Is Knee Pain Really A Life Sentence?

More than 80% of a physiotherapists regular clientele consist of either knee pain or shoulder pain. And narrowly in third place is hip/low back issues.

The sad implications of this is the knees being put on a bigger pedestal than the average guy puts a girl in the 6-7/10 on the looks scale these days.

This has led to all kinds of moronic misinformation being sang as gospel truth; the most famous of all being the knees-shouldn’t-go-over-the-toes ‘rule’.

Incredibly, this is actually taught in level 2 & 3 fitness qualifications! Yep, this means industry qualified ‘professionals’ will buy into this notion………..

Can the knees go past the toes in a deep squat?

Yes! They HAVE to. Otherwise You will round your back which is MUCH more dangerous. ~Bret Contreras

Another move that gets bastardized and is almost looked at like the cigarette of the exercise world is the lunge. Believe it or not, I’ve had people come to me after decades of knee problems and often times even post surgery, and say they’ve been told to avoid squats, lunges and almost all other free weight lower body movements.

Instead their physio has advised them to do seated unloaded (YES, UNLOADED) leg extensions for very slow reps and a shit ton of banded hip abductions with some crab walking thrown in for good measure!

And we wonder why nobody ever follows the routines physios give them?!

Granted, we need activation drills at a low intensity right off the bat but when they’re presented with no end goal or graduation markers, how can we really expect anyone to want to trust or complete the ‘process’?

If you’ve read any of my content before you’ll know I don’t like to talk from a place of no experience. One of the cheapest ways to falsely sell yourself as an authority or ‘expert’ online is to quote studies and rehash the work of others, all the while having no real experiences of your own to speak from or go off.

These guys sit in their room jerking off to pubmed and finding citations for theories, then trail forums like reddit, looking for people to argue with and science punch to oblivion.

But these virgin sex therapists haven’t ever had to figure things out on the spot. They haven’t had to substitute a move there and then because their client was in pain from it or simply couldn’t do it.

‘Oh I’m sorry Ms Richards, let me just check what the studies say is the best exercise for someone who gets back pain when hinging at the hips. OK?’

Instead of………

‘Right, let’s make sure your spine stays completely neutral as we hinge forward and we will ONLY hinge forward as far as we can stay completely neutral. Make sense?’

If I would have waited for the research to validate & verify my training methodologies, I would never have gotten anyone strong!

~ Charles Poliquin

Case Studies

Recently I’ve had the honor of working with 2 women who both suffered from knee pain. One was very acute to the extent she has had 3 dislocations and keyhole surgery over the last decade or so! Sadly this has led to the knee becoming arthritic.

The other lady, Carla, would always have issues when walking beyond a certain distance as her left knee would flare up and be inflamed for days after. Differing levels of severity but still the same issue; knee pain that won’t shift.

In the first case, Paula had started doing Pilates classes in January in the hope of mitigating the harsh effects of winter on her joints, and she and her friend Christine began doing personal training sessions with me. The knee was always going to be an obstacle as it will affect virtually anything we do for the lower body.

In Carla’s case we started working together remotely through Zoom during the corona virus circus, just so she could keep up a certain strength/athletic level without gym access – a common story. It was only when she began complaining of knee pain after long walks (well over 10,000 steps) that I delved deeper into things.

Where are they now?

As of this week (late September 2020) Paula is now doing rear foot elevated split squats for sets & reps with no knee pain, and more importantly, her boating season has felt loads easier this year compared to last year and the winter is looming again, which will be another test for how things are. As we know, the British winter makes your joints hate you.

But when we first started working together, even the mere mention of bodyweight squats made her grimace and take a deep breath…….

Gradually though, with time we’ve worked our way up to split squats with low elevation of the back foot. This was unheard of at the start of the year! Her physio would have also said such an image was only a scene in a fantasy land.

With Carla we went from struggling to stand on one leg to doing sets of 8 through full range on the single leg Romanian deadlift with 30 kg for multiple sets! And of course, the knee is fine on long walks now and she even feels the glute work while walking, as well as fire up after only the simplest of leg exercises.

(Oh and both women are above 40 years of age. Paula is in her 50’s!)

The magic between the ears

While the infographic above shows the marvel that is the human brain in its fundamental glory, we can scale the marvels down to the wonder that is psychology.

A strong personal subset of psychology is one’s attitude to challenges and situations. Accepting things for what they are and harnessing a willingness to try and improve the current situation is worth more than anyone telling you the ‘perfect movement’ or ‘best training plan’.

In both cases above, both women knew there was an issue and were both willing to follow my lead on what moves would help rectify things. It sounds easy and cliche but put yourself in such a position: you’ve had knee issues your whole adult life, had confirmation that it’s arthritic and you’ve been told to avoid classic, time tested exercises like squats and lunges…….

It would be incredibly easy to accept this and resign yourself to being impaired and thus, avoid walking, stairs or in some cases even going out as much. This is literally sitting waiting to deteriorate! The ‘we’ll have a go’ attitude has to be there before any training even takes place.

And another crucial component is quietening the desires for instant results. The reality is: you will need months to see drastic changes – and by drastic changes I mean to where you’re in less pain, doing more advanced movements in your sessions and your self-limiting beliefs have been altered.

Training protocols

While I can’t give exact templates here as everyone’s journey was individual, I can share some common findings and perhaps formulate a loose philosophy on rebuilding movement function in the lower body while eliminating knee pain.

Whenever there’s an issue somewhere in the body, you always have to look beyond the affected area. In the case of knees you need to look at the feet and more so, the hips. If there’s dysfunction in either, you’re instantly at a higher risk of knee trouble.

Stability is my personal go to. How stable are their hips? How stable are their feet and ankles? People (wrongly) think of stability as nothing more than balance, while failing to realise stability is strength and strength is stability.

You don’t get one without the other.

One of the simplest ways to stabilise a joint is to balance the strength ratios on each side of it. Delving further into this, we can also look at strength balance between individual limbs. With the hips you can find some abysmal imbalances between leg strength! An unwritten rule is anything beneath 80% (implying your ‘bad’ side is 80% as strong as your ‘good’ side) instantly makes one more prone to injuries.

I’ve actually seen ratios way worse – I’ve seen barely 50% and even less at times. I’ve seen people able to lunge with weight on one leg and barely be able to stand on the other. No story time exaggerations here either!

Everyone needs some ass in their life

Glutes are in. Male or female, a good set of glutes is supposed to ramp up your sex appeal nowadays. Obviously when you’re eyeing that guy or girl up you’re just looking at the size and perkiness, not the actual function, right?

See, I’m so cool I not only appreciate the aesthetics of an ass but also the function. And to be honest, as a coach, it’s the function I care about most and assess for most.

It’s incredible the amount of people who have good gluteal development but actually don’t have glutes that fire correctly or even activate well at all. You can be a 2-3 plate squatter for reps and still have glutes that are dysfunctional. I should know, that was me for years.

And in the case of side to side discrepancies, you can have one side super activated and dominant with the other side totally asleep and not working. Therefore there will be an obvious weight shift, or weight preference, to one side. Over time this can cause overuse issues on the dominant side and/or cause sheering forces on the knee as the weak side is trying to shift to the center-line, and over to the dominant side.

This is why you can get some pretty athletic people with knee issues. You logically assume knee issues would be out of the question thanks to an athletic lifestyle or background, but the issue isn’t so much the athletic endeavours themselves but more what’s happening during them and the other 22-23 hours of the day?

Awareness

In a world where attention spans are shortening year after year and time seems to be racing past faster and faster, awareness is becoming the modern spiritualist’s fetish. But however you think of the spiritualism/meditation world, their principles apply to such a vast amount of aspects of our lives, none more so than exercise and movement.

As lengthy and fairly complex an article as this is, the fixes can sometimes be as simple as: when walking, try to keep your knee out a bit more. Or, stop leaning on the right leg so much. Or even, keep a bit more weight on the outside of the non-dominant foot when walking long distances. The point is the client has now become aware of their issue and how seemingly unrelated situations are either worsening or improving things overall.

The combination of patient progressive movement done consistently, alongside improved daily habits under professional guidance is deadly. Within a matter of months on even only a once per week frequency, life changing results are possible, for people of all ages and backgrounds.

Thanks for reading. I hope you now know many situations aren’t as dire as they’re painted out to be by generic ‘authorities’.