The following blog features information presented by the National Academy of Sports Medicine (NASM) and from myself. Information will be credited as MTC for myself and NASM for the re-posted material. – CS
I’ve noted over my years as a personal trainer that I’ve had a disproportionately high number of female clients with knee related issues as compared to their male peers. Men on the other hand hold a commanding lead in the bad shoulders department. Training clients with knee related problems can present a challenge to a trainer that does not have a corrective, or therapeutic exercise background. Unsurprisingly, many trainers use the seated leg extension machine in order to strengthen the knee joint and quadriceps muscles while avoiding squats. While I’ll agree there is some rehabilitation benefit to the seated leg extension and seated leg press, I also believe they should not form the core movements of a knee rehabilitation program.
A look at the knee…
I’ve had quite a few clients with knee issues. The most common have been ACL (Anterior Cruciate Ligament) and Meniscus related.
I’ve also received guidance from Physical Therapists to engage clients Vastus Medialis Oblique (VMO) and Rectus Femoris muscles.
Trainers: Have any client you intend to take on receive permission from their Doctor/Physical Therapist for physical training if they have current knee issues (along with any other condition that warrants medical clearance.)
Clients: If you have received medical clearance for physical training and have a personal trainer assisting you make sure you communicate when exercises hurt, or don’t hurt. If your trainer asks you if something causes pain, YES OR NO are really the only acceptable answers. Being vague tells the trainer nothing.
I’ve had clients give pretty vague descriptions of things going on with their bodies during exercise. My personal favorites to date were “I think my hair hurts” and “I think your routine is giving me the meat sweats.”
In combat the knee is both a great target and weapon. That said, why is it you never see guys fighting in business suits?
The math of your knees: Multiply your body weight x 3= How much force is being absorbed by your ankle, knee, hip and low back every time your foot strikes the ground while running (Don’t ask me about walking, I’m not that good at math.)
For every excess pound/kg of weight you are carrying, there is approximately 3-5 lbs/1.3-2.2 kg of pressure put on each knee.
I use the front and high-bar squats in my programming along with a few other squat variations.
All my knee troubled clients perform squats in one version or another. My personal favorite quote on squats being bad for the knees comes from Mark Rippetoe. “Yes, if you squat wrong it goofs things up. If you squat correctly, those same goofed-up things will ungoof themselves.” (Edited to keep this a PG rated site)
Did you know females are more susceptible to knee pain and injury than males? (I did!) This is due to a number of reasons including: anatomical differences, hormonal differences, biomechanical differences, and strength imbalance differences (MGH Sports Physical Therapy, n.d.).
The good news for women is that many of these factors can be modified in their own gym or studio. Most muscles of the hip influence the alignment and strength of the knee so focusing on hip strengthening exercises can help to prevent injury.
A recent study showed that women with pain in their knee caps (patellofemoral syndrome) had 43 percent less knee pain when incorporating hip strengthening exercises in comparison to those performing knee strengthening exercises alone; those in the knee strengthening group had only 3 percent less pain at 4 weeks (Deydre, 2011; Dolak, 2011).
In addition to improving knee cap pain, hip strengthening exercises are also used in ACL injury prevention programs. Massachusetts General Hospital recommends incorporating forward lunge progressions, monster walks, bridge progressions, plank progressions, and single leg reaching drills in order to gain stability in the knee (MGH Sports Physical Therapy, n.d.).
Here are some suggested exercises for muscle imbalance correction, or in the presence of general kneecap pain:
Many of the exercises discussed in this post place relatively little stress on the knee joint itself, therefore, incorporating them into your program is likely to have greater benefit and lower risk than a program designed to strengthen the knee directly. However, if you or your client has persistent knee pain, known acute injury, redness, or swelling, be sure to consult with a medical provider before exercising. Knee pain has multiple causes so a proper diagnosis and classification is important in order to create the most effective and specific programs (Wilk, 1998).
Note that this article is not intended to diagnose, treat, or specifically prevent any condition.
Deydre, ST, Ed. (2011). Knee pain: strengthen my hips? But it’s my knees that hurt! Journal of Orhtopaedic and Sports Physical Therapy. 41(8): 571.
Dolak, KL, et al. (2011). Hip strengthening prior to functional exercise reduces pain sooner than quadriceps strengthening in females with patellofemoral syndrome: a randomized clinical trial. Journal of Orthopaedic and Sports Physical Therapy. 41(8): 560-700.
Massachusetts General Hospital, Sports Physical Therapy (n.d.). Sports Conditioning for the Female Knee: An Injury Prevention Program. Retrieved from: http://www.massgeneral.org/ortho/services/sports/pdfs/conditioning-female-knee.pdf
Wilk, KE, et al. (1998). Patellofemoral disorders: A classification system and clinical guidelines for nonoperative rehabilitation. 28(5): 307-322.