No one likes dealing with nagging pain.
For athletes looking to enhance performance and get after it, such pain is particularly troublesome.
All too often, it’s the knees that are the source of recurring pain or injury. Quite simply, many people’s knees suck. The good news is that they probably suck for a few key reasons, and it all boils down to your body and the way you move. If we can address these issues, we can conquer the most common types of knee pain.
1. You Move Like Crap
A well-executed lift looks almost effortless. But most people are on the other end of the spectrum.
I’m talking about the person whose knees buckle toward one another when they squat, making them look like a drunken giraffe. Or how about the guy whose lunge looks like a tight rope walk about to end tragically?
Yeah, that’s moving like crap.
When it comes to the knees, poor movement patterns are going to result in joint deterioration and pain. It’s all about keeping the knee joint as neutral as possible. When the knee is neutral, it’s in a position where it can accept, transfer and dissipate the most force. When it’s not, the forces from action like jumping, running, playing sports and lifting weights place excess stress on the structures of the knee.
Excess stress leads to breakdown. Breakdown means pain! There are three big movement flaws to be aware of when it comes to the knee.
The first one is the hip shift. When you are on a single leg, as is the case during most athletic movements and many exercises, your knee should be in line with your hip. Meaning if I were to stand in front of you, your knee should not look like it’s more in line with your belly button than it is your hip.
Unfortunately for many of us, our core is not strong enough, or does not activate well enough, to keep our hip from shifting outward. When this happens, the knee dives in toward the mid line of the body, which places extra stress on the knee (as well as the hip) because the forces are not going directly through the center of the joint.
More specific to training, when you are going for a Lunge, Split Squat or Step-Up, it is common to see the hip shift outside of the knee. This places the foot at the midline of the body and the knee inward.
The goal is to keep the hip “in” and not to let it shift “out” with respect to the midline of the body. This allows you to keep the hip and knee stacked and forces to be efficiently transferred.
The second common movement flaw that affects knee is knee valgus. At first glance, a valgus position looks a lot like a hip shift. The difference is that the foot and the hip are in fact stacked, unlike what occurs with a hip shift, but the knee is turning or collapsing inward.
In this case, the core is working well enough to keep the hip in place, but the glutes are not working well enough to keep the femur (upper leg bone) from rotating inward.
Again, the forces that are supposed to be going directly through the center of the knee are now being transferred through the medial and lateral sides of the knee. That’s no good!
Once the hip is “in,” it is then imperative to make sure that the knee stays “out” to achieve the full stacked position. Here is a quick video to give you the visual between the hip shift and knee valgus:
The last movement pattern that often beats up our knees is excessive forward knee, or anterior translation. “Don’t let your knee go past your toes!” You may have heard this before. You may have even had a trainer scream this in your face.
While I do believe your knee can move forward; and depending on the exercise, your anatomy and your level of ankle mobility, actually go past the toes (this is particularly for tall athletes), this cue is meant to keep you from causing harm to your knee.
When your knee goes excessively beyond your toes, there is again an inefficient transfer of force through the knee. This time, the forces are going through the front of the knee as opposed to the middle. Many times, this will result in pain in the knee itself, or just above and/or below the knee. Imagining a glass wall in front of your toes for exercises such as Lunges, Step-Ups and Squats can be a great way to avoid this.
If you can prevent these three common movement flaws from occurring, you should be able to keep a lot of excess stress off your knees.
2. Your Core and Butt are Weak
The movement flaws above typically occur because of weakness at the core and glutes/hips.
Very rarely do I find an athlete who falls into the patterns above who does not have a strength deficiency in one or both of these areas.
When your core is weak, or does not activate at an optimal time during movement, the hip shifts out of place. This is directly linked to the hip shift movement flaw.
What also happens is that when the hip shifts, the glutes are no longer in a position that’s conducive for them to turn on with any degree of strength. They are in a suboptimal alignment to create high amounts of force.
When the glutes (especially the gluteus medius) don’t fire well, and/or are not strong enough, the upper leg (femur) will rotate internally, causing the knee collapse or valgus. As we know from above, this is not a good position for the knee.
So what can you do?
Try the following exercises to first get the core activated and then the glutes turned on. You can use this sequence as a quick warm-up, or as a standalone circuit depending on your conditioning level.
1a) Deadbug 1-3 x 8/sd
1b) Birddog 1-3 x 8/sd
1c) Glute Bridge 1-3 x 10-12
1d) Side Bridge Clam 1-3 x8-10/sd
Then when you perform exercises such as your Squats, Deadlifts, Lunges, Step-Ups, etc., focus on what these exercises do for you. Keep your abs engaged like you would for the Dead Bug and Bird Dog, and then use your glutes as you would with the Glute Bridge and Side Bridge Clam. Boom!
3. You Don’t Create Torque
Creating torque is all about your glutes.
The glutes create the external rotation force at the hip joint (the upper leg rotating out), which helps keep the knees from collapsing inward. So the best thing you can do is create that external rotation force, or torque force, before you even begin a movement.
Stand with your feet about hip-width apart, maybe slightly wider. Your toes should be pointing relatively straight with maybe a slight turn outward (10-15 degrees). Now imagine your feet were screws and your upper leg is the screwdriver. Try to screw the feet into the ground by creating a rotational force outward with the upper leg. Your feet shouldn’t actually move, and your feet should always stay flat on the floor. Try keeping this screwing force going as you descend into and out of a squat:
You should feel your glutes (again, your butt) working overtime while going through the squat. And there you go…torque!
This same principle can be applied to the Deadlift, as well as single-leg movements. The biggest caveat is to make sure that you are not over-torquing and having the foot come off the ground or the knees shift excessively outward. Create an appropriate amount of torque during setup and aim to maintain it throughout the movement.
4. Your Anterior to Posterior Chain Work Ratio is Off
Many of us are anteriorly (toward the front) dominated creatures.
Our eyes are on the front of our head (hopefully), and most of life takes place in front of us. We go to school or work and sit with our bodies oriented forward, and then we play sports that are anteriorly dominated.
And then what do we do?
We go home and binge watch Netflix or spends hours hunched over our phones, or go to the gym and perform anteriorly dominated movements. We squat, split squat and forward lunge—and some of us do leg extensions!
While these movements are not bad by any means, they all heavily tax the quads, which have a huge influence on knee health. You see, the quads come down and attach to, and around, the patella (knee cap). When your quads are being used a ton, they are constantly creating force on the knee. Again, this has to happen for life and sport, but when these forces are not balanced out by strength in the posterior chain (backside), they can create issues with the knee.
To prevent this from happening, try focusing on movements like Deadlifts and its variations (single-leg, Romanian Deadlift, Trap Bar Deadlift, etc.) along with Reverse Lunge variations, Step-Ups and Hamstring Curls (the stability ball or slideboard variations).
Just going through the motions on these movements, though, is not enough. You must focus on creating a posterior chain drive.
When performing Deadlift variations, focus on creating torque as discussed above, and finish the movement by squeezing the glutes hard at the top.
For Reverse Lunges and Step-Ups, focus on driving the working side heel into the floor/box. Envision driving the floor/box behind you as you pull yourself up from the bottom of the lunge or step up. By doing so, you should feel your hamstrings and glutes do the majority of the work instead of your quads.
This takes practice, but once you get it, you will start to notice that you are using your backside to perform more work, which is good news for your knees.
Lastly, I’d suggest performing a 2:1 ratio of posterior chain movements to anterior chain movements. This means for every Split Squat or Forward Lunge, you should complete two posterior chain movements (Deadlifts, Reverse Lunges, Step-Ups, Hamstring Curls).
This will help balance out the ratio and set the knees up for long-term performance and health, and you will start to build a more athletic posterior!
5. You Neglect Soft Tissue Work
Last, but certainly not least, your knees will bother you if the soft tissue that attaches to (or around) them is “gritty.” That’s the not-so-scientific term for having knots or adhesions in them.
If the tissue around the knee is not doing so hot, it can negatively impact overall movement. But this is a chicken-or-the-egg argument, and for the most part, I find that crappy movement causes crappy tissue.
All of the other factors above create gritty tissue. And once the tissue is gritty and left unaddressed, it can create unwanted tension on the knee.
Typically, we are talking about the quads and the IT band. However, the hamstrings, adductors and calves can also be factors. When these tissues are not optimal, not flossing well, and impeding on nerves that run through them, you will likely experience pain at the knee.
For this reason, it is imperative to take care of soft tissue work before and after training. Soft tissue care should become part of your daily routine, and be looked at as a preventative measure and an easy way to enhance performance and decrease your risk of pain or injury.
If you have the ability to work with a practitioner who has solid manual skills such as a physical therapist or massage therapist, this can also help with addressing the soft tissue.
The takeaway here is that you must ensure that the soft tissue around the knee is optimal if you truly want to prevent knee pain and enhance performance.
So, you’ve got bad knees? Well, try moving better, getting your core and glutes to work for you, creating torque, strengthen your posterior chain and taking care of your soft tissue. Those five steps should be enough to make a massive difference in most types of nagging knee pain, and significantly improve your athletic performance in the process.
Photo Credit: filadendron/iStock