Both of my knees are struggling during most Quad movements. Anything close to or beyond 45° bent is very uncomfortable and often downright painful.
Even sitting in an office chair hurts the top side of my knees.
I need to get some scans done. Luckily i have the VA to pay for that, but i need to find the right physician afterwards. I don’t want someone whose just going to say “just go easy on your knees” as a forever solution.
I’m 30. I need to be a fully functioning 30 year old.
If the solution is temporarily taking it easy on my knees, that’s fine. I just don’t want to be stuck with that solution forever.
So what kind of physician or specialist should i be looking for? Sports Medicine?
How do you find a good one?
Your GP could probably give you referral to a Physical Therapist that’s specializes in Exercise / Active Recovery. IMO you need to first rule out true “structural” issues maybe through an Ortho or even just discover what they are first before the PT can come up with the proper therapy.
It’s probably a good idea to get checked but if it’s both knees, I doubt you have an injury. I hope I’m right. It sounds like tendonitis. I had something similar and it was from doing too much volume with heavy weights with squats. Besides learning to deload or just take a day off with consistency, and not waiting for the pain to tell me to back off, I found that collagen protein worked. At least I think it did. It’s one of those supplements, like most supplements, you don’t really feel working and it doesn’t work overnight if it does work. I also used voodoo flossing.
As far as physicians, find out who they work with, regular people or athletes. Tell them what your expectations are. I went to one doctor and he said that his initial advice to me would be to stop lifting weights, but since I wouldn’t do that he said to let it get better then don’t be stupid.
I think imaging would be a waste of time and money for what sounds like a pretty straight forward case of quad tendonitis. And the thing about imaging is whoever looks at it is just about guaranteed to find something, and when they pass it along to your ortho they’re bound to find an excuse to cut you up or at minimum give you a cortisone injection.
You need to find a good manual therapist, not physician. Unfortunately, I’d say maybe only 5% will actually be useful so it’s a bit of trail and error to find them. From my experience, having found a few of the best therapists in Chicago a few things to look out for:
Avoid chains like Athletico at all costs. I refer to them as the McDonalds of physical therapy. They just follow a set rubric. So whether you are a 23 year old running back who developed patellar tendonits or a 75 year old couch potato who hurt your knees getting out of a car, they will put you on the exact same program for the same amount of time. You could seriously get a superior treatment plan from ChatGPT. And watch out, because these chains will be most of the first to come up when you do a Google search of your area.
Seek out the ones who have their own private practice with maybe one or two more carefully selected practitioners at the clinic. If they’re passionate enough to put their entire livelihood and financial dependence into it, you know they really believe in what they’re selling.
This one is tough to swallow, but I tend to go with the ones that don’t use insurance. Insurance will handcuff the hell out of PTs. For instance, if you go in with knee pain complaints, they won’t approve work on your glutes or feet. Any PTs I know worth their salt know this is impossible as treatment is holistic, especially for someone like you, more athletically conscious as you say. Any time I’ve seen a manual therapist, I’d say maybe 90% of the time the source of my pain is entirely different than the site of my pain. Additionally, you inevitably get more time with these guys. Insurance approved treatment may only have you with the therapist for 15 min, while the ones I’ve found are typically treating me for 50 min to even 1h30 per session.
Pay close attention to the certifications. Look out for ones like CFMT, FFMT, FAAOMPT, and my personal favorite CMTPT (this means they are certified in trigger point therapy, typically treated through dry needling.)
Very often, the more seemingly obscure certifications listed on their website, the better. It says to me they are in a state of continual education and expanding their knowledge base well beyond their initial DPT.
Diversify treatment. I’ve also had my best success with alternating between a few different PTs that specialize in different methodologies and diagnostic perspectives. For instance, at the moment I see a dry needling specialist, who is really more technician when I give him specific areas to treat. He has a great sense of all the trigger point patterns throughout the whole body, and when I show him one problematic area or movement pattern, he has a really good sense of all the areas that could be compromised and contributing to the dysfunction up and down the chain. But I also alternate with a more functional manual therapist, who has a background in powerlifting and crossfit herself. She’s more about retraining tissues through targeted movement. And her hands on work focuses more on fascial and visceral manipulation.
Avoid anything described as “chiropractic,” “sports medicine,” or “ortho.” (Unless you’ve legit blown out your knee in a contact sport). If it’s not truly a major structural injury, they only know things like “anti-inflammatories,” “ice it,” “rest it,” but nothing functional that will help you whatsoever in the long run. They legit might just tell you “you have tendonitis,” and think they’re work is done and that’s the whole diagnosis and you’re good to go lol.
Hope this helps. Happy to answer any follow up questions. For your specific issue, I think dry needling would be supremely beneficial in facilitating a rapid improvement in tissue quality, and you should pair that with some functional range conditioning targeting hip flexors/quads. If you tell me what area you’re in, I could do a quick search online too. I’ve gotten pretty good at filtering through all the bullshit.
Do you know when you initially felt the pain and what exercise it was?
Do you believe it is your patella tendon that is injured and nothing lateral?
Are you referencing 45 degrees from straight?
How many months has this been persisting?
What quad exercises can you do pain free or not much pain, if any? And how much weight (percent of your maximum)?
When I hurt both of my patella tendons, sitting in a car was very painful if I couldn’t straighten my legs out frequently. The back seat was out of the question.
I was able to do leg presses with my feet high on the foot plate. I never got medical help, but very little sports medicine was around in the mid to late 1970’s
Yep. I dreaded driving long distances. If I had to, I would start taking ibuprofen a couple of days beforehand. Thank God I was able to use cruise control so I could straighten my leg out.
No, there was no initial injury. It’s more like discomfort that gradually grew into pain.
I’m not sure, but i suspect Bursa tendonitis (buristis?)
The straighter my legs, the better they feel.
2-3 months maybe?
All quad exercises hurt. The more weight, the more it hurts.
Sissy Hack Squats and Quad Ext are the two most favorable movements. Still painful though.
My patella tendon pain I can point to a single set when I started with too much weight on a leg extension machine without warming up at all. Huge mistake. Considering that, I have not much to add. I would try to get a medical opinion from a knee specialist who works with a major football team, if possible. You might have something that just a little time off will rectify. an accurate diagnose would be extremely helpful.
I do have a story of what not to do when you have patella tendon pain:
The friend of mine who introduced me to powerlifting was in his late 40’s and preparing for a powerlifting meet. He was experiencing patella tendon pain and started using lidocaine. At first he rubbed the lidocaine in with DMSO. As the pain persisted and, the meet came closer, he started injecting the lidocaine.
He went to the meet and when doing one of his squats in competition, his patella tendon tore in half, collapsing his knee joint where his calf folded into his thigh. Obviously, he totally missed the lift. He needed to have his tendon reattached and was out of commission for a few months.
Moral of the story: You can relieve the pain, but not necessarily a catastrophe.
@jskrabac that was incredible. This thread is timely, as I’m having issues again. I’m one of the patients that just goes in and gets cortisone. Everything you wrote sounds right on the money; I’m going to try a smarter search too.
@Andrewgen_Receptors one thing to note, depending on your insurance. You can often still file a claim yourself even if the provider doesn’t work with insurance. I’ll often do this at the end of the year for everything my family may have done anywhere (that didn’t fall into my insurance’s scope). They won’t cover everything, for sure, and it’s a bit of annoying paperwork, but it’s sometimes enough for me to hit the annual deductible and get a little bit back. Kind of up to you if the hassle is worth it, depending on how far you are from the deductible. As I type this out, I’m talking myself out of doing it. Huge pain in the butt for what might end up netting you a couple hundred bucks.
This sounds like a classic overuse issue. I had something similar but unlike what you have done so far, I used ice and NSAIDs to train through it for years. This wasn’t entirely my own stupidity – one of the sports medicine orthos I saw told me I could keep squatting heavy and that if my knees hurt I should take some Aleve. If I could go back and talk to myself at 36-38 when my knees started hurting, I’d tell myself to stop doing the shit that caused my knees to hurt. (Seems pretty obvious in retrospect.) Were I in your shoes that’s what I’d do UNTIL I was able to figure out what the issue is and how to fix it.
If you can get an MRI done with the VA, I’d do that – might as well know what’s going on with your knees and have baseline images. Just be prepared that the MRI will probably show something because they all seem to show something, even in joints where people don’t have pain.
As for finding the right ortho, I looked for people who had been team doctors for local college or professional teams. I ended up seeing two orthos for my knees, neither of which offered to cut on me or give me a shot.
I agree with the others that ultimately the best thing to do is to find a great PT. But I wouldn’t skip over the steps of getting the images and seeing a sports medicine ortho.
IMO…lifters reach a point when the warm-up becomes critical. I don’t just mean the specific movement so much as in a general sense. Try 15-20 minutes on a station bike with mild resistance followed by some static/dynamic stretching. Think DeFranco’s Agile 8 or something like that prior to training.
I’ve seen a few anti-warmup posts from influencers on social media recently and it just boggles my mind. Then I check into them and they are almost always in their 20s or early 30s. Which explains everything about their views on warming up.
