First up, I have to highlight that I am talking about non-eventful knee pain. This is any nagging knee pain that comes and goes and typically you can’t pinpoint an exact moment that caused it. It is normally felt as soreness and tenderness either on the top (quadriceps tendon) or bottom (patella tendon) of your knee cap and can quite easily progress into a tendinopathy if not addressed. If you have sustained an injury or this pain is constant and persistent, stop reading, this isn’t for you, seek medical advice from a Physiotherapist.
Experiencing knee pain when training is pretty normal, most of us at some point have felt some sort of discomfort. A lot of the time the finger of blame is pointed at our squat based movements or running volume. Whilst it does make sense to look at the exercises themselves (PART 1) I believe we also need to investigate the use of mobility and warm up exercises or lack thereof (PART 2).
So for PART 1 of this article we are going to look at what might be causing this knee pain and how we can modify things to hopefully alleviate the problems.
Too much running – plain and simple this can easily cause knee pain. Ease into running and ask yourself could you be doing your cardio differently in the first place? Think of the surface you’re running on, the shoes you are wearing. These are all factors. If you aren’t trying to be a better runner and just looking for general fitness I’d suggest whipping together some circuits instead (check my previous blog).
Leg Extension – this exercise has been vilified enough, mainly because its an open chain exercise that causes a great amount of shearing forces through the knee. I’m not saying this exercise can’t or hasn't be used safely and effectively, but I don’t prescribe this exercise for anybody because I typically have people doing enough squatting and single leg work. So, if you are doing a lot of leg extensions and experiencing knee pain, simply put – stop doing leg extensions and focus your time elsewhere, more squats?.
Lunges – Without getting too deep into it, some people just don’t agree with lunges especially walking and alternate forward lunges. Similar to the leg extension, if we step forward into a lunge we begin with an open chain movement and once the foot makes contact with the floor the quadriceps and patella tendon (top and bottom of the knee cap) absorb a lot of that force, especially as our bodyweight shifts forward. The fix for this is really simple, replace forward lunges with reverse lunges or Bulgarian split squats. During both of these exercises the foot on the working leg is in constant contact with the ground providing a stable base and limiting the need to absorb the higher eccentric forces of a forward lunge.
Breaking at the knees – this sounds dramatic but this is a term us coaches use to describe what moves or unlocks first when people are squatting. Ideally I teach people to break at the hips as they sit back/down into a squat. If you are experiencing knee pain during or after squats I would suggest using a box squat to help cue you to sit back into your squat a bit more and squat with a more vertical shin. It would be dogmatic to say that everyone should squat like this, there is just too much variation in the way people are shaped and the way they naturally squat. But, I do find that a lot of people load their knees first, so simply training a hip break can definitely help.
That’s it for today, be sure to check back for PART 2 where I’ll go into detail about mobility and warm up exercises that will help stop knee pain and if you need any help in this regard feel free to get in touch.