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Damn My Knee Hurts

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Mike Robertson just had a killer post on what causes knee pain and the answer might surprise you.

If there is pain in the knee, it does not necessarily mean you have a knee injury or the pain is originating in the knee itself.  In fact, the issue is typically traced back to the kinetic segment above or below this joint.  The knee requires stability.  Stability to absorb forces and engage movement without buckling or shifting.   But if the adjacent joints (hips and ankles) are immobile (and they require mobility), the forces that translate across the kinetic chain must get mobility somewhere.  The knee, unfortunately, has to compensate.

As a result, pain happens.  Either immediately through an acute, traumatic injury or over time.  Microtrauma and wear and tear of the soft-tissues and support structures will occur.

So Mike offers two solution; improve hip mobility and activate the balancing force couples, ie. the gluteals to improve posture and restore movement.  I discuss this in my new muscle building system AMD in detail and provide strategies for long term health.

Here are a few exercises to improve hip mobility and activate the glutes to get you started:

1.  Kettlebell Swings

Kettlebell swings will activate the glutes and provide a decelerative loading of the posterior chain.

*Dec 03 - 00:05*Desk email

2.  Bulgarian Split Squats

The benefits of Bulgarian split squats are three fold.  They activate the glutes, activate the quads and stretch the hip flexors.  Again, the goal is to restore neutral hip alignment and improve movement.

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3.  BTR Deadlifts

Beyond the range (BTR) deadlifts will not only improve hip mobility and hamstring flexibility but also develop strength in this new range of motion.  I term this “strength mobility”.

Check out this video:

And finally,

4. Seated Piriformis Stretch

If the piriformis muscle (abducting and laterally rotating the thigh) is tight from too much time on the computer, at your desk or on the couch, it will pull your hips into anterior pelvic tilt.  This causes a TON of problems including putting the hamstrings and abdominals on tension and shutting down the glutes.  So keeping this muscle (group) stretched is essential for hip mobility and if we look down the chain, knee health.

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17 Responses to “Damn My Knee Hurts”

  1. Rob Williams Says:

    Smitty good article. I just did an article about the importance of T-Spine mobility last week.

    I noticed the picture you have under the psoas stretch. Is this the correct picture? Because it looks like a seated piriformis/external hip rotator stretch.

  2. Scott Umberger Says:

    Smitty,
    Always great ideas from you guys! The videos are great as well! I love the elevated KB sumo deadlifts. Great idea for some of my atheltes that are brutal at overhead squats. Like you said, a great way to work on hip mobility.
    I’m a Stern fan so I appreciate the Artie post! Funny ass guy but sad story!

  3. Jim Smith Says:

    Rob – Great Catch!

    I mistakenly put psoas and meant to say piriformis, thanks!

  4. Lean Bulk Forums Says:

    […] kettlebell stuff. Defranco reccomends the other two (the girl pic is even from Defranco’s site): Diesel Crew – Muscle Building, Athletic Development, Strength Training Blog Archive Damn My Knee Hur… […]

  5. Travis Says:

    Someone actually mentioned to me how it was odd MR didnt provide any options after posting that. Then you post this! Awesome DC!

  6. Goody Says:

    This is a great post! I’ve been struggling with more knee pain than usual and recently had some strange and acute hip pain. The lack of mobility in my hips is actually hurting my squat – I’m having trouble getting to proper depth. I can’t wait to try some of these movements. Thanks!

  7. mitchel Says:

    Ok guys this looks great; but there is no way I can do any of this. I have had 3 knee surgeries. I am 31 and I am tired of my knee hurting every day. I am tired of hydro codone and lyrica. My whole life sucks and I am ready to cut my leg off. I have been riding a bike at the gym 1 time a week, doing small squat, climbing a ladder, and regular leg exercise. what can I do….. please help infact just sitting here hurts.. I am 31 189 lb and 57. ouch ouch ouch [email protected]… any thing

  8. Jim Smith Says:

    Mitchel,

    Definitely work on your hip mobility with the piriformis stretch.

    Other movements that you can google and do are:

    1. Glute Bridges for reps or hold isometrically for time
    2. Terminal Knee Extensions (TKE’s)
    3. Isometrically held lunges – go into a lunge (depending on how far you can do it) and hold for 30 sec to 1 min
    4. One leg leg presses (on the machine) for high reps

    The goal with knees that have been repaired is to get the quads to fire. If they shut down, and they will, you knee will become really weak and unstable – trust me I know. I had a bad knee for many years because after I tore my meniscus I favored it and did not use it. My range of motion became limited, my quads shut down and I couldn’t do anything.

    Start foam rolling everyday, stretching your hips and getting those quads firing again with the exercises I mentioned above.

  9. Eric Says:

    Here’s what worked for me:

    I have had real problems with knee pain, specifically in my right patella, as my squat and DL weights have gone up. (FWIW, I’ve had 2 reconstructions on that knee). Strength was good, and my weights were steadily increasing. However, the pain and stiffness in my off days and in the mornings hobbled me to the point of barely walking. I was afraid I would have to give up lifting heavy.

    I researched it a bunch and found a couple of sites which suggested lifting barefoot, so I started doing my squats and DL barefoot about three weeks ago. I noticed a dramatic improvement within three days. I have none of the morning pain and stiffness I had before and am walking normally. My weights continue to climb, pushing nearly 200 on squats and hit 1 RM 300 on DL (I’m 5’4″ 155lbs and 42 yrs old). Be careful not to drop a plate!

  10. Manoj Says:

    The way I see it is pain results from three things..either direct knee injury or imbalance of the muscles around the knee joint or an overemphasis on the knee joint itself during movement i.e. a lot of people tend to put direct stress on the knee joint instead of using the quads etc.. for taking the main load . Depending on which one it is .. one needs to work on the specific weakness and then work around it.

  11. Bill Jones Says:

    Cool article. Me: I am a physical therapist. Me: I have bilateral knee pain. Had it since June 09. Got better with “traditional PT” but I screwed them up again Aug 09. Couldn’t even walk the dog for distance.

    I still did my “brand of training” but they got so bad I had 2 MRIs in Dec and almost went under the knife. I have an old left ACL injury (martial arts) from the 90s that showed up along with 3 tears in the medial meniscus. And one tear of the lateral meniscus on the right. The surgeon is a freind of mine and said he could squeeze me into his schedule but it would be great if I could wait until Jan 2010. What the hell…I could last another few weeks. It’s only pain.

    So I decided to “do something different”. I blasted my thighs/glutes with bodyweight squats/lunges/monster walks w/bands. Just had to find the right groove in the movement.

    The doc stopped by my place late Jan and asked when we were going to cut the knee. Told him they were doing fine right now!

    Great site, Great info!

  12. tnthudson Says:

    Smitty, thanks as always. I’m doing your AMD program (modified, since I can only hit it about 1 x/week), and I just finished week 8 front squats. My left knee used to hurt quite often in the past, but had quit hurting for the most part– until week 8 when I hit those darn front squats.
    I have been doing x-band walks, foam roller, etc. that you outline in AMD… I think it’s just been years since I’ve done front squats (and I use a Smith Machine) so I know my technique was off, and that contributed to the pain I’m sure.
    However, I’ll continue to do the activation/recovery work in AMD, and I’m using a CHO-PAT strap, and my knee feels better already.
    The improvement AND recovery time in my knee pain since I started AMD has been noticeably MUCH quicker and better.
    Also, I now work out barefooted (learned from a RKC kettlebell instructor) and that seems to help a whole lot.

  13. Michael Says:

    I have had knee pain ever since I broke it when I was 20 (now 35). I can do multiple 1 legged squats (aka pistol squats) with my “good” leg but I can not even do half of one with my bad leg. When I try these it feels like someone has a knife in my knee and is twisting it around. This pain/injury has impeded and limited me over the years. Recently I got the idea that squatting heavier then normal would help (trying to build muscle). It did a little. I also did the 20 rep squat routine for 6 weeks. My max squat went up but the pain is still there. And I now do as much of my workouts as possible barefoot. I am still hoping it will get better with muscle building type leg exercises and stretching. Anyhow, thanks for the post.

  14. David Burk Says:

    This is an extremely important and helpful post. Mitchel’s response touched a nerve with me because I’ve been through a similar journey with my knee. Here’s part of a note I sent him:

    I’m 53 years old, 5-9 and 242. I tore my right medial collateral ligament playing football my sophomore year in high school. In those days, they cut what looks like a softball seam in the side of your knee and used a metal staple to reattach the ligament, cutting out lots of your cartilage to make it fit. Then a cast for a long time, I believe 8-12 weeks. Then some minor physical therapy, mainly some light leg extensions and some range of motion work. Bottom line, I never rehabbed it properly, played two more years of high school and a year of college, plus one season of wrestling. The knee hurt some but held up remarkably well under the circumstances. However, by the time I was 35, I had considerable pain—never much of the kind you describe where it hurts just sitting there—usually more during and after exercise or activity. When it started hurting every day when I took my first steps, I went to see an orthopedic specialist. Turns out not only did I have a very loose MCL (both that doctor and another excellent specialist I saw about 8 years ago couldn’t help chuckling when they saw how far they could bend my lower leg out to the side), I had also somewhere along the line badly torn my ACL (which meant doctors can also have a lot of fun seeing how far they can pull my lower leg forward too). The doctor and I argued for several minutes about whether or not I was favoring that leg when I went up steps and so forth. I said I didn’t but he proved that I did. The pain was from the resulting arthritis. It was a tough visit, including facing up to the fact that I was a candidate for knee replacement, though at the time too young for it. But information is power, and I came away with the knowledge that I would either have to find ways to strengthen the touchy knee or lose it.

    I should say that the recovery is far from total. I feel some pain in my knee every single day, and I cannot run or jump rope for more than 30 seconds without flaring up the pain later that day. But I compete in deadlifting and squat in my training, can walk up to 8-10 miles and feel normal the next day, and I can use an elliptical trainer for 40 or more minutes. There is hope for a normal life, and a beyond normal though not elite training life.

    Here are some things I wish I would have known sooner:

    The exercise that got me started on strengthening the quad was a high rep one-legged bodyweight squat done off two cinder blocks positioned inside my dip bars. Paul Anderson did a similar exercise, but he only held onto one vertical pipe for balance. I set up as if doing dips, but just used the one leg to take as much of the weight as it could. This was the only way I could find to start light enough. I found these worked best with a set of high rep one-leg leg extensions, 20-30 reps for some pre-exhaust. These supersets not only strengthened my leg, they also somehow worked as pain relievers. My knee felt better after doing them. I now do box pistols with similar results, but they would have been too difficult to start with.
    Proper squat form, along with what several other posts mentioned—going heel-less or barefoot, got me back into squatting. I had my feet too narrow and was also letting my knees travel too far forward. Now squats are almost never a problem. I really like using chains and bands, now, too, because they are lighter at the bottom. But I am still careful not to squat more than twice per week, usually once.
    It’s not just the muscles that shut down when your knee experiences pain, injury or surgery. The proprioceptors stop working as well. Rehab now includes work on bosu balls and inflatable balance disks. I’ve got a couple of those disks, and they help my knee relearn how to balance on the one leg.
    A few years ago, I got a state of the art Breg brace, specially fitted. I don’t wear it all the time when I train, and I never wear it when I hike, but it really helps on the elliptical, when I’m doing pistols, and when I’m using kettlebells.
    I wear a neoprene sleeve for warmth all the time when I train, and I always start with 10 minutes on the elliptical, even when I’m not working legs that day. Many times the sleeve and warm-up make whatever pain I’ve been feeling that day go away.

    It boils down to unilateral work, including balance work, starting with below bodyweight if necessary, slow progression, excellent form when a movement involves your legs, some tender loving care, and knowing your limits. Add in the regime in Smitty’s post, keep taking the anti-imflammatories, and keep a positive attitude.

    David Burk

  15. knee pain treatment Says:

    Hi bud would it be ok if we used some info from here to use on one of our blogs? cheers mate

  16. Jim Smith Says:

    No you cannot use any information on this site on your blog to promote your products.

    Jim Smith

  17. nick Says:

    It’s all about the glutes! What about the gluteus medius and ankle mobility for knee stability? The maximus has little to do the w/ knee stability relative to the medius and deeper hip muscles. I like beyond the range single leg dead lifts, lateral band shuffle/walks, and calf stretches that I got from Gary Grey.

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