Sometimes our knees don't feel 100 percent. Some of us deal with ongoing or intermittent pain. We don't want this to shut down our leg training and force us to break out the lounge-around-the-house sweatpants.
Don't worry, though. I've got a workout plan that allows you to make adjustments to minimize or eliminate knee pain, thus allowing you to avoid missing leg training. My sincerest apologies for ruining your best-laid excuses to sit this one out.
First let's look at the exercises, then I'll give you a workout plan to follow.
1 – Box Squat
Set up a box or bench allowing parallel squat depth. Go a little higher if you're still feeling pain, but don't let it become a way to use too much load through a miniscule, restricted range of motion.
If you're able to use a greater range of motion pain-free, go for it. Parallel tends to be a safe starting point for most people.
Begin by "gripping" the floor firmly with your feet. Torque and rotate your hips externally to pull the knees into alignment with your hips and toes, thus creating a strong arch. Foot stance varies by individual, so find one that allows comfortable movement and the best range of motion.
Keep in mind that the feet don't need to be placed symmetrically – not everyone has symmetrical hip joints. Aim for a placement that allows you to feel the leg muscles evenly. Maintain external rotation of your hips through the entire rep. This should prevent your knees and ankles from collapsing inward, which would place greater stress on the knee joint and ACL.
Maintain vertical shins by sitting back into your hips onto the box. A common issue here is poor ankle dorsiflexion. This can be immediately addressed by elevating your heels with squat shoes or a wedge, but is better managed with ankle mobility work for long-term resolution.
By sitting back farther than a regular squat, we reduce the shear force, potentially alleviating the pain. Take a big breath and flex your abs hard to lock in that air and maintain a neutral spine. Brace your core all the way around your spine.
Sit in a controlled manner onto the box without disengaging your core or legs and avoid rocking backwards to create momentum for the positive, or lifting, part of the rep. Use a controlled touch or brief pause. For added challenge, sustain a longer pause before the positive rep.
Keep the movement strict and avoid failure, which would increase the likelihood of further aggravating your angry knees.
2 – Rear-Foot Elevated Split Squat
Rear-foot elevated split squats, Bulgarian squats, or whatever fancy name you have for them, are easily adjusted so they're knee friendly while simultaneously strengthening muscles around the knee joint. Just as with box squats, adjust the movement to maintain a vertical shin.
Begin with your front foot more forward than usual. Place the back foot laces-down on a bench or roller. As you descend into the negative, drive your working hip down and back to maintain a vertical shin (a hip that only moves down shoots your knee forward).
Allow your back knee to bend as you descend (many lifters instinctively lock this knee, reducing hip range of motion). Pivot your torso forward while maintaining flexed abs and neutral spine. Retract the shoulder blades to maintain a neutral spine against the load.
Reverse direction at the bottom by pushing evenly through the entire foot. You can emphasize pushing through your heel if it tends to lift off. Finish all reps on one leg and then switch. For heavy loads, rest between working the left leg and right leg. Start with the weaker leg or crankiest knee.
3 – Single-Leg Romanian Deadlift
RDLs shouldn't result in knee discomfort and are among the best tools for strong hamstrings that stabilize knees. Strong mobile hips, hamstrings, and glutes moving in a proficient hinge pattern alleviate many issues lifters have with poor loading patterns that result in knee and low back issues.
But avoid the locked-knee straight leg deadlift to eliminate the risk of hyper-extending knees under load. Straight knees also tend to lead to a rounded lower back.
Bilateral RDLs work, but I've chosen the single-leg version here because they provide more training stimulus in more planes with less overall system stress. These are often taught with offset load (a dumbbell in only one hand vs. both), but for ease of learning through better balance, we'll use a symmetrical load.
A barbell or pair of dumbbells or kettlebells will work, but the barbell is harder to balance and learn.
Instead of focusing on pivoting forward, control your back leg as you slowly elevate it. Imagine lifting your back foot and tipping yourself like a jug of water. Pivot the hips back and torso forward to your fullest available hip range of motion.
Feel the stretch through the hamstring and up into the glute. (These take practice to maintain balance.) Maintain a slight knee bend, neutral spine, and straight feet. Perform all reps on one leg and then switch.
4 – Glute Ham Raise Machine
GHRs are another knee-friendly, hip dominant movement. Since we've done single-leg RDLs, we can focus on the hamstring dominant variation of the glute ham raise.
Lock your feet into the machine and begin with bent knees and an upright torso. Flex the abs to maintain a neutral spine through all phases. Lower your torso forward through a controlled negative until your knees and entire body are straight.
Pause briefly and reverse direction by curling your bodyweight back to the starting position. You should experience a loaded stretch of your hamstrings. Avoid extending your lower back to cheat. To make the movement more glute dominant, add hip flexion and then extension to the end of the movement.
If you can do more than 8 reps using bodyweight, hold a plate to your chest. If it's too difficult to perform the positive portion, use the bars to push yourself back to the starting point and focus on the negative. Keep practicing these until you're strong enough to do the full movement.
If your gym doesn't have a GHR, any hamstring curl machine can fill in.
5 – Suspension-Strap Reverse Sled Drag
Attach suspension straps to a Prowler/sled and reverse drag it to mimic a rapid-fire, super high-rep leg extension. The difference in force pattern creates less shear across the knee joint, and even the most frail, elderly trainee can perform these with appropriate load.
Walk in reverse with arms extended and shoulder blades retracted. Tense your abs and maintain a neutral spine. Step with straight feet and resist the temptation to twist or waddle as you fatigue. This one's hard to screw up.
|A||Box Squat (Warm-up – 3 ascending sets X 10-12)||3-4||8-10|
|B||Dumbbell Rear-Foot Elevated Split Squat (Warm-up – 1 X 10/leg)||4||8-10/leg|
|C||Dumbbell Single-Leg Romanian Deadlift||4||8/leg|
|D||Glute Ham Raise or Hamstring Curl||4||8|
|E||Reverse Sled Drag||4||50 m.|
This program, or surgically chosen pieces of it, should sustain your lower body training through mild-to-moderate knee discomfort.
- Consider using knee sleeves for support. At this stage I'd avoid using knee wraps, though. This alters the mechanics of knee flexion and may aggravate existing issues. Reserve these for aggressive strength training at, or near, maximal lifts.
- Program a thorough warm-up, of course. This doesn't mean wasting 30 minutes stretching and doing elaborate foam rolling. Just increase blood flow to your legs on a bike or machine of your choosing.
- Use some targeted short duration foam rolling between early sets to relax the neural tone of tight muscles and allow better joint mobility.
- Consider using some dynamic mobility drills. Start with light sets of your first movement for improved blood flow and increased muscle temperature. Starting light lets your body detect pain or discomfort without the risk of injury with heavier loads. Find out if something isn't right before you further aggravate the issue and risk setting yourself back.
- Take a break from some of the more stressful movements on knee joints. Squats, especially high bar and front squats, can irritate sore knees. Walking lunges are a major no for aggravated knees and forget about sissy squats. Bypass the leg extension machine until your knees are happier. Shift more of your training to the hip, glute, and hamstring dominant training that's all too often neglected.
Obligatory Final Note
Get the knee pain checked by a skilled physical therapist and complement your current training with a program to rehabilitate and resolve the underlying reason(s) for your knee pain.