kneepain

Do you have knee pain when you squat?

For some clients, that question is akin to:

Does a bear.....?

Is the pope....?

And I get it. Somewhere along the way, our knees become cranky from years of abuse; playing football, field hockey, or running away from cops at keg parties in the corn field.

Not you? Um...well, there's not a lot to do in Western PA. 

We try squats as part of a workout routine, discover they hurt our knees, and so we quit squatting. 

 
kneesklf.jpg
 

It’s like the old joke.

Do jumping jacks make you pee your pants?

Yes.

Then you can be sure they'll be in your next program.

I kid, I kid. Kind of. 

Here's the thing: you can avoid jumping jacks, but you can't avoid squatting. 

Sure you can avoid doing squats with your training, but you can’t avoid them in your day-to-day life. You squat to get into a chair, out of a chair, into your car, into bed etc. etc. etc. 

Squatting is your independence, especially as you age. Incorporating squats into your training helps build strength in the legs and hips, and stronger muscles mean more stable joints. (For those of you reading this who work out with my parents, please tell Rita to start doing them.) 

If squatting is this important to your daily life, why on earth would you not make it a priority in the gym? Well, probably because the movement caused too much pain, you felt like you’d never get back up again if you tried it, or, and I’ve heard this one several times, you’re afraid that actively squatting will make your thighs hyooooge.*(Hint - It won't.)

My dad is 70 years old, golfs every day, and has cranky, arthritic knees. He’s spent the last two weeks doing three sets of 15 bodyweight squats every day, and reported Sunday during our weekly FaceTime chat that, shocker of all shockers, his knees feel better.  

I'm not suggesting that you go all willy nilly with the squatting game here and load 200 pounds on your back, but below are some tips to get your squatting game on and, hopefully, avoid any discomfort in the process.  

1. Limit your range of motion

There is no need to squat ass to grass the way my nephew does when he's looking intently at a bug in the yard. He can do it because he's four years old. For the rest of us, poor ankle mobility, core strength and glute strength make it really difficult to get that low. The good news is unless your competing in a powerlifting competition, there's no need to go below parallel. 

So in the beginning, limit your range of motion and stop before you feel the pain.   

 
 

Begin by squatting to a high box. In the video above, I'm using a dumbbell held vertically to load the movement and squatting to an 18 inch box. Start with a 10 or 12 lb weight held tight to your chest, and tap the box, don't sit on it, before standing back up.

If squatting to this level still causes pain, raise the box a little higher with the addition of a plate or a few mats. 

The use of the box helps ensure that you can get to the desired depth, and can also help with technique. Speaking of which...

2. Concentrate on technique

One reason squatting may cause discomfort is that you end up too far over your toes. For a dumbbell goblet squat, think of touching your elbows to the inside of your knees and sitting straight down into your heels. You can also use a kettlebell or, if you have one, a sandbag. Keep your eyes straight forward and imagine putting your shoulder blades into your back pockets. Once you tap the box, push up through your heels to stand up. 

Pay attention to the movement of your knees - if your gym has a mirror, do the squats in front of it and make sure your knees aren't caving in. Think of pushing your knees out throughout the movement. You don't want it to look like this:

 
 

 

Make sure your heels are not coming off of the ground during the movement. For some people with poor ankle mobility, sitting back into the heels can make them feel like they're going to lose their balance and fall, as one client said yesterday, 'ass over teakettle'. If that's the case, try placing the box against a wall, or use a TRX:

 
 

Not sure what kind of ankle mobility you have?

Try this trick. Put your arms up over your head, and perform a deep squat. Then, raise your heels up on an inch-high plate or board and perform the same movement. Is it easier to squat with your heels raised? If so, you may have poor mobility in your ankles. 

3. Build the muscles around your knees. 

Strengthening your quadriceps (front of your thigh) and hamstrings (back of your thigh) can help decrease pain and help you better tolerate arthritis. Perform other exercises that will help strengthen these muscles as well.

Some of the exercises that can help with that are split squat, the bowler squat, the step up, or the TRX with knee drive. 

 
A suspension trainer like the TRX can be a great tool for those who are working on leg strength and balance. In this exercise, use the TRX as little as possible to steady yourself until you can do the movement without any assistance at all.
 

I could, and probably will, do an entire series on suspension training systems like the one seen in the video above (also called a TRX, which is a brand). These rings are incredibly useful for strengthening a movement - in the video above, I'm lightly holding onto the rings. Use the handles as little as necessary, until you work your way up to performing the exercise without requiring any assistance at all. 

If that movement feels too easy, graduate to using a box step up with a knee drive. (I like to call these Jane Fonda's, because it looks to me like something she would have done in one of her videos.)

 
 

In summary:

Squat. It's important. Limit your range of motion, work on your technique, and incorporate other exercises to strengthen those muscles around the legs. 

If you're not sure about your technique, film yourself from the front and the side and send the video to kim@kimlloydfitness.com. I'd be happy to take a look. 

* Some women are concerned especially that squatting will give them thunder thighs and for the most part, that's not the case. 

**Everyone’s hips sit in the joints differently, so while one person may squat comfortable with a wider stance, others may be more comfortable with a narrower stance. 

AND....

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Back pain? Knee pain? Take a look at your shoes

Did you look at your feet right there when I said what's on your feet? Did you? 

Made you look :)

But seriously, what are you wearing on your feet right now?  Are they sneakers? Are they tennis shoes?* Flip flops? High heels? 

 
These are all sneakers right? Yes and no. Not one of them is actually designed for performance. These are all retro throwback shoes that were once used as running and tennis shoes, but don't have the modern day technology that actual performance shoes have. And yes, I have a shoe problem. No, this isn't even close to all of them...

These are all sneakers right? Yes and no. Not one of them is actually designed for performance. These are all retro throwback shoes that were once used as running and tennis shoes, but don't have the modern day technology that actual performance shoes have. And yes, I have a shoe problem. No, this isn't even close to all of them...

 

If you are wearing sneakers, do you know what kind? 

If they are running shoes, do you know if they are stability shoes or minimalist shoes?

In today's saturated sneaker market it can be especially daunting to find the right type of shoe for your workouts. You might pull something off of the shelf because you like the color or the way they make your calves look in the mini-shoe mirror. But are they the best shoes for what your doing?

The right shoes matter for so many reasons. Do you have chronic back pain? Check your shoes. Knee pain? Check your shoes. Hip pain? Yes check your shoes. 

Also, just make sure they're tied. K?

Avoid sportswear and lifestyle shoes for training

So I have sort of a shoe problem, as you can tell from the photo above. More like...well...let's just say I would welcome a walk-in closet. :) I have a particular fondness, along with vinyl records, for vintage sneakers.

These vintage styles have made a big comeback in recent years, much to my delight, but even though they look like workout shoes, they're not meant for training. In fact, companies like New Balance, Puma, and Nike refer to these as lifestyle shoes. 

Double-check your workout shoes and make sure they are designed for performance. 

Running Shoes vs. Training shoes

Most clients I see walk in to the gym are wearing running shoes which isn't necessarily a bad thing. Most running shoes offer some lateral support and, depending on the style, cushioning. 

The biggest difference between runners and trainers is the tread. Running shoes typically have a more aggressive tread, while trainers have a flatter sole, more suitable to indoor surface. 

Are you primarily a runner who adds in two days of strength training? Choose a running shoe. Have you signed up for the local bootcamp, Zumba or crossfit class? Choose a trainer. The general rule is that trainers are safe for 3-5 miles of running, and runners are safe to do 1-2 days of training. 

 
It's tougher to see in this picture, but the shoe on the left is a running shoe, while the shoe on the right is a trainer. The tread on the left is much more aggressive and still fine for wearing in the gym, while the tread on the right is designed specifically for smooth surfaces. 

It's tougher to see in this picture, but the shoe on the left is a running shoe, while the shoe on the right is a trainer. The tread on the left is much more aggressive and still fine for wearing in the gym, while the tread on the right is designed specifically for smooth surfaces. 

 

How can you tell the difference?

If you're at at a box shoe store such as a DSW Warehouse it's nearly impossible. The sneaker collection is lumped together in one aisle and this is where it becomes more difficult to tell a running shoe from a fashion shoe. 

But if you visit your local sporting goods or running store, you'll find different sections for training and running and lifestyle.

Are you a pronator, supinator, terminator or neutral?

If you're the Terminator well...I don't think shoes are a big concern for you.

Do your ankles cave in? Do you have a low arch or flat arch? You're a pronator.

Do you walk more on the outside of your feet? Then you're a supinator. And if you don't do either, chances are you're neutral. 

That's a crude explanation of foot types, but if you go to a running store to find a good pair of shoes these are what the sales folks are looking at when they look at your feet. 

Minimalist shoes

A few years ago, the book "Born to Run" by Chris McDougall revolutionized the running world, and the shoe world in general. By the time the book was written, Nike was already experimenting with the Nike Free and Vibram had produced those weird alien looking five fingered shoes that you'll still see at races and in gyms. 

McDougall began the book because he was looking for an answer to foot pain. The book is an excellent read, but the conclusion for McDougall is that he was simply wearing too much of a shoe and it was dramatically affecting his gait. 

I mention this here because minimalist shoes, such as the Nike Free, the New Balance Minimus, Altra Zero Drops, and others are great shoes that have been mixed into the market, but:

1. They are not for everyone

2. You should be aware of what you're buying when you buy them. Again, these shoes will be mixed in with the great deals at DSW Warehouse and TJ Maxx, but if you head off to a bootcamp class with a pair of minimalist shoes with no lateral support, you might be setting yourself up for injury.

This is just the tip of the iceberg when it comes to running and training shoes. But the bottom line is, pay attention to what's on your feet. 

And if you see me, pay attention to what's on my feet too, 'cause I kind of obsess over my shoes. :) 

* For some reason, growing up in Western Pennsylvania, we always had tennis shoes even though none of us played tennis. I digress.