I have heard this story many times so I thought I’d shed a little light on the situation. So if you can relate to the title of this post then take notes. Most people just call it knee pain but whether it is patella tendonitis, patella-femoral syndrome, or chondromalaysia, the truth is that it is probably coming from somewhere other than your knee. And like most people, you have probably gone to get it checked out by your doctor and received the same response each time “strengthen around the knee and stop doing squats and lunges”. What most doctors don’t know is that unless you have actually had a knee injury the problem probably isn’t your knee.
Treating the knee as the source and not searching for the real solution is a symptom-based approach which most times doesn’t fix the problem. Think of a leaky roof. You can stop the leak temporarily but unless you find the source it will keep coming back. In other words, the pain in your knee may be coming from your roof.
Using a cause-based approach, current research has led to the conclusion that most knee pain is caused by soft tissue restrictions, poor glute function, poor ankle dorsiflexion, and poor trunk control. Strength coach Mike Boyle uses the “rope analogy” by comparing pain a noose around your neck. If I place a noose around your neck, stood in front of you and pulled on it, you would tell me that the back of your neck hurt. If I simply stopped pulling on it the pain would disappear right? The fact of the matter is that nothing was ever really wrong with your neck, this is just where you felt the pull. Get the picture?
So the first order of business is to stop pulling on the noose which is in this case your IT Band. The muscle that is doing all the pulling is your gluteus medius. The first step would be to loosen up that grip with some soft tissue work. Foam rolling and soft tissue work around the TFL and hip flexors will allow you to stretch those areas more efficiently and working on the glute max and glute medius will help reduce stress on your IT band and knee.
The next step is to mobilize your knee to allow for more dorsiflexion. I use several different techniques with my clients including this one where you place a stick outside your foot and inside your knee while kneeling and glide your knee forward keeping it outside the stick. This will keep your ankle supinated while you mobilize the joint.
Once you are moving a little better and the pain has subsided it is time to begin working on strengthening hip extension. What, what in the butt. I’m sure I am a broken record at this point but I can’t emphasize glute training enough. What can I say, I am a butt guy. But in all seriousness, your glutes may not be weak but misfiring and working on the patter will help stabilize your hips and allow you to use proper form when squatting. Great progressions for training the glutes are bridging, single-leg bridging, and the hip thrust exercise made famous by Bret Contreras. Learn his methods and reap the benefits.
The last piece of the puzzle is to focus on exercises to help stabilize the hip to aid in posture and movement. Working the abductors and external rotators such as the glute medius will help your body to activate the proper muscles during squatting. If these muscles don’t come in to play your knees will collapse during your squat and you will fold like an accordion. Focusing on proper squat technique will help your body stabilize your hip and protect your knees in the process. A great exercise is performing squats with a mini-band or tubing around your knees. It might make you feel funny but look over at the ass-clown on the leg extension machine and think about all the damage he is doing to his knees.
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