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Amanda’s son was now 5 years old, and he was starting school. Over the past few years, the demands of motherhood and career had left Amanda* with little time and energy to exercise, but she was determined to get back in shape now that her son was becoming more independent.
Amanda began to attend CrossFit twice a week at a local gym. She liked the supportive community and enjoyed challenging herself. When exercises seemed too difficult or caused her pain, the CrossFit coach suggested different exercises.
Amanda wanted to push herself to get stronger, but she didn’t want to hurt herself. And it seemed like any type of squatting exercise caused discomfort in her knees.
When Amanda came to see me, she told me was tired of avoiding squats.
I then asked Amanda how long her knees had been limiting her. She nonchalantly responded, “Oh, I’ve had sore knees since I was in high school.”
For over two decades, Amanda had experienced knee pain off and on-- even with lower impact activities like cycling and rowing.
While her leg muscles weren’t optimally strong, the knee discomfort that Amanda was describing wasn’t from weak muscles. Her knee discomfort was occurring because the inside of her knees were not strong enough to tolerate the pressure placed on them.
The first step to strengthening the inside of her knees was figuring out how much pressure they could currently tolerate. I determined this by using a Variable Incline Plane to measure her Squat Load Tolerance. (Squat Load Tolerance is the percentage of body weight that someone can squat five times without pain and with good motion control.)
Amanda’s right knee tolerated 29% of her body weight. This meant that her right knee felt good when squatting on her right leg using 29% of her body weight, but she had some knee pain when she tried to squat with more weight than that. Her left knee tolerated 35% of her body weight.
When people perform squats at the gym, both of their legs together must withstand 100% of their body weight. Amanda’s right and left knees together only tolerated 64% of her body weight. Given she weighed 140 lbs, this meant her knees could only tolerate 90 of her 140 lbs. With each body weight squat-- at the gym or even when rising from a chair-- she was overloading her knees by 50 lbs.
Amanda clearly didn’t need to lose 50 lbs.; rather, her knees needed to be stronger to support her healthy body weight.
By performing the exercises that I prescribed-- exercises that were less than full body weight, exercises that gently and gradually challenged the inside of her knees to get stronger-- she was able to safely squat with greater amounts of weight.
Within 6 weeks, Amanda’s Squat Load Tolerance improved to 56% body weight on the right and 62% body weight on the left. This meant that her right and left knees together tolerated more than 100% of her body weight, which allowed her to perform bodyweight squats during CrossFit workouts without any knee pain.
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