Monday, January 19, 2015

Knee Pain? Train the Posterior Chain!

Thanks to your winter-long commitment to high-intensity workouts, you're in the absolute best shape of your life. Your clothes have never fit better. You've never been more proud of your beach-ready body and all your latest personal records in the gym.

But there's one problem: you have knee pain.

Knee pain when you squat. Knee pain when you take the stairs. Knee pain when you drive. Knee pain even when you just sit around.

You've been so committed to training with good technique. What gives?!

You go to the doctor. He gives you a shot of cortisone and sends you for an MRI. Surgery is the recommendation. Something about an abnormal meniscus since birth -- which quite frankly doesn't make any sense since you've been active your whole life but have only recently developed pain.

Might there be any other solution besides surgery? You sit down with a trusted friend to review your training program from the last few months. Heavy squats on Monday, light squats on Wednesday, medium squats on Friday. Your friend identifies the problem immediately.

Drum Roll, Please...

Lots and lots of squatting and zero deadlifting! Sure, high frequency squatting is great for leg development, functionality, and body composition change, but it absolutely must be balanced with equal amounts (or more) of hip-dominant exercises like deadlifts and glute bridging.

Thus, knee pain can very easily be the result of a strength imbalance between your quads and hamstrings/glutes (the front and back muscles of the upper leg, respectively). In fact, poor posterior chain function is practically an epidemic in our desk-bound modern world.

Spending a few weeks focusing exclusively on strengthening those backside muscles could just lead to a dramatic reduction in knee pain, not to mention a bigger booty. (And who doesn't want a bigger booty?!)

The Recommendation

Let's begin by stating the obvious: if it hurts, don't do it. Meaning, for the next six weeks, swear off all knee-dominant exercises like squats, lunges, step-ups, and box jumps.

Instead, do nothing but hip-dominant ones. That is, focus on exercises targeting the glutes (hip external rotators, abductors, and extensors) and hamstrings (hip extensors and knee flexors).

Your lower body training will consist exclusively of the following exercises:

  1. Side-lying clamshells (hip external rotation)
  2. Super-band monster walk (hip abduction)
  3. Glute bridging and slider leg curl variations (hip extension and knee flexion)
  4. Bird dogs (hip extension)
  5. Nordic leg curls (knee flexion)
  6. Barbell hip thrusts (hip extension)
  7. Roman chair back extensions (hip extension)
  8. Deadlifts (hip extension)
  9. Stiff-legged deadlifts (hip extension)
  10. Single-leg stiff-legged deadlifts (hip extension)
  11. Cable pull-throughs (hip extension)
  12. Kettlebell swings (hip extension)

Watch the video playlist below (12 videos, 11 minutes total) for technique tips on all the above-listed exercises:

--Videos courtesy of No Bull Training--

Now How Do You Feel?

When it comes to the human body, there's no such thing as magic, of course. But this protocol may just be the next best thing.

After six weeks, reassess those knees. Warm up with a few easy posterior chain activation drills like clamshells, glute bridging, bird dogs, and monster walks. Then perform a couple sets of step-ups or light goblet squats, perhaps down to a box. Take it slow, and focus on keeping a fairly vertical shin.

Still in pain? Let's hope not!

Disclaimer: I'm not a doctor, and this recommendation does not stand in for real medical advice. Always consult your doctor if you are in pain.

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