Andrew’s Story: From a Year of Right Knee Pain to a Pain-Free 315 lb Squat
Age: 35 | Sport: Powerlifting | Condition: Chronic right knee pain (~1 year) | Outcome: Pain-free 315 lb squat single — hit 12 weeks into care
The Problem
Andrew came to RXN Performance with right knee pain he’d been dealing with for nearly a year. As a powerlifter, the bottleneck wasn’t just discomfort — it was that the knee was actively limiting how heavy he could squat. Every meaningful session was negotiating around the same joint, and his programming was suffering for it.
What he wanted: get back to squatting heavy, pain-free. What he was doing: scaling weights, modifying technique on the fly, and watching his numbers stall.
What We Found in the Assessment
The right knee was the loudest joint, but it wasn’t the driver. The movement screen showed two clear restrictions on the left side:
- Limited left hip internal rotation
- Limited left hip flexion
The downstream effect: every time Andrew squatted, his pelvis quietly shifted toward the right side at the bottom of the lift to make room for what the left hip couldn’t do. Months of heavy squatting with that shift loaded his right knee in a way it wasn’t built to absorb. The knee was telling the truth about the load — but the load was the symptom of a hip that wasn’t moving.
This is one of the most common patterns we see in lifters: unilateral hip restriction → contralateral knee pain. It’s almost never structural damage to the knee itself. It’s compensation.
The Treatment Plan
Three things, in parallel, every visit:
- Anterior hip mobility work to open up the restricted left hip flexors and restore flexion
- Targeted internal rotation work on the left hip — joint mobilization plus loaded patterning so the new range actually held
- Posterior chain strength work to balance out the squat from underneath: glutes, hamstrings, and trunk all asked to do their share
The goal wasn’t to “treat the knee.” The goal was to make the squat symmetrical again. Once the squat is balanced, the knee stops being asked to compensate, and the pain has nothing to feed on.
The Outcome
Andrew’s target was a pain-free 315 lb squat single. He hit it about 12 weeks into a 15-week care plan — three weeks ahead of schedule.
More importantly: the pain that had been there for almost a year was gone. Not masked, not pre-loaded with ibuprofen — actually gone, because the pattern driving it was no longer happening on every rep.
Why This Worked
Most knee pain that shows up in active adults — runners, lifters, cyclists, recreational athletes — isn’t a knee problem. It’s a hip or ankle problem that the knee is paying for. At RXN Performance, every chronic knee pain case starts with a full movement assessment exactly so we don’t waste your time treating the symptom and missing the cause.
Lifting Heavy With Nagging Knee Pain?
If you’re a lifter, runner, or athlete with knee pain that’s been limiting what you can train, a movement assessment is the right next step. We’ll find out whether the same pattern Andrew had is driving yours — and if it isn’t, we’ll be straight with you about what is.
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Written by Dr. Ryan Giniel, D.C., founder of RXN Performance in Uptown Dallas. More about Dr. Ryan →