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Molly Maloof, MD

Director of Clinical Content
@DoctorBase

Lateral knee pain, no trauma, no swelling, a lot of squatting

30 yo male, fit, healthy, etc.

Started ~2 mos. ago. Had been doing 3-4 days/wk of heavy squatting for a few months prior. Front squats w/very full depth. Started insidiously. Continued squatting heavy for several weeks, pain stayed mild but has gradually increased to where it's quite uncomfortable to squat.

Pain at worst when knee is fully flexed (bottom of squat) and then trying to stand. Mild joint line tenderness. No swelling, pain free full flexion & extension. No locking or clicking.
Poster
  • Male | 31 years old
  • Complaint duration: 60 days
  • Ethnicity: Caucasian / White
  • Height: 72
  • Weight: 180lbs
  • Medications: none
  • Conditions: none
  • Hospitalizations: none

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Featured Answer

6 UpVoted this answer
The pain that you're experiencing on the outside of the her knee could be related to an iliotibial band friction rub syndrome, lateral meniscal pain or lateral patellar retinacular pain. The iliotibial band is a ligament that runs from the outside of the hip to just below the knee and it attaches at the leg bone or the tibia. The ligament can become irritated on the outside of the knee were it crosses a protuberance known as a lateral femoral condyle. The tenderness is noted to be just above the joint line and will be more painful when you're touching this area and year flexing and extending her knee.

Meniscal injury frequently would result in swelling and pain with pivoting. The lateral patellar retinacular pain is typically just inferior and lateral to the patella, next to the patellar tendon. If you have any tracking issues of your patella this area could also be irritated/inflamed. A thorough evaluation by an orthopedic knee specialist or a Physical Medicine and Rehabilitation doctor would be appropriate.
4 UpVoted this answer
Where are the symptoms? If they are primarily at the joint line, I'd suspect that the meniscus is adhesed to the knee capsule. Is your knee range of motion full (butt touching heel)? Front squats at full range put high loads on the knee ... not a bad thing in itself, but has to be progressed slowly and systematically. Is your front squat 70% of your back squat 1RM? Are there any other provocative movements? Can you touch your toes? What is your ankle dorsiflexion range of motion like? Answer some more of the questions and I can give you more details.
Christopher Stepien
3 UpVoted this answer
Iliotibial band rubbing syndrome. The ITB can rub on the head of the fibula. There is likely for over pronation and hip weakness contributing. Pro tip: evidence is starting to show that rolling out IT bands is not effective. See a good PT.
2 UpVoted this answer
One consideration that may have been missed is that symptoms in your leg may be coming from your back. These "radicular" symptoms can involve the whole leg, partial leg, or sporadic areas. Your squatting activity involves your low back significantly and repetitively. If you have not been successful with other treatment and therapies on your leg and knee then consider a mechanical diagnosis and therapy options from a certified McKenzie therapist.
2 UpVoted this answer
Your symptoms are concerning for a possible meniscal tear. This is usually an injury found with rotational type trauma, but peripheral tears can happen with deep flexion, especially when loaded. I could be a number of other, less serious problems, but it sounds like you should be evaluated by someone who is knowledgeable about knee injuries.
Jacob Benford
2 UpVoted this answer
The muscles that surround your hips have a tremendous impact on what happens at your knees. Research has shown that individuals who present with patellofemoral (knee) pain, like yourself, often have significant strength deficits in their gluteal muscles. Weakness of these muscles or an inability to recruit them properly will ultimately result in increased stress at the knee joint, eventually causing pain. With that said, your squatting technique could also be a contributing factor. Poor form can put an unnecessary amount of stress on the knees. You would be best served to schedule an appointment with a local physical therapist for a full assessment.
Dr. Bobby Esbrandt
2 UpVoted this answer
Pain laterally in the knee can be due to several things, but the lack of trauma/injury narrows the choices a bit. Needless to say a good knee exam would be crucial to being confident of the diagnosis, BUT based on the history of heavy squats in the weightroom and pain laterally, I would suspect that you have either irritated the cartilage underneath the kneecap (patellar chondromalacia) or you have significant inflammation in the IT band insertion on the lateral aspect of the knee. I'd make sure you are icing the knee after working out, taking an NSAID like ibuprofen etc afterwards to see if it minimizes the pain, and you are stretching both your quad and your IT band as tightness in these structures could contribute to the pain. I would also back off on the heavy squats for a bit and limit knee flexion to no more than 90 degrees.
C. Andrew Hunt
2 UpVoted this answer
I suspect the problem lies within the ITB band. The tensor fascia lata originates at the anterior aspect of the iliac crest and ties into the ITB band which inserts at the lateral aspect of the tibial plateau and tubercle. Ober's test may confirm this pathology. Stretching the thigh into adduction can help stretch this structure. I would also recommend foam rolling the lateral aspect of the thigh from the iliac crest to just above the joint line of the knee. Ice massage to the lateral aspect of the knee can help control inflammation.
Cary Eisenhut
1 UpVoted this answer Aaron LeBauer, DPT, LMBT Physical Therapist, Greensboro
Sounds like it's your iliotibial band. I recommend you make an appointment a physical therapist to get evaluated or you can try and Google stretches/strengthening exercises.
Stavros A. Rologas
My best guess would be muscle imbalance with the patella being pulled lateral. This causes running of the cartilage and the bone of the femur. It can also lead to significant ITB tightness at the end insertion point and cause actual weakness in the quad. Try changing foot position and work the top portion of the squat only. Riding a bike at low resistance high cadence can Also help
Marci Catallo-Madruga