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PaperclipPerfector  17d ago (text post)   1405 thread views

Wellness Wednesday for February 5, 2025

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

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When I was in middle school, our English teacher played us The Sunscreen Song for the "fill in the missing words" task. Back then I had no idea why it mentioned the knees specifically, but that's no wonder given the original title was "Advice, like youth, probably just wasted on the young".

Anyway, the knees. It started with leg extensions. I would get a sharp pain inside the knee if I added a bit of weight to the machine. Then I started feeling pain when squatting and I don't squat a lot of weight at all. I switched to squatting in a Smith machine, but now even this hurts when I get close to parallel. I can still do ATG bodyweight squats and squat with an empty barbell.

Where do I go from here? I had an xray done - nothing was found. Do I follow the knees over toes guy's program?

Where do I go from here? I had an xray done - nothing was found.

What did the doctor who ordered the x-ray advise?

Skip leg days.

Can you see a physical therapist? They'd be the experts on what would help or hurt.

Both knees, or just one?

Try goblet squats with a kettlebell or dumbell instead of barbell squats. I'd also recommend exercises that require good stability and alignment, like split squats (or Bulgarian split squats, but probably wait until you are comfy with the basic variation). You'll get immediate feedback if you are doing something weird.

Balancing exercises can be good for training. Often there is something wonky happening at another joint (like ankle caving), so balancing on one leg or on a balance board will help engage the whole leg, just so you know what it feels like or if there are any places that are straggling.

Reverse sled pulls are a nice warm up and exercise if your gym has the equipment and space. It trains leg extension in a very natural movement, no awkwardness of the machine.

Both knees. Thought it was just the left one at first, then got the same pain in the right one.

Is it a bad sign that I hate split squats with a fiery passion? Not as much as olives, of course, but they still fill me with irrational rage.

Hahaha, split squats suck! They're hard. Which is a good reason to do them.

Unfortunately, really hard to tell if it's a technique issue without seeing it in person. If you can squat bodyweight (+0 lbs), that would be what I think is most probable though.

I generally don't think leg extensions are warranted if you are not very advanced, like squatting bodyweight + 1.5x bodyweight or even 1+2x. Even then I think there are better quad exercises. The problem with leg extensions is that even if the center of rotation starts aligned, there is only exactly one Q-angle where the rotation of the knee will be exactly aligned with that of the machine. So the probability that your leg has exactly the right Q-angle is roughly 0.

If it is just a matter of the muscularity supporting the knee, very gradually working up from the point where you can squat with no pain works for some reasonable majority of people. Make sure to be very careful with knee tracking, avoid valgus collapse, and engage your abductors and gluteus to hold hip external rotation. Try different heal heights, generally the higher-bar you squat the move vertical the torso, the higher the heel required. You might also find some other variation does not cause pain. I prefer something where you have control over all the degrees of freedom of the knee tracking. Maybe squatting to a box or front squats. Smith machine, hack squats, and belt squats might be okay, but still force you to follow the path of the machine rather than the path that avoid the pain point. Sissy squats are amazing for knee health, but pretty advanced to do in free space.

Sometimes it's just a matter of a bit of warmth and pressure. ACE bandage weight knee wraps or sleeves should be enough. Heavy power-lifting weight versions are probably overkill, and shouldn't be needed to avoid pain. Don't be afraid of a lot of volume with light weights to warm up. Something like 10xbw, 20xbw, 12x45, 5x95, 2x135, 1x185, 1x225, 1x275, 315 working weight. Yes it does take forever, but you can probably eventually take bigger jumps once you find a squat pattern that doesn't cause pain.

With any luck your leverages will change as you train and one day you will wake up and it won't be a problem anymore. If it's not a trivial problem an x-ray probably won't be able to see it either.

So the probability that your leg has exactly the right Q-angle is roughly 0.

What's Q-angle? The extension machine has the benefit of having split weights, so I can be sure that both quads are pulling their own weight (my right side is noticeably stronger). I can't put more than 5kg plus whatever starting resistance it has before the pain starts, though.

Sometimes it's just a matter of a bit of warmth and pressure. ACE bandage weight knee wraps or sleeves should be enough. Heavy power-lifting weight versions are probably overkill, and shouldn't be needed to avoid pain.

I have neoprene knee wraps, but I don't know if they help at all. Sometimes I feel like they keep my patellae from moving naturally.

Don't be afraid of a lot of volume with light weights to warm up. Something like 10xbw, 20xbw, 12x45, 5x95, 2x135, 1x185, 1x225, 1x275, 315 working weight. Yes it does take forever, but you can probably eventually take bigger jumps once you find a squat pattern that doesn't cause pain.

The highest I've ever gotten to was 1x185 (I hope these numbers are pounds) and 135 used to be my comfortable working weight for the 5-10 rep range. Now the pain starts at 10x95 for me.

Q-angle is the angle the quad meets the knee, but I was more generally trying to suggest that it's (basically) impossible for a machine to have same number of degrees of freedom as your leg. If you sit in a neutral hip position, then extend your leg, your foot will generally not track straight in front of you. Or more precisely, the arc the contact point with your tibia traces out will not be on a curve exactly parallel to the sagittal plane. On a unilateral machine were you can only adjust how far forward you sit and the distance of the shin pad, they should try set the pivot so it is coaxial with the pivot of of the average users knee. This can't be aligned for everyone because you have only two degrees of freedom for adjustment and (at least) 4 degrees of freedom for the pivot axis. Twoish translational and twoish rotational.

For sleeves and wraps I would guess the majority of the beneficial effect is proprioceptive. Some people have an easier time feeling where their knee is in space if something is touching it, others can feel the tracking better if there is nothing "interfering" with it. I do not think it is generally good to rely on supportive equipment to hold your body together.

Yes, I was talking about pounds. I personally think isolated quad training is unnecessary if you are squatting less than 1.5x bw (that is 1+1.5x assuming not over fat male). Fortunately? At the weights you quoted the pain will likely go away if you get stronger. Both from a supporting musculature and kenisthetic awareness perspective. I agree with @Boarchariot, for your strength levels goblet squats are a good option. Unless you are a very light person, body weight might be too much for a first warmup for now and reverse sled pulls might be a good general warmup. If using a bike for general warm up, make sure your seat is high enough you can almost lock out your leg, and you are being careful with knee tracking through the whole cycle. You might also consider step-ups, really focusing on controlling your knee tracking and the eccentric, if split squats are just too awkward.

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