Knee pain is a very common issue seen throughout the health and fitness world. Oftentimes, it can limit your ability to perform lower body exercise (ie. squats, lunge, jump rope, running, etc), which can then lead to avoiding workouts altogether. Knee pain can be very frustrating, but should not be something you have to continue pushing through during every leg day or trip down the stairs. Instead, you may just need to develop a proper plan to treat the issue and temporarily modify your training. How do we do this?
3 STEPS to decrease knee pain:
- DO NOT stop exercising. Find ways to initially work around the discomfort while still working out (ie. box squat vs. front squat / sled drags vs. running)
- Find and treat the underlying cause(s)
- Gradually reintroduce previously irritable movements and improve overall capacity of the knee
In this blog we will discuss how we go about treating knee pain, how to perform a self-assessment, exercises that may be helpful in reducing your pain, and tips to modify your programming.
Areas to Assess
More often than not, knee pain is not simply due to one issue isolated to the knee. Typically, there can be a few contributing factors that all should be considered. Some of these that we like to look at include:
- Stability at the hip/ankle
- Mobility at the hip/knee/ankle
- Capacity to load your knee
Stability at the hip/ankle
- Single leg touchdown
- Goal: 10 repetitions without noticeable compensations
- Side plank endurance test
- Goal: >45 seconds without noticeable compensations or significant fatigue
90/90 shin box
- Looking at ability to access rotation of the hips
Knee over toes test
- Assessing dorsiflexion mobility between sides
Seated tibial internal rotation
- Ability to access rotation of the knee (necessary to normal flexion/extension of the joint) between sides
Capacity to load the knee
Anterior step down capacity test
- Goal: 10 repetitions, observing for compensations
- Assessing ability to load the anterior knee
Once we have identified some of the areas that need worked on in the assessment, we have the information we need to start effectively treating some of the areas that may be contributing to the knee pain. Treatment does not need to be over complicated – it just needs to be specific. Below are a few exercises that may be appropriate to work on based on your assessment.
Difficulty with stability tests?
- Side plank variations – isolating hip strength
- Static quarter squat exercises with “tripod” foot – challenging both ankle/hip
- Single leg touchdowns with progressing height – working dynamic stability
Difficulty with mobility tests?
- 90/90 shin box → hip airplane
- Knees over toes test → banded knees over toes split squat
- Seated tibial internal rotation → self mobilization in split squat, banded mobilization
Difficulty with capacity tests?
- Step down variations progressing from hip to knee dominant (posterior → lateral → anterior), adding weights or bands to increase challenge as necessary.
To decrease irritability of the knee, temporarily modifying programming can be helpful. Typically movements that are hip dominant and focused more on posterior chain development are tolerated better. This does not mean you should completely remove all lower body exercises that stress the front of your knee, but as we discussed in the treatment section, we need to slowly rebuild capacity in these movements.
- Front squats → box squats
- Forward lunge → kickstand RDL
- Back squats → deadlifts (trap bar or straight bar)
How to modify programming:
- Increased hip hinge dominant patterns:
- Deadlifts, hip thrusts, box squats, bulgarian RDL
- Add in more machine work (biking, rowing, ski erg, backward walking, etc.)
- Continue to focus on full range of motion through the knee with tolerable loads
- Try open chain or isometrics
Are you struggling staying active or with your workouts due to knee pain? Let’s chat about how we can help you get a gameplan to get back to performing at a high level without limitations due to pain.