Knee pre-hab/strengthening
November 9, 2017 9:54 AM   Subscribe

When I lift heavy weights, my right knee feels a twinge of pain. I would like a way to make sure my knee joints are in the best shape they can be.

I go through heavy lifting phases, but when I usually get to back squatting anything above 315lbs, my right knee feels a little painful. Wearing a knee brace helps, but I'd rather not have to do this.

Recently, I've found myself being aware of my knees when rowing in a "is that pain or am I imagining it".

To avoid permanent knee anxiety, I'd like some advice on how to keep my knees healthy and strong while doing intense fitness things
posted by tedious to Health & Fitness (15 answers total) 16 users marked this as a favorite
I compete in powerlifting, although as a 56 y/o female, I am not lifting as heavy as you. I also have severe arthritis in both my knees per my physician.

Here's what I do to keep my knees happy as I train squats:
- Make sure to keep my knees pushed out on descent/ascent. This becomes harder as the weight is heavier or at the last rep or two of a set.
- Floss my knees.
- I have found that knee sleeves make my knees feel better when I squat.
- I have found barbell quad rolling to be helpful at times too.
- After lifting, I soak in a hot bath with epsom salts. I'm lucky to have a deep tub in the master bath.

FYI, although reddit can be a cesspool, I have found r/powerlifting to be a good source of info.
posted by elmay at 10:35 AM on November 9, 2017 [3 favorites]

This is a complete shot in the dark but is it possible that our knees bend too far forward as you squat? It would cause increased stress on your knee per repetition.
posted by invictus10 at 10:42 AM on November 9, 2017

I have found the knee sleeves make a world of difference. They aren't a brace so much as a way to keep your knees warm and the blood flowing.
posted by munchingzombie at 10:49 AM on November 9, 2017

One other thing, when I was first diagnosed with the arthritis (after running a 5k race), I had a lot of physical therapy. One of the PT's told me that he saw a lot of knee/back trouble, but in many cases, it came down to weak hips. So, I did a lot of clamshells including variations of clamshells and hip thrusts.
posted by elmay at 11:07 AM on November 9, 2017 [1 favorite]

Response by poster: Elmay did the clamshells help?
Invictus, I sit fairly far back, so my shin bones are fairly vertical.

My temporary solution for all this has been to do front squats, which double as an absolute workout. :(
posted by tedious at 12:05 PM on November 9, 2017

I've done a lot of things over the past 3 years or so since I did that work with a PT. At the time I was in treatment, there was a lot of other stuff besides the clamshells, so I can't really tell you how much that specific exercise helped. As my acute pain diminished, I began training with a big-box trainer, not doing squats, but other weight training like leg press, leg curl, hack squats, etc...

I got intrigued about powerlifting and entered a push-pull meet (bench press + deadlift). I liked it and realized that there was a lot of technique to the sport that my big box trainer didn't know, so I found a powerlifting-focused gym and coach. That's where I've been training this past 2.5 years.

What I've found is that I'm quad-dominant, and so the barbell rolling of the quads (as much as it hurts!) helps along with the knee flossing. In my training now, I don't do clamshells, but I do a lot of squat variations, including box squats, pin squats, SSB squats, front squats, etc...

If you can access a good sports PT or Chiropractor, it may be worthwhile to get some insight into your specific situation and some expert advice.
posted by elmay at 12:17 PM on November 9, 2017

My temporary solution for all this has been to do front squats

As an experienced powerlifter, if I see someone able to do front squats with no/minimal pain and who has knee pain during back squats, almost assuredly your posterior chain is at fault.

Film yourself squatting from the side - under heavy load, is the bar path moving forward on either descent or during the lift? If so, you're likely loading up on your quads and knees to compensate for weakness or a lack of firing in your glutes. Try lower weight eccentric squats (4 seconds count going down) for 4-5 reps regularly to train your glutes to get more involved.

If that's not your problem, try filming yourself from the back - are you maintaining core stability during the whole lift (i.e. your breath and lower back are held and do not sag at the bottom), and are you achieving depth? Are your knees staying stable or caving in? If not, that's likely the fault. Try paused squats - 3-4 seconds at the bottom under moderate-to-heavy load to train yourself to really hold your core stable. For crashing knees, try banded squats.

Otherwise, it might be an issue with limited anle dorsiflextion. Try a banded mobilization before you lift (add a medicine ball to your knee to increase the range of motion) and see if you achieve a better position that takes the heat off your knees.
posted by notorious medium at 12:51 PM on November 9, 2017 [5 favorites]

Keep in mind your legs (and body) acts as a spring, so your knees are not isolated. How strong are your other bending points? For me, my knee got wonky because my hip flexors, ankles and ab muscles were weak, so the knee was having to do more work. Things like minimalist shoes when running/jogging/raking leaves/hiking help keep my feet and ankles stronger. And then exercises focusing on strengthening my hip flexors also helped remove pressure from my knee.
posted by jillithd at 1:07 PM on November 9, 2017

Not a weightlifter but I had a knee get wonky because my big toe wasn't bending right! If none of the above tips help you, please do consider visiting a sports physical therapist about it. Your instinct to protect your knees is a good one.
posted by purple_bird at 2:57 PM on November 9, 2017

Joints are really complicate systems that interact with other complicated systems like other joints, muscles, tendons, ligaments, etc. A weakness in one area can create problems in another, and it's often hard to know where a potential weakness is. One thing to try that helped with my knee pain from cycling was using a foam roller to work on my IT band and big muscle groups.
posted by lilies.lilies at 5:17 PM on November 9, 2017

If the knee brace helps don’t be too proud to use it until this is resolved.
The brace might even give you enough of a break to clear the issue. Worth a try.
posted by littlewater at 5:28 PM on November 9, 2017

Notorious medium above likely has it, but if not....

Read these articles by a serious powerlifter and scientist, colin nuckols.

How to squat

(warning - vast! contains every little thing about technique. may address yours)

How to make your squat catch up with your deadlift

Talks about core bracing, which is key for good technique...

Why would you read him. As he says:

If you’re new here, you may be asking yourself, “who is this guy, and why should I care what he has to say about squatting?”

Fair questions! I’m a coach and drug-free powerlifter. I’ve been training for 11 years and coaching for 8. I’ve squatted 650lbs without knee wraps at 220lbs and 750lbs with knee wraps at 242lbs in competition. The 750lb squat was an all-time drug-free world record across all federations. I’ve coached lifters at all experience levels, teaching hundreds of new lifters how to squat on one end of the spectrum, and training several 600lb squatters and 3x bodyweight squatters on the other end of the spectrum. I’ve also learned from some of the best squatters in the world like Chad Wesley Smith and Max Aita. This is combined with a thorough understanding of the biomechanics of the lift. Check the reference list at the end of the article; it’s tough to make it through that much scientific literature without picking up a few tidbits along the way (which largely match my personal experiences as an athlete and coach, I’ll note).

I don’t say any of that to toot my own horn. I just want you to know I’m not just some random internet dude opining about the squat. I’d never claim that everything I say is right just because I squat a lot, and I’m entirely open to changing my views as I gain more experience, talk to more high-level athletes and coaches, and as new scientific evidence is published.

posted by lalochezia at 5:15 AM on November 10, 2017

I experience occasional knee pain from squatting that seems to be caused by knee valgus, or my knees caving in on the ascent of the squat. I combat that by direct strengthening exercises like leg abduction machines after my squats, activating those muscles with clamshells beforehand, and using a resistance band around my knees (to trigger them to push out against the band) during all my sets below 60% of my max.

This article has more info about diagnosing the cause of the knee collapse and how to rehab it (and Bret Contreras is generally considered the top source for any glute exercise science, so I recommend poking around his website)

To build on notorious medium's answer as well, I always do some kind of bodyweight glute activation before squats (in addition to the clamshells mentioned above) - studies have shown that activation exercises are really important for "waking up" your glutes. Something like a 10-15 reps of a glute bridge, frog pump, or similar works for me.
posted by jouir at 10:00 AM on November 10, 2017

Response by poster: I haven't squatted since I made this post to do some more reading and to recover for a bit. Since the consensus seems to be 1) try more glute activation excercises 2) prime and warm up knee area properly 3) see PT for more analysis, I thought i would start from easiest to hardest.

It seems that kettlebells are a good exercise for posterior chain strengthening/activation; is that something y'all have an opinion pro/against?
posted by tedious at 4:23 AM on November 14, 2017

I find glute stretches helpful for this kind of thing. Activation not so much but YMMV.
posted by daveliepmann at 9:28 AM on November 14, 2017

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