I got a few questions about how to get in good lower body work when you deal with knee pain.
Of course the typical caveat up front, I am strictly going to talk about how to get a good training effect, so you can feel like you accomplished some stuff at the gym, and am speaking specifically to some common ways that knee pain happens. Nothing here is meant to replace a physical therapist.
I’ve been there, when you can’t squat or do lunges because your knees are hurting, it sucks. You start to wonder if you’re destined to an eternity of bicep curls in the squat rack or making every day bench press day.
The good news is there is a ton of exercises for your lower body that don’t put as much force into your knees. And perhaps you’ll get enough lower body strengthening out of it where it’ll carry over to exercises that give you problems now and make you feel better with them. *Anecdotal evidence alert* I certainly know that is the case with me, I’m able to tolerate a lot more work at the knee than I used to be able to, but getting started again after knee injuries sucked before I got some guidance (shout out to Cressey Performance in Hudson, Mass).
Generally, people who get knee pain during exercise are able to tolerate most hip dominant movements. Lower body exercises can be divided into two categories : knee or quad dominant, where you see the shin angle change as the knees jut forward towards the toes; and hip dominant; where the shin stays vertical (in standing exercises), as if the ankles and knees are cemented into place, and the hips move around these fixed points.
Luckily, there are a lot of hip dominant movements to play with. Whenever in doubt, look at the shin angle. If you’re having knee pain and an exercise has the knees moving towards the toes, you will probably have a bad time with that. Another thing to think about is where on the foot is the force being distributed, exercises where you can drive through your heel are going to feel better than driving through your mid-foot.
A few examples of hip dominant movements are Romanian Deadlifts (1 leg or two) and glute bridge and hip thrust variations (googling any of those + “Bret Conteras” should get you some good stuff if you’re unfamiliar). Those movements are the hardest to mess up and turn into knee dominant exercises.
But there are others that can be performed in a more hip-driven way. Either way you slice it, a basic forward lunge is going to be pretty challenging for knee. But if you are able to maintain a vertical shin, reverse lunges and maybe even split squats (“static lunges”) may be tolerable. Same deal with step ups. The challenge in all of these exercises is that people often perform them with the knees driving forward, making them more knee dominant than they should be.
For these exercises that could go either way – being more hip or knee dominant depending on you perform them – a few basic principles in regards to form are important. To make that vertical shin happen, you want to:
1) make sure you’re not stepping too short or too long. It can help to actually start in the bottom position of an exercise, such as with the split squat, to ensure that you’re in the right 90/90 position with both legs. It’ll help to get a feel for this position, and then you can apply it towards your reverse lunges (and maybe even eventually your forward lunges)
2) Keep your abs tight so that you’re low back isn’t going into an excessive arch. This will make it easier for you to sink your weight into your hips. If you go into that exercise arch, you’ll find your weight will be more likely to shift forward. Think “ribs down” and it can help to place a finger on your belly button and chest and make sure the distance between the two doesn’t increase.
3) Allow yourself to actually hinge at the hips. Many times lunge variations are taught with a perfectly vertical posture (overlap here with tip #2), which not only puts the spine in excessive extension, but prevents the hips from helping out fully. You want to have a long spine, but that doesn’t need to be vertical. Picture a deadlift – your spine is straight, but you hinge towards the floor and then un-hinge back to standing. You can apply this in your lunge variations as well. Here’s a good video on that: http://www.tonygentilcore.com/blog/are-we-doing-lunges-wrong-hint-maybe/
In summary: the way to get more work done with your lower body when you’re dealing with knee pain is generally to shift more work to your hips. Warning: you may develop more glutez.
Hope that helps,