There is always a reason why a body part hurts. Most injuries that just seem to pop up out of the blue can be traced to poor body mechanics, muscles that are too tight, and weakness in the muscles that help stabilize joints. Knee pain is one of those common problems that many gym goers run into. Knee pain can be extremely frustrating especially for those of us who like to squat. Well here is how to fix that pain and keep your knees healthy.
First and foremost, you need to take a step back and evaluate how you move to figure out why you are hurting in the first place. Video yourself doing some squats (or look at some old Instagram posts of your squat). Do your knees cave in? Do you hit the hole really quickly? Do your heels rise off the ground? Do you shift your weight to one side more than the other? Do your quads do almost all the work? Always remember, if you aren’t an electrician, then you probably shouldn’t rewire your house, and you definitely shouldn’t rewire someone else’s house. If you really don’t know exactly what you’re doing, then you should look to a professional for help (like me J). If your squat mechanics are poor then that is something you need to address and really focus on. When you get back to squatting again, start light and work on good quality reps.
Another factor to evaluate is how much you move throughout the day. If you have a typical desk job, chances are you sit most of the day. This can cause your quads and hip flexors to become extremely tight. This can lead to knee pain because of the excess tension from the tight quads pulling on the knee. If this is the case, then focus on myofascial release and stretching for the quads and hip flexors. Also make sure to move more often throughout the day.
If your squat mechanics are good and your quads and hip flexors aren’t the problem, then the next step is to look at your exercise program. You might be putting too much stress on the joint to where it cannot recover. You may be doing too much volume, too much frequency, or too much weight. For this case, you may just have to scale back your program a bit to allow for proper recovery from your workouts.
So now that you hopefully know why your knees hurt, here is what your game plan should be:
1. Gaining mobility and stability should be your first priority. Focus on myofascial release and stretching of all the muscles that play a big role in movement of your knee. This includes quads, hip flexors, calves, tibialis anterior, adductors, IT band, hamstrings, and glutes.
2. Corrective exercises are going to be next on your to do list. The vastus medialis oblique (VMO), hamstrings, and gluteals need to be strengthened to rehabilitate and protect the knee from future injuries. For those with knee pain, it is important to not complete full range of motion (only go to 70% of extension) on the knee extension machine. Closed chain knee extension exercises, like a terminal knee extension using a band, are recommended for those who have had a knee injury.
3. After a given period of time of mobility work and corrective exercises, you can slowly return to placing a load on the knee joint. Box squats are my favorite way to start introducing load to the joint. Box squats make you sit back, placing less stress on the knee, and they can help you learn to how to maintain a stable knee out position. Sit down to the box in a very controlled fashion (pretend like you are sitting on glass), maintain tension while seated on the box for a second, and maintain that tight position (with your knees out) while standing back up.
Knee Rehab Exercise Protocol:
* Factors such as how someone actually got injured and the severity of that injury, lifting experience, and current strength and mobility will determine the exact program an individual should follow. The following exercise protocol is for the recreational strength athlete or powerlifter who can’t squat without having their knees hurt (mostly patellar knee pain). The knee pain is felt throughout the day as a “twinge” or ache while walking or sitting down and standing up. This knee pain was caused from having some knee valgus during squats.
Week 1
Complete 2- 3 days per week with at least 48 hours between workouts
Warmup:
1. Foam Roll and Stretch Quads, Hip Flexors, IT Band, Calves, Tibialis Anterior, Glutes, and Hamstrings
2. Pistol Heel Taps (from plate) 1 set x 10 reps each leg
Workout:
1a. Seated Leg Raise Straight Up and Down 2-3 sets x 10 reps
1b. Seated Leg Raise Abduction/Adduction 2-3 sets x 10 reps
1c. Seated Leg Circles In and Out 2-3 sets x 10 reps each direction
2a. Back Extension with Focus on Glutes (toes turned out, rounded upper back, core remains tight, and no flexion/extension of back) 2-3 sets x 12 reps
2b. Hamstring Curl 2-3 sets x 12 reps
2c. Lateral Banded Walk 2-3 sets x 12 steps each direction
2d. Single Leg RDL 2-3 sets x 12
2e. Cable Kickouts 2-3 sets x 12 reps
Week 2 (may need to repeat one more week if knee pain is still noticeable after the week is over)
Complete 2- 3 days per week with at least 48 hours between workouts
Warmup:
1. Foam Roll and Stretch Quads, Hip Flexors, IT Band, Calves, Tibialis Anterior, Glutes, and Hamstrings
2. Pistol Heel Taps (from plate) 2 sets x 10 reps each leg
Workout:
1. Block Pull (light weight, focus on glutes and hamstrings, vertical shin) 3 sets x 6 reps
2a. Seated Leg Raise Straight Up and Down 3 sets x 12-15 reps
2b. Seated Leg Raise Abduction/Adduction 3 sets x 12-15 reps
2c. Seated Leg Circles In and Out 3 sets x 12-15 reps each direction
3a. Back Extension with Focus on Glutes (toes turned out, rounded upper back, core remains tight, and no flexion/extension of back) 3 sets x 12-15 reps
3b. Hamstring Curl 3 sets x 12-15 reps
3c. Lateral Banded Walk 3 sets x 12-15 steps each direction
3d. Single Leg RDL 3 sets x 12-15
3e. Cable Kickouts 3 sets x 12-15 reps
Weeks 3-5 (do this for at least 2 weeks and slowly increase the weight each week)
Complete 2 days per week with at least 48 hours between workouts
Warmup:
1. Foam Roll and Stretch Quads, Hip Flexors, IT Band, Calves, Tibialis Anterior, Glutes, and
2. Pistol Heel Taps (from plate) 2 sets x 10 reps each leg
3. Seated Leg Raise Straight Up and Down 1 set x 10 reps
4. Seated Leg Raise Abduction/Adduction 1 set x 10 reps
5. Seated Leg Circles In and Out 1 set x 10 reps each direction
6. Back Extension with Focus on Glutes (toes turned out, rounded upper back, core remains tight, and no flexion/extension of back) 1 set x 10 reps
7. Lateral Banded Walk 1 set x 10 steps each direction
8. Band Abductions 1 set x 15 reps
Workout:
1. Box Squat (keep it light and focus on your form) 3 sets x 5 reps
2. Block Pull (keep it light and focus on glutes and hamstrings, vertical shins) 3-4 sets x 6 reps
3a. Single Leg RDL 3-4 sets x 12-15 reps
3b. TKE 3-4 sets x 12-15 reps
4a. Cable Kickouts 3-4 sets x 12-15 reps
4b. Hip Abductions 3-4 sets x 12-15 reps
4c. Hamstring Curl 3-4 sets x 12-15 reps
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