Persistent mild knee pain due to squats - push through or stop?

Question

Over the last 2 months or so of doing heavy squats (200 lbs - 262 lbs) I've frequently had pain in my knees. During the last 2 weeks, it's been especially persistent and seems to be mostly in my left knee. I'm normally sore after working out, especially in my legs and lower back, but the knee pain seems to persist long after the other pains go away.

What does it feel like? Well, it's on the front side of the leg, centered just below the knee cap. By "below" I mean "in the direction of my foot", not "closer to the bone". It's hard to describe the sensation exactly. It's kind of a pulling/burning feeling. It feels somewhat different than muscle soreness elsewhere, but I don't feel like anything's grinding or scraping or popping. It's not a "sharp" pain.

As far as intensity goes, it's not excruciating. Actually it's mild enough that I feel that I could ignore it when doing my squats and continue performing my workouts as planned. I'm just not sure that's a good idea. It is bad enough though that running for more than a minutes or so is a very unpleasant idea.

I do not feel any pain when standing, sitting, or walking. I do feel it whenever I ascend/descend at all. Getting up from a chair, walking up or down a flight of stairs, and of course when doing squats. I also feel it when running.

I've tried skipping a couple workouts, and although the pain seems to gradually get better with time, 5-6 days is not enough to get rid of it, and it comes right back when I resume my workouts. I had been more or less ignoring it for the last month or so, but since it's now preventing me from running, I'm getting more concerned.

I have also tried using a foam roller on the muscles surrounding my knee (but avoiding the knee itself). This seemed to help with some other pains/soreness I'd had, but not with the knee pain.

I'm 95% sure the pain is caused by my squatting. It always gets worse during/after I squat. I squat just below parallel, with a shoulder-width stance and my feet pointing outwards about 15 degrees. I try to keep my knees following that 15 degree direction, pointing in the direction of my feet, when I descend. Historically I've done 5 sets of 5 reps, but more recently I've been doing 3 sets of 5. I rest about 5 minutes in between sets.

So, should I be concerned about this, if so how should I handle it? Is it likely that I'm doing something wrong? Should I take a couple weeks off from squatting and running? Ignore it and keep going? Deload significantly and work back up so my body adapts more? See a doctor? I know you are (probably) not a doctor and not qualified to give medical advice. I'm just hoping to find out if this (1) ignorable, (2) a concern, but something that can be solved with a period of rest and/or dealoading or (3) a big problem I'll need professional help with.

Update 2011-09-09

Update: I saw an osteopathic doctor yesterday. He told me my tendons and ligaments were fine. In fact he said "your ligaments look like they're built to take a lot of punishment!". He diagnosed patellofemoral pain syndrome AKA "runners knee". He told me the inside of my knee cap had become rough. He prescribed R.I.C.E (Rest, Ice, Compression, Elevation) as well as a twice-daily stretching regimen, and weighted leg extensions 3 times a week. He also suggested I take ibuprofin, especially if I'm doing anything to aggravate my knees. He told me recovery could take 6 weeks or more, but call him if I didn't see a significant difference by the end of the month.

So at this point I'm going to follow the routine the doctor gave me for the next 6 weeks or so, and avoid squats, deadlifts, and running. I will continue doing the other exercises I'd been doing (bench press, overhead press, rows, and pull-ups). I may also try swimming if I feel like doing cardio (but I'm a terrible swimmer). After I feel I've recovered I'll start squats with about 50% of the weight I was last doing (262 lbs was my peak work weight) and I'll work my way back up. I'll have someone check my form then too.

Thanks for the answers. They helped me to realize that this wasn't something I should ignore, and that my squat form was likely at fault. I'm marking Dave's answer as "most helpful" for the strong suggestion to see a doctor, which I did. But I also really appreciate Berin Loritsch's answer for the form tips and the TUBOW suggestion especially.

Answer 1

That sounds like a ligament or tendon issue, which could be serious. I would worry about your squat form: perhaps your knees are tracking forward, or your stance is too narrow, or you're coming off your heels, or perhaps something else is going on that no one can figure out through the Internet.

Whichever one it is, it doesn't sound like a muscle problem. It sounds like a joint problem that you need to get looked at by a coach/physical trainer, or doctor. Or both. (The doctor is there to diagnose the issue, but don't let them convince you to stop squatting or lifting for the rest of your life.) If I were you, I would:

1. Stop squatting for a couple weeks.
2. Go to a coach who knows the squat inside and out, and have them do an extensive form check. (This would entail a significant deload.)

I believe Mark Rippetoe sums it up aptly: "[If] you squat wrong it fucks things up. If you squat correctly, those same fucked-up things will unfuck themselves." It's kind of important that you find someone who can tell you what's wrong and how to do it right so that the corrective process can begin.

Answer 2

Very likely it might be a form of tendinitis caused by some form problems. Someone I know recently had similar symptoms, and posted about their journey here. The thing causing most of his issues was a slight slide forward at the bottom of the squat. He isn't the only one who experienced this problem, and it is common enough for Rippetoe to write about it.

The solution is twofold:

• Use a TUBOW (Terribly Useful Block Of Wood) in front of your shoes. You should touch your knee to it in the first third of the squat, but do not move the wood while going down.
• Deload to a weight you can do with the TOBOW in place.

Eventually your squats will look like this: http://www.youtube.com/watch?v=cQlI_ztFk1g

The happy ending to the rehab work that this guy did is that the knee soreness is gone and he's lifting heavier than before. I recommend fixing the form issue before going any further.

Answer 3

Is there a hard bump there that hurts when you press on it? If so, it could be Osgood Schlatter's. Actually, even if there isn't a bump yet, it could still be this.

On the other hand, if the pain is in the tendon attached to the kneecap, it could be Jumper's Knee.

Either way, as Dave said, make sure your squat form is perfect, BEFORE you go heavy. If you're squatting right, there will be no joint pain, only possible muscle soreness.

I had Osgood Schlatters a while ago; it seemed it was because I wasn't sitting back in my squat enough. If you don't sit back on your heels and take the force of the squat in your glutes and hamstrings, all the force goes into your quads and knees.

You should be taking barely any weight on your quads at the bottom of a squat; your core should be tight, and your glutes and hams should be TIGHT, taking the weight. Concentrate on feeling that tension in your glutes, ready to explode the weight upward.

If you read the Stronglifts "how to squat" article I think he explains it pretty well.

Answer 4

I had an ACL reconstruction on one of my knees 12 years ago. I started a workout routine with squats and deadlifts earlier this year. After about 4 weeks I had similar pain in my ACL knee. I figured out I wasn't warming up enough. I started doing 5 min of bike when I first walked into the gym and the knee pain disappeared.

Answer 5

Usualy the form of performing is really important. Now knee pains might come from many areas not just from squatting, but it might manifests there. I would advise you to go through few of the basics of squatting before squatting and a proper warm up.

http://www.bodybuilding.com/fun/no_pain_squat.htm

http://healthy-joints.net/sport/how-to-squat-to-avoid-knee-and-back-injuries/

Answer 6

I have a torn medial meniscus in my left knee, so I was always terrified of squats. However, after 2 years of doing squats now below parallel and working on form, I can say that not only have I not had knee pain after squats, but my legs actually feel a lot stronger. I have a fast synopsis of how to avoid knee pain after squats here.