Client Question: Help me with my knee pain!

Client Questions:

“Can u give me some good stretches to loosen My IT band? My knee is very sore all the time so I’ve been foam rolling on my outer thigh. I just find I’m Very limited working out as my knee kills squatting lunging running”

First of all- great question! I am happy your aren’t giving up on trying to be active because of the pain.

There are a large list of things we should look at in order to figure out why you are having knee pain and how we can help it. Remember, I am a Kinesiologist so I can’t diagnose what’s wrong with your knee, but I can help to observe faulty movement patterns and provide corrective exercises and stretches for the movement.

So when I hear “knee pain”, and I am assuming lateral knee pain, because you mention your It band, I think of a few different things:

  • Tightness in all aspects of your quad/lower body.
  • Faulty squat and lunge movement patterns.
  • Glute muscles that don’t fire well (and probably aren’t even working in this exercise for you).
  • Lack of pelvic control.
  • Something crazy happening down at the foot.
  • An acute overuse injury?
  • Lack of range of motion in the hips/something happening in the spine causing you to favour that one knee.

There is a LOT that could be going on, but if you are keen on fixing it, read on and try a few of these things to see what’s happening.

  • Tightness in all aspects of your quad/lower body. Most commonly what I see with knee pain is tightness of the surrounding muscles of the knee and IT band. First of all, I would suggest not rolling your IT band anymore. The IT band is a thick fibrous tissue that runs over the hip and knee joint. It’s purpose is to extend, abduct, and laterally rotate the thigh, as well as stabilize the knee joint. It is supposed to be tight (or better said, taut) for a reason. If the IT pain is causing issues it’s most likely not because all of a sudden this fascia has become super tight on you, but most likely because the surrounding muscles are creating too much further tension in the IT band, or something is happening in your hip mechanics to cause the IT band to tighten. So rolling the IT band probably won’t help, but correcting these other issues may as a result bring the IT band back to its regular amount of tension. So instead of rolling the IT band, I want you to roll the following muscles:

Remember, foam rolling is only effective when you really dig in and make structural change in the muscles. Try to breathe, relax and dig deep into the tissue. Move slowly over the muscle. Stay in the area until things feel better or more loose, then move to the next region.  Roll before workouts, after workouts, or whenever you can really!

Quads (straight down from the hip to knee)blog 1

Vastus Lateralis (your side quad muscle)- be careful, it’s not quite on the IT band, but it connects into it, your hips should still be pointed relatively downwards.

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Tensor Fascia Latea: *This one is a bit tricky to get into, but once you hit it, you will know! Play around until you find the position.

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While you are at it, your might as well do the inner thigh and calve, this is only going to be further helpful.

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* If you have been foam rolling for awhie and not feeling any more relief, it’s time to go deeper! For example, I have been rolling for some time and find I can’t dig deep enough into these tissues. I have started to use myofascial balls to dig into areas in a new way, I can help you with that additionally if interested.

#2: Faulty squat and lunge patterns.

Squats and lunges are HARD to do correctly, and I see them done incorrectly every single day. If you are looking for correction with your squat or lunge, send me some videos of you doing them from the side and front and I will e-mail you back with some suggestions. (Katherine@optimal-health-coaching.com). Try to follow the following movement directions:

Lunges:

  • Standing tall take a large step forward, plant all aspects of the front foot into the ground.
  • Ensure both hips, feet, and shoulders are pointed forward throughout the entire motion.
  • Bend the back knee and lower it towards the ground. Keep your shoulders and torso over the hips so that the weight drops down, not forward onto your front leg.
  • Ensure your front knee stay’s behind the front toe.
  • Ensure you are taking a large enough step (the back knee should be behind the hip).
  • Pictures below: Right: Proper lunge. Left: Poor lunge form, not a large enough step and body position too far forward.

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Body Weight Squat/ Back Squat (bar on the back)

Check out this video for a detailed explanation: http://www.youtube.com/watch?v=tTYCBITD0nA

  • Feet are slightly wider than hip width and toes are pointed out slightly (5 degrees).
  • With all the weight in the heels, but pushing your big toe, pinky tow, and heel into the floor, sit back and down.
  • Try this first with a dowel rod down your back so you can get a feel for blog 9what a flat back feels like as you squat deep (head, upper back, and tailbone maintain contact).
  • If using a bar: Secure the bar on the ‘shelf’ created on your upper back. The shelf is the soft part of your back, below your neck, and above your shoulder blades. Try to break the bar in half- this activates the shoulder girdle.
  • If you don’t have a barbell you could hold two dumbbells at shoulder or waist height.
  • Ensure that you keep the bar over top of the midfoot as seen in the photo (like the deadlift), this will force you to keep your upper body tilted forward blog 10slightly for the low bar squat (the spine and the shin should stay parallel to each other).
  • On the way back up, drive the hips up and squeeze the glutes to move the hips forward. You must squeeze the glutes or else the knees will cave inwards. Press strongly into the floor.
  • When you gain proper ankle and hip mobility you should start to take your squat below parallel (90 degrees), as this will ensure you active the quadriceps and hamstring muscles equally, as well as the glutes. Squatting above parallel is a quad dominant squat.
  • Keep the core tight the entire time. I take a large inhale at the top of the motion, brace my core, do the squat and exhale as I am coming up.

Common mistakes– Photos below: Squeeze the glutes so that the knees do not cave inwards as seen in the second half of the photo. Do not round your back, the photo below shows an improper curve of the spine.   If you lack mobility you may find that you have a ‘butt wink’ at the bottom of the squat, meaning you are losing your lower back neutral arch. Improve your range of motion to prevent this.

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3: Faulty Glute (Butt muscle) activation.

Do you sit most of the day? Do you ever actually squeeze/engage your butt muscles when you workout? Lack of glute use is one of the biggest issues I see in my day-to-day practice. They have become lazy and people forget how to use them!!

First thing you can do, is start to actually use and engage your butt when you squat and lunge. If you don’t engage your butt on your squats I bet you your knees are either shaking/wobbling, or collapsing inwards. Do your squats facing a mirror and make sure that your knee is tracking solidly out and stable on the way up and down of your squat.

Not sure if you are squeezing your glutes? Try this exercise : https://www.youtube.com/watch?v=R-vENo-7jQ8. You will have to keep your glutes engaged to keep your knees tracking out.

Some other great glute strengthening exercises are:

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1) Bridge lifts. (pictured to the right) When you do this your feet should be hip width apart and close to your butt (as shown). Before you lift engage your abs (so your ribs don’t flare up). I only want you to lift with your glutes and core, don’t push with your low back and try to quiet the hamstrings. Do 20 reps in a row with a huge squeeze of the glutes (juice an orange with your butt cheeks!).

  • Glute kick backs. Try this one without a band first, it is surprisingly difficult when done correctly. Assume position on hands and knees (wrist under shoulders, knees under hips). Create a perfectly table top blog 15back position. Engage the core and without just shoving all your weight into your opposite hip try to extend your leg straight back and squeeze the butt. Bring it back in slowly without affecting back position. Here are some SUPER common mistakes that I assure you will do if you haven’t done this before:
  • Shift your weight side-to-side or front to back to perform the motion.
  • Arch your back
  • Kick your leg super high
  • Bend your elbows
  • Crunch your shoulders up towards your ears.

So don’t do any of those 😉 Do 20 reps a side with no band, and eventually add the band.

  • Lack of Pelvic Control

A lot of people start to squat when they exercise because they see everyone else doing it. What they don’t factor in is how many small stabilizing muscles are required for this challenging movement. One of the biggest stabilizers that people forget to train are the transverse blog 16abdominals. The transverse abdominals are the ones that run deep to some of the fancier ab muscles, and are super important in stabilizing the pelvis during movement.   This picture to the right attempts to demonstrate where they are located.

What happens when our pelvis is not stable during a squat? Commonly a person will shift side to side in their hips, favouring one knee during a squat. You can see how in this photo to the right her hips have not lowered to the bottom evenly and more of her weight is in her right knee. Try a few squats in the mirror and observe your hips. You could also stand really close to a flat blog 17wall and sit back into a squat and notice if one knee is coming more forward.

To find them on yourself do the following:blog 18

– Lay on your back with your feet flat on the floor, knees bent, neutral arch in lower back (not pushed down or arched up). Put your hands on your lower abdomen below your pant line. Press firmly into your abdomen and try to create pressure within the abs so that you can feel them engage out towards your fingers. It looks a bit like this:

If you can’t feel them engage try coughing, or engaging your pelvis to prevent urination. Still not working? Pick your heels up off the ground, you have to feel them now!

Now here’s the test, try to engage those abs (with your feet on the floor). Keep them firing just as hard while taking 10 deep inhalations and exhalations. I want your air to come down into your ribs and abdomen (make a big belly) each time. Those muscles shouldn’t stop firing for all 10 breaths. If they do, you are lacking some basic T.A endurance! This exercise is a good place to start.

The next level is to work up to some Dead bugs. The dead bug is done like the photograph of the guy in a purple shirt. He is holding his knees and blog 19arms up together while keeping a neutral spine. Inhale and get your core ‘cylinder’ tight and then lower down opposite arm and leg. Exhale and bring them back up together. There should be NO movement in your core cylinder, no rocking back and forth. There should also be NO pain or discomfort in the lower back. If that’s happening your core is not strong enough for the one yet. If it’s easy, straighten your legs throughout the whole motion.

That’s all I am going to say about these abs for now. If you wan’t more exercises for this muscle group please let me know! They are the foundation to a strong core until in every exercise.

  • What’s happening at your foot?
  • Try a squat in bare foot. You might find your arches are collapsing, or you are up on your toes, or something else funny is happening. All of your force is generated from pushing into the ground, so if you are pushing into the ground incorrectly you will end up sending force up your body (into your knee) at a weird angle. As you squat look down at your feet and make sure your heel, big toe and pinky toe (your tripod) are all pressing down. Also, remember you toes should be out only 5-10 degrees in a squat, and in a lunge your knee should be pointed out over your 2nd toe, don’t let that knee cave in!!!
  • 6) Is your IT band inflamed/overused?

If you have been running/squatting/lunging a TON all of a sudden after being inactive you may have irritated that tissue. Try resting, icing, and limiting these movements (choose other exercises instead) until the tissues can calm down. Then start a bit slower, and exercise with perfect form from preventing that happening again!

7) How is your hip range of motion?

Many people squat without first ensuring they actually have the proper range of motion to do so. In a squat we need good ankle and hip range of motion primarily. We need hamstring flexibility, and quad flexibility as well. Here are a couple tests to try (below): (If any of these positions are not exactly as shown in this photo, you’ve got some mobility work to do!

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I could write pages and pages on each exercise and what you would need to do, so instead let’s just say that if you need some help with one specific range send me an e-mail!

I hope this helps! Remember, you are reading this advice on the internet and it might not be suitable for your condition, so before trying anything I would suggest seeking advice from a trainer professional who can be with you while you do it!  Also, this might not solve your problem, and there might be something else going on- don’t give up finding it!

More questions? Let me know!

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