the right number of centimeters to separate my legs or the exact right angle of my knees or the exact right balance of weight on my heels then everything will work out.

Are you warming up properly? I get the same stabbing pain in my elbows when I try to bench press anything over 115 lb, and an experienced powerlifter friend suggested it might be because I'm not adequately warming up my joints before I start -- it can be tight muscles pulling on tendons, or a bunch of things. I haven't had a chance to experiment, unfortunately, as I injured my wrist (not while lifting) and am waiting for that to heal, but...

To warm up for squats, try some or all of the following:

- using a rowing machine

- running for a little bit

- "high knee" jogging -- on the spot, lifting your knees up to your chest

- doing lots of bodyweight squats, then lots of squats with just the bar

- kettlebell swings (making sure to bend your knees and throw your butt back at the bottom of the swing)

- cycling (taking care with knee position if you get knee pain there -- I get knee pain cycling if I throw my knees out sideways; trying to lift them vertically works much better)

I would suggest the following:

- If you're squatting high bar, switch to low bar because it puts less stress on the knees.

- Practice the "asian squat" stretch. Squat all the way down while keeping your weight on your heels and sit there for a while. Do you have a tendency to want to tip forward onto the balls of your feet when you do that? If so, that's a problem and you need to practice this position more.

- Get a foam roller and foam roll all sides of your legs (especially your IT band) and your glutes before squatting. I have chronic IT band tightness on one side that pulls on something in my knee and gives me pain around the patellar tendon, but it goes away when I foam roll the side of my leg.

- Do lots of warmup reps with bodyweight and/or just the bar.

- Don't stop at parallel. Squat below parallel, until you get a "bounce" from the stretch reflex of your hamstrings. If you stop at parallel, there is shearing force on the patellar tendon as that's where the tension is at the time when you change directions. But if you go all the way down, there is almost no load on your patellar tendon at the bottom when you change directions--the load is transferred to your glutes and hamstrings.

Based on what you've told me, I really think it's likely you aren't squatting down low enough, and that's irritating your patellar tendons.

Yeah, it sounds like you have aggressively pursued using correct form. For most people, form is the issue, but I get the feeling that you might just have a physiological issue with doing squats. Have you tried leg presses as a substitute?

Another possible thing to TRY (if it hurts don't do it) are Goblet Squats. Look up a youtube video and you will quickly see what it is. It is a very effective way of increasing hip mobility so that if/when you do try to do squats again your hip flexors will take the weight instead of your knees.

Also, (this is extremely important), google "low bar squat form." Anyone with knee issues should be doing low bar squats (in fact they are all I do, because they are as good as high bars but easier on the knees). If the bar isn't resting BEHIND the traps and on top of the delts, then you are doing a high bar squat which puts far more stress on the knees.

Look up videos by Rippetoe. He is controversial for advanced lifters, but for beginners he is a good resource. He is also a huge advocate of the low bar squat, and he has a video on Vimeo where he talks for several minutes in detail about positioning the bar for the low bar squat. Get the bar position correct, and the squat will take care of itself.

There is very high chance that you were not performing squats properly. Tiny deviations in squat form can mean the difference between a PR and knee pain for me.

Could be the meniscus. MRI might help to figure out what is going on. Just my 2 cents.

Where is the knee pain, what type of squat are you doing and to what depth?

The knee pain is just below or possibly right under the kneecap. I try to go to parallel, even though the deeper I go the more likely one of my knees is to crap out. I'm doing regular squats AFAIK, not box squats or anything out of the ordinary. I've worked on my posture, and gotten people to critique it at the gym.

Foam roll your quads (can be very painful at first), standing quad stretch after each squat session and at least once a day, low bar squat (less stressful on the knees than high bar or front squat), video tape yourself to be sure you are going to parallel (otherwise your hamstrings aren't balancing the force from your quads and your knees are stressed), be sure that your knees don't track forward at the bottom of the squat (stressful on the knees since you are removing tension on the hamstrings, see Rippetoe's terribly useful block of wood), knee wraps or knee sleeves can be helpful.

Squatting correctly is more nuanced that it would first appear. Starting Strength 3rd edition explains the mechanics of the squat in great detail and justifies why you should squat in a certain way.

Not everyone can squat but most people are just doing it wrong. It is such a useful exercise that you should be very sure that you actually can't before you give it up. You can get good critique of your form by posting a video at the starting strength forums where you might also find useful information from a search for patellar tendonitis/tendinitis.

Are you sure you're going below parallel on your squats?

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