by Knee Pain In Powerlifting
Patellar and Quad Tendinopathy/Tendinitis is a pain in the butt. Most people are in search of some magic cure for it, but in my experience it really just comes down to load management, patience, and the right mindset. Barring some obvious movement fault, you probably are not going to find some immediate answer for the pain, but rather need a structured and flexible approach of managing load and volume to provide a stimulus for recovery.
Case study in hand right now is Adam. In the beginning of May, Adam aggravated his patellar tendon. We started a slow progressive load management protocol and built up through the month of May from only being able to tempo safety bar squat 155lbs. to low bar tempo squatting 345lbs. There was a big key though in this approach, and that was to only work to what he could squat pain free each day. We have to understand that just like strength gain or weight loss, rehabbing injuries is not a perfectly linear process. There will be good days and bad days, and we must adjust accordingly to what we can tolerate on a session to session basis. The session after he hit 345lbs. pain free, he worked up to 365lbs. and felt some slight pain. According to the protocol this meant to drop back down in weight to find the correct pain free range for the day. But as with most powerlifters including myself on many occasions when I’ve been injured in the past, we do not want to drop the weight back and we force things, which is what Adam did. He kept at that weight and re-aggravated the patellar tendon. This sent him into another negative spiral and took about a month to get his mentality back onto the right approach. So beginning in early July, we started the process over again, with the biggest difference being Adam’s mindset and the understanding that progress would not be linear but rather adjust day by day as we could. You can see this in the above video’s screenshots (CLICK HERE) that were 2 weeks apart, with the top one being from July 11th and bottom from July 29th. On the 11th as he pyramided up in weight he found that at 345×4 he was experiencing some pain, but this time he stopped and concluded that was his tolerable loading level for the day. Fast forward two weeks later and he was hitting 405×4 completely pain free. Fast forward 1 more week, and Adam has hit 455×5 pain free, and this next block we will be resuming normal squat programming again.
I struggled for 2 1/2 years with quad tendinopathy always trying to look for a quick and easy fix. And then once things started feeling better, I would try to rush back to my old weights and inevitably re-injure myself once again. Once I slowed down, remained patient, and took each day’s wins as I could, within 3 months I was pain free and haven’t had any issues with my knee since. In hindsight, I think about if I had just done that from the start rather than looking for these 1-2 week quick fixes. If I had just been patient for 3 months, I would have had over 2 extra years of productive training. In the present, 3 months of rehab and slowly building back up sounds like an eternity to a powerlifter. But in hindsight that will seem like just a small blip in your strength journey compared to the years of off and on struggle with chronic pain.
Great article Steve.