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1. Purchase some knee sleeves
Ill make this first one easy on you. Go out, buy some knee sleeves, and wear them every time you train your legs.This could be quad-dominant day, hip-dominant day, leg day, or whatever you want to call it. Just put them on before the workout, warm-up thoroughly, and bask in the joy that healthy knees bring to you.
2. Dont skimp on your warm up
This idea is beautiful in its simplicity, yet often ignored for various reasons such as Im in a hurry or I dont need to warm-up because Im 22 and therefore ten feet tall and impervious to harm. Well, Id love to see what that lack of warm-up is doing to your joints, pal Beyond improving your training performance for numerous reasons, warming up reduces the viscosity of synovial fluid (the stuff that fills your joint space), providing better lubrication and healthier joints in general.
3. Want healthy knees Focus on ankle and hip mobility
It may sound counterintuitive, but when we have knee issues, where do we focus most of our attention? The knees, right? You know what else? Thats a big part of the problem.The fact of the matter is that knee issues are typically due to issues at other areas of the body, not the knees themselves. Lack of hip mobility in all planes can not only lead to knee pain, but back pain as well. Eric Cressey and I covered about a zillion hip mobility exercises in our Magnificent Mobility DVD, so Id highly suggest checking it out.However, one area we didnt cover as in-depth was ankle mobility, and this area is often poorly addressed, or worse yet, not addressed at all. After reviewing Mike Boyles Functional Strength Coach DVD series, I realized how poor sagittal plane ankle mobility is in many athletes. Here are some drills to help out.In the first exercise, all youre going to do is set up next to a wall with your feet a few inches away from it (you may even want to start with your toes touching the wall at first). Rest your hands on the wall, place all your weight on your heels, and then stay tall and try to shoot your knees over your toes In this second exercise, youre going to place a small board underneath your toes to put you into a dorsiflexed position. I find it easiest to place this board in front of the wall so you can balance yourself with your hands. While staying tall, youre again going to try and shoot your knees over your toes. Dont worry if there isnt a ton of range of motion at first; itll improve as you practice it.
4. Get your glutes firing
This is another area that not nearly enough of us are addressing, as most who have patello-femoral pain are only worried about isolating the vastus medialis obliquus (VMO). In research by Ireland et al. (1), they found that athletes with patello-femoral pain had significantly decreased strength in both hip abduction and hip external rotation. How much is significant? These subjects were 26% weaker in hip abduction and 36% weaker in hip external rotation. Now that we know what movements to train, what muscles are most affected? Specifically, were talking about getting your gluteus maximus and posterior fibers of the gluteus medius firing. So before we do low-body work, we should be getting some activation work in to make sure those muscles are stimulated and ready to go. X-Band walks are perfect here.Youll see in the video that the set-up is a little funky, so hopefully seeing it will make it easier than me trying to explain it. Big things to focus on here include turning the toes out slightly and bracing the core throughout. This will prevent you from using the Weeble-Wooble substitution pattern that typically occurs in hip abduction movements. Stay tight, tall, and use those glutes and you should be just fine.In maintenance phases (where Im focusing on max strength), I may only do one set before training. In phases where motor control and recruitment are the priority (for instance, in the early off-season or a transition phase), I may perform three or even four sets of these exercises before training.
5. Forget about isolating the VMO
A lot of athletes and lifters are interested in getting that VMO to fire, especially those with patello-femoral (PF) pain. This anterior knee pain, in many cases, is due to soft-tissue imbalances between the stronger tighter lateral knee structures and the weaker inhibited medial knee structures (the VMO). This muscle imbalance leads to a lateral (outside) pulling of the patella into the femoral condyle, resulting in knee pain.The obvious solution here would be to isolate and then strengthen the VMO, but it just doesnt seem to be that easy. In fact, there doesnt appear to be any true VMO isolation exercises. Sure, terminal knee extensions (TKEs) hit the VMO, but its not isolated.In an article discussing muscular control of the patella, Malone et al. (2) flat out state, The concept of VMO isolation through specific exercise should no longer be part of our lexicon.It should be noted that each and every knee is different, requiring a specific and individualevaluation and treatment program. Im not trying to rehab people here, rather help them prevent the need for rehab. However, I just dont see the need for direct VMO isolation exercises in that treatment program, as their use hasnt been justified in research at this point in time.
6. Get some balance in your training
Im still shocked at how many people dont adhere to this rule. Theyll squat, then lunge, then do leg extensions, and then maybe get some hamstring work in if they arent totally wiped at the end of their workout.If you dont follow this rule, your knees may not hurt now, but I can guarantee they will in the future. When I say that we have to balance your training, we arent talking within the training day or even the training week. You need to address the long-term health of your body when you lay out your programming. Dont just plan one cycle, follow it, and then forget about it when planning the next one. What you did (or didnt do) in this cycle directly affects ensuing cycles.So if you did a ton of quad-dominant work in one cycle, you better make up for it with some serious hamstring and glute dominant work down the line. As Alwyn Cosgrove always says, Time magnifies all programming errors.
7. Stop pain provoking activities
This is the simplest tip Ill give, but for whatever reason people still fail to listen to their body and grasp the concept If it hurts, stop doing it. This can include squatting, lunging, running, playing basketball, or any other pain-provoking activities. Your second grade PE teacher could give you the same advice. Remember that sometimes taking an extra day or two off isnt a bad thing if you can train harder (or pain-free) the next time around. As well, there are also those times when you need to take a step back and work toward a total-body overhaul. If your body has been functioning in an ineffective fashion for a long time, it can take some time to get things sorted out. Take the time sooner rather than later to do this.Each and every time you step in the gym you need to work on being better, and if youre injured, that just cant happen.
8. Dont be afraid to isolate after traumatic injury
Most of the time, isolation exercises totally suck, especially if strength and or performance are your primary goals. However, in a rehabilitation setting the rules can, and need, to change.Following my knee scope, I started back into training with basic proprioceptive exercises, working on regaining mobility, and then progressing back into single-leg exercises. Problem was, my quads were flat-out weak. Just like any other time one muscle is weak, another one is forced to compensate. So by not isolating my quads, I was reinforcing another muscle imbalance.So I begrudgingly got on the leg extension machine and watched myself struggle with 40 pounds. Seriously, Id rather have a bullet in my head than be seen struggling with 40 pounds on the leg extension, but its what I needed to get my strength back.If nothing else, remember this motto A muscle thats weak in isolation will be weak in integration. Do what it takes to get the strength back, even if it means resorting to machines for a short time. The end-goal is to increase tissue tolerance and get to a point where we can perform single-leg exercises without compensation.
9. Do some single leg work
Lets focus briefly on point number four. Remember how we discussed above that those with knee issues need to improve general quadriceps strength, and also need to improve gluteal strength as well? For these reasons alone, single-leg exercises can do wonders for preventing (or rehabilitating) injuries. Beyond that, far too many of us stick solely to the big exercises in the gym. Im all for big squats, good mornings, and pulls, but single-leg exercises move us out of the sagittal plane and force our bodies to learn stabilization patterns in the frontal plane. Im a firm believer that the better our stability is in the frontal (and transverse) planes, the better well be able to perform in sagittal plane exercises.In laymans terms, the more proficient you are at single-leg exercises, the better you can become at double-leg exercises.
10. Get your glutes and hamstrings stronger
We discussed above how people with patello-femoral pain have significantly less strength in their gluteals. So whats the easiest way to rectify the situation? If you said Get their glutes stronger, you get the gold star for the day. By working to activate the gluteals pre-workout, and then working to strengthen them within your workout, youll be well on your way to healthier knees in the future. But what about the hamstrings? Have you ever seen someone who just cant sit back when they squat? Or lands on their toes when they lunge? Flat out, these people have terrible posterior chain strength. Its important to note that we want the glutes to be our primary hip extensor, but we cant forget about our other big hip extensors, the hamstrings. Finally, its important to note that while a lot of women who suffer ACL tears are genetically predisposed (via a large Q-Angle and wide pelvis), they could do a lot for themselves by following this tip alone. This genetic predisposition lends them to flawed posture and movement patterns where the quads and adductors do most of the work, while the hamstrings and glutes do minimal work. Couple this flawed posture with the fact that more and more females participate in quad dominant sports such as basketball, soccer and the like, and you have a recipe for disaster. Every female athlete I work with is going to get a steady dose of posterior chain work glute-hams, RDLs, deadlifts, reverse hypers, and pull-throughs. It can be difficult, but try to focus on bringing up total strength of the posterior chain while also optimizing recruitment patterns. Focusing on squeezing the glutes at the top of all movements can go a long way.
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