Knee Pain? What Your Program Might Be Missing
Patterns are everywhere, from spider webs to architecture to those found in human movement. Have you ever taken a step back at the gym to observe how others move? Every week I have the privilege to work with many athletes, ranging from novice to elite. The more I learn about how we move and the patterns we use, the more similarities I see between those of all levels. Poor movement patterns can hinder performance, as well as result in pain. Patellar tracking disorder, also known as patellofemoral pain syndrome, is a common issue among recreational exercisers and athletes alike. We have well over 200 members at the gym I work at, and I have seen this problem arise on occasion.
So before I go any further, I am going to throw a disclaimer out there that I am not a doctor. I do not pretend to be one, and if I ever think an athlete has a serious issue, I will refer them to the appropriate individual. With that being said, the more I learn about movement patterns and their relationship to performance, the more I have been able to identify biomechanical inefficiencies during exercise. What I have noticed lately is that these athletes are getting patellar pain because of poor knee position and a lack of stability in the knee while exercising. Due to this poor position and instability, the quadriceps can become over dominant and force the patella into bad positions. The patella is then essentially rubbing against tissues in the knee. This can cause pain and swelling in the knee, which typically can restrict a person from exercising, result in loss of strength and reduce range of motion. So how can you fix it?
We know there is pain at the knee, but that does not necessarily mean the knee is the culprit. As mentioned before, pain is the result of poor knee position and instability, but what is causing that? To improve knee position we must look toward the trunk for stability. By creating a stable core with the pelvis and diaphragm, we give the legs a solid platform to move from. This in turn improves hip and knee position and improved performance. Often I have heard of doctors prescribing anti-inflammatories, rest, or ice. While all of these are viable solutions, there has been a failure to address the movement that caused the issue. Putting a band-aid on the problem is not the answer. A medical solution will not fix a movement problem. If movement is making you hurt, you are moving poorly, and you need to fix it. You should be able to jump, run, and squat without pain. Improving movement then seems like a reasonable solution, particularly for athletes concerned with performance.
This is where the glutes join the party. The glutes and quadriceps have a unique relationship. Many people do not use their glutes correctly when moving. The glutes can become inhibited by poor motor control, position, and/or pain, causing them to become less and less efficient. As this is happening with the glutes, the quadriceps and hamstrings begin to pick up the slack by becoming tight to add stability. If the patella is being exposed to greater stress from a poor position, then activities like running, jumping, and squatting can irritate the surrounding tissues. So if our glutes are inefficient, we have an opportunity to correct it with glute activation. Plain and simple. Wake up your glutes and they will do their job, helping to improve your positions and taking the extra workload off the quads and hamstrings–not to mention this will help stabilize your pelvis, which is important enough to warrant its own article.
I have a number of favorite corrective exercises I use when people come to me with these problems. Before we dive into specific exercises, I have to mention a couple of things. First, specific muscle activation will not overcome a poor movement pattern. Be sure that when performing these exercises your core is properly engaged first to eliminate rib flare and keep the pelvis neutral. Secondly, I would like to say that this may or may not help every individual, but it is not going to hurt you, hinder your performance, or have any real negative effects. The athletes that I have worked with have benefited greatly from these exercises, reducing or even eliminating their pain, and improving how they move and perform.
The first exercise, the glute bridge, has a number of variations that come with it. It is extremely simple. You will lay on your back, heels planted in the ground, arms down to your side with palms facing up. From there, squeeze your butt and raise your hips off of the ground, maintaining contact between the shoulders and the ground. The biggest problem people run into with this exercise is that they allow their hamstrings to contract and compensate, defeating the purpose of the exercise, which is to activate the glutes. I typically have the individual perform three sets of twenty reps, though you can always do more if you feel inclined to do so.
The next exercise is the leg raise against a wall. You will lie on your side with your shoulders, back, and butt against the wall. With the leg that is against the ground, take that foot and plant it against the wall. This will cause you to flex your knee and hip. The other leg will be the one that is being raised. Keep this leg straight, pulling your toes toward you and keeping them facing away from the wall. Keeping your core engaged, you are going to raise your leg, keeping the heel in contact with the wall. I typically prescribe three sets of twenty reps per side for these as well.
The final exercise will be side lying clam shells. Again there are a number of variations with this exercise but we will be focusing on one that I think is the most simple and effective. You will start by lying on your side, perpendicular to a wall, with your feet about two to three inches apart and planted against the wall. Note that when your foot is planted, make sure to have contact at the ball of the foot, the base of the pinky toe, as well as the heel, this keeps the foot stable. Knees and hips will be flexed, with knees in line with ankles and hips behind the knees. Hip crease should be at or slightly above ninety degrees. From here, with the leg on top, you will slightly raise your knee focusing on not letting the hips open up towards the ceiling. Again, always remember to engage the core. This will be the same rep scheme as the leg raises, three sets of twenty reps per side.
You can do these exercises whenever, wherever, and they take very little time. If you are having some knee issues, these should be done every time you train, if not every day. Personally, I like to use them in my warm up. They prime your system, getting you ready to move. What more could you want from a warm up? Even if you are not having knee issues, try them out as part of your warm up and see if you feel a difference when performing some basic movements like jumping or air squatting. They should allow your glutes to become more active and engaged in your movement, thus allowing other muscles like your quadriceps to function properly. By now you should see how important this is.
Your muscles have to work together for you to be able to move correctly, stay healthy, and perform better. A physical therapist or someone with similar credentials, could elaborate more on this and get very specific as to the exact cause of knee pain. Again, as I stated earlier, I am not a doctor. With that being said, hopefully these exercises will allow us to improve performance, help reduce injury, and break poor movement patterns.
Author: Sean Smith