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I have mild knee pain in my left knee only whenever I have a small break in form when doing any squat type exercise (ie, my knee goes past my toes when my feet are flat on the floor). When in proper form, the knee is pain free and this does not happen to my right knee at all, regardless of form. I have no pain in the knee when not exercising (ie standing, going up stairs, etc) but am worried that I may be setting the ground work for a future knee injury. I wish I could always have perfect form but this isn't possible, say, on the last 2 reps of my last heavy set. I keep proper form >90% of the time. Once the pain hits and I correct my form, it goes away. Also, I cannot take ibuprofen b/c of a reoccurring stomach issue. Should I be concerned? Since it is in one knee only will it continue to get worst or will exercise strengthen the joint? Should I be doing other exercises to strengthen my knee or go see a doctor? I squat once a week and do jumping exercises ones a week. I also deadlift ones a week so 3 days a week I have this issue.

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Here are few questions on knee pain while performing squats. 1st question 2nd question 3rd question. Please check if your question is related to any of these. –  Freakyuser Jun 16 '13 at 17:39
    
I don't want to take away from the main question, but just wanted to mention that knee past toes is not necessarily poor form (common myth among non-lifting PT types) - in fact, it's probably necessary for good form! Otherwise, hard to keep balance & the right structure with load bearing over the center of your foot. Just try to squat below parallel with your toes (and therefore knees) against a wall! –  Greg Jun 16 '13 at 21:53
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5 Answers 5

I have suffered from knee pain, chondromalacia to be precise... knee pain can be very nasty, can take a long time to recover (and may not do so perfectly). While I do agree that "proper form" is important, I do not agree that this is the only thing you would need to pay attention to. I think you would benefit from doing pre-emptive rehab work (at least I wish I did it before the pain got bad). Unfortunately it is difficult to say what you need to do exactly without seeing you. Stiff quads, hamstrings, weak vmo muscles can all lead to problems later, and all need specific rehab work. I would suggest that you work together with a good physiotherapist to prevent future problems.

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It sounds like the knee is borderline on inflammation problems. Inflammation happens when a joint is under stresses it isn't ready to handle or is not designed for. Our bodies were made to squat, and it's an innate ability toddlers possess. The question is what is causing the inflammation? Here are possibilities I've run across:

  • Working too heavy all the time
  • Way too much volume
  • Subtle technique issue exposed by heavier weights
  • A different exercise is causing the problem that is being exposed by squats

If you are constantly pushing or pulling weights in the 90+% range of what you can do, you are just going to grind yourself down. It is important to hit those weights periodically, but not as a mainstay of your training. Your joints need a break from the heavy weights so they can also get stronger.

By the same token, there's a limit to the amount of volume your body can take at once. Prilepin came up with a table where he found his weightlifters were able to still make the best progress without killing themselves in the process. This is a very useful tool to help prevent over-use related injuries (i.e. inflammation).

Form is very important, and as fatigue increases form breaks down. Sometimes you have subtle imperfections in your form that only come to light when the weight gets heavy enough. Fix the form issues and many of the problems will resolve themselves.

Sometimes you need to do rehab work. Rehab work consists of very light weights for a lot of reps. We're talking weights that don't even register a proper training stimulus, and doing 50-100 reps total. All that work is designed to flush blood through your joints to remove the inflammation. They also help strengthen supporting and stabilizing muscles that don't get a lot of attention when the weight gets really heavy. Body weight or light lunges might help as an assistance exercise. Or perhaps leg curls (exercise ball leg curls are surprisingly challenging).

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I wish I could always have perfect form but this isn't possible, say, on the last 2 reps of my last heavy set. I keep proper form >90% of the time.

I think the proper answer to this question is to do everything in your power possible to maintain proper form at > 99.9% of the time. If that means dropping the weight, then do so. Gutting out those last few reps on your heaviest sets with poorer technique is not worth the potential damage it will do.

If you really are intent on attempting those last few reps at increased weight, then make sure you always have a spotter to help you squat. Mentally this allows you to focus on your technique and not worry about failing or cheating because your spotter, assuming the spotters knows what to do, will be able to let you finish.

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The solution is in your question. You have pain only when you lose form, so the solution is obviously keeping good form. If you lose form towards the end than you are simply not concentrating, I don't believe it is muscular. Before the last sets take a slightly longer break (get your pulse down), then focus, and lift. Also, stop looking at the hot chicks! (it never helps my form anyways)

Remember that you don't necessarily feel any pain when losing form, therefore setting ground work for and injury is always a risk. Be smart be safe, good form is not optional!

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Your knee is so important. If this were me, I would do two things. First I would lift lighter, as this means it will put less stress on the knee. If you do this and it still hurts, then you should go see a doctor and let them x-ray the leg to see what's going on. But like I said, look after your knee - it's so important!

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