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I have been having pain and almost a grinding sound in my left knee. Doc told me I have arthritis in my knees. So, what exercises can I do for my lower body. The split squat is what hurts my knee the most. Is there anything that will strengthen my knees? Any recommendations?
No, I don't have pain doing regular squats at this time. I do hear the grinding in my knee when I squat down. I'll try the step-ups and see if they hurt. Thank you!
Thanks, Uconnjulie. I don't like the thought of giving them up, but it definitely may be for the best for right now. I am just concerned how long I have to give them up for!
Julie.....when you recommend targeting her glutes, is that due to the flexed hip posture that is typical with knee OA patients (or was it hip OA? or both) leading to poor glute activation?
I would stick with Julie and do 2 major things:
- glute activation - glute bridges, hip extensions, pulltroughs(light)
- posterior chain(hip dominant) movements - deadlifts, romanian deadlifts, probably I would start with both of these on a rack(rack pulls), pulltroughs(heavy). I would also lay off the single leg work for now.
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Tsvetan Vasilev
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Thank you so much, everyone. I will do as Julie says. I tried the step ups, but they hurt, as well. It really seems that the single leg exercises hurt my knee a lot. Probably a stupid question, but what are pullthroughs?
So no leg extensions either? I was not sure if that would build the area around my knee, helping it to become stronger?
Julie.....when you recommend targeting her glutes, is that due to the flexed hip posture that is typical with knee OA patients (or was it hip OA? or both) leading to poor glute activation?
Since she didn't post her age nor post pictures of her posture, I can't say one way or another about that. Many PCPs will hear crepitus and diagnose "arthritis" ... so not too sure about that one either without films or direct examination.
What I do know is that her quads are likely doing more work than they should. Most people with knee problems have gluteals that don't function well ... they are inefficient at decelerating pronation, so the quads do more of the deceleration, leading to irritation of the knees. Treat the knee and it will likely come back. Fix the glutes and it should help.
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Since she didn't post her age nor post pictures of her posture, I can't say one way or another about that.
I'm 45 and have had poor posture with stooped shoulders all my life (though this is improving with working out and really trying to pay attention to standing up straight!)
Since she didn't post her age nor post pictures of her posture, I can't say one way or another about that. Many PCPs will hear crepitus and diagnose "arthritis" ... so not too sure about that one either without films or direct examination.
What I do know is that her quads are likely doing more work than they should. Most people with knee problems have gluteals that don't function well ... they are inefficient at decelerating pronation, so the quads do more of the deceleration, leading to irritation of the knees. Treat the knee and it will likely come back. Fix the glutes and it should help.
Hmmm....the gluteals actually play a role with decelerating pronation? I know that the posterior tibialis does that. Are these two related?
Right, but what Rich is asking about is someone with advanced OA ... generally I don't see that posture in anyone under 70 ... with the exception of former athletes with really bad knees but whose orthopedic surgeons have refused to do TKAs until they were over 70.
Although they teach you generalizations in school ... in the clinic really get away from that. Each person is an individual and will have individual clinical presentation.
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you would get a valgus momentum at the knee with IR and ADD at the hip....is that correct? I'm basing this off what occurs with over pronators.
And to counter IR and ADD you use what?
Julie's point is that pronation does not affect the leg below the knee only. It affects the whole kinetic chain(s) upwards.
Rich, I feel that you have the right potential to figure out many things, just haven't been asked the right questions yet
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Tsvetan Vasilev
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Yes ... Rich, really look at the whole chain ... what happens at each joint ... and what muscles counteract those movements. What muscles create supination?
When you jump off a 16" box and land, what movements occur at what joints? What is the whole movement called? (If you said pronation, you are correct!!) When you react from that position and jump into the air, what movement is each joint doing? (if you said supination, you are correct).
Pronation and supination are not just subtalar joint motions, but rather basic movement patterns.
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That's pretty interesting because we've only learned of supination and pronation in regards to the ankle. I've really only looked at the kinetic chain from bottom up instead of top down (unless a person has poor pelvic stabilization affecting the knee). More learning for me I guess....
Whaddaya mean "we didn't cover it?" You said it yourself:
Quote:
Originally Posted by WalkingDysfunction
you would get a valgus momentum at the knee with IR and ADD at the hip
so your knees cave in and you get internal rotation. If you use the glutes/external rotators/abductors(oh...and glutes!) then you get no valgus. If you don't - your knees cave in shutting off your glutes. If your glutes shut off - you use your hams and lower back to compensate for the hip-extension-strength deficit and they start working harder.
They gave you the tools Rich, but you have to start using them. You have a hammer, just start looking for nails.
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Tsvetan Vasilev
I want to know. I want to be able to. I want to be.
Whaddaya mean "we didn't cover it?" You said it yourself:
so your knees cave in and you get internal rotation. If you use the glutes/external rotators/abductors(oh...and glutes!) then you get no valgus. If you don't - your knees cave in shutting off your glutes. If your glutes shut off - you use your hams and lower back to compensate for the hip-extension-strength deficit and they start working harder.
They gave you the tools Rich, but you have to start using them. You have a hammer, just start looking for nails.
Well that's the thing....I'm learning about glute dysfunction on my own, it really wasn't something that was covered in class. We learned about the kinetic chain in regards to bony alignment, so a lot of the recommended interventions were orthotics due to looking at the chain from the bottom up.
I do agree though, I do have the tools to figure out a number of things....I just sometimes need someone to open my eyes to a situation and I'll say to myself "OH RIGHT....DUH!!!" Learning about glute dysfunction and knee OA in this thread was pretty useful....thanks.
Correcting a glute dysfunction can help limit the excessive wear of the knee joint from that valgus in patients with lateral knee OA? or are we talking about the muscle imbalance between the anterior and posterior musculature that will throw off the arthrokinematics at the knee?
Overthinking again ... anytime a person walks/runs/etc, they have a "pronation force" thoughout the entire body (kinetic chain). Pronation at the knee involves valgus force, flexion, and internal rotation. If the glutes and other short lateral rotators (like the piriformis and gemellus superior and inferior - AKA The Gemelli brothers ) aren't doing their jobs, there will eventually be pain and breakdown somewhere along the chain. Some people compensate at the foot by avoiding foot pronation (we see these people as supinators) ... some develop tight TFLs/Glute Medius (ie ITB ... but since that is not contractile tissue, it can't really get "tight") to control that motion, etc etc.
Over time you will see people with patellofemoral dysfunction ... or knee pain or arthritis.
Although they teach a regional approach in school, you are better off trying to see the bigger picture ... from a movement standpoint or a kinematic chain standpoint. Otherwise you end up missing stuff ... like the baseball pitcher with the weak glute on his stance foot ... or the mom with neck pain who always carries her toddler on the right hip.
Keep asking questions ... that's how you'll start to put everything together!!
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That's interesting that you've mentioned patellofemoral dysfunction. I was at my job today and a trainer asked me for help teaching her client how to perform a RDL. Just by looking at her I could tell that she had weak scapula retractors, core, and glutes. The client told me that she has laxity in her joints and has chronic patella subluxation (she wears knee braces with the patella hole). I asked her if she's gone to therapy to address her lateral tracking issues and she said yes, but she still has this issue.
I was thinking to look at her feet to see if she's overpronated, but now it would make sense that her lack of glute activation contributes to her issue (could be in combination with the foot). She's not my client though, so I can't really step on the trainer's toes (she has no clue about this stuff). Her trainer did mention that she has a dynamic valgus, so that further leads me to think that something is going on with the posterior chain.
I actually do have a question.....I've heard that a dynamic valgus during a squat is due to poor control of the lateral gastroc and lateral HS's...do you agree? Ever encounter anyone with a flat butt that had proper glute activation?
Thanks for taking the time to educate me....I really appreciate it.
The only stupid queston is the one that you never ask. Keep that in mind and keep repeating it to yourself(I know that it takes a lot of practice to realize it).
Now that client with the weak core..If you're not assesing, then you're guessing. Things are out of wack - no problem. Just rate them and determine where to start. Due to my lack of foot expertise - I would start with the glutes and posterior chain.
Now about the knee cave-in during the squat: Bill Hartman had an excellent blog feature about it. Bottom line - wak medial thighs(adductor, medial hamstring). Now why the hell?
The body puts itself in a position where weak muscles do less work. With the knees together you get less adductor magnus action, less medial hamstring action, more latteral hamstring action, and the glutes don't count because you don't use them anyway.
Think of it this way: which one puts more stress on the medial posterior thigh - sumo or conventional deadlifts? Sumo, right? Meaning that to keep the knees out, you need more adductor/MHS.
At first it sounded counterintuitive to me, but now that I've developed the propper intuition....
Now you tell me why my toes are spread out, and my knees are pointing forward.
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Tsvetan Vasilev
I want to know. I want to be able to. I want to be.
I actually do have a question.....I've heard that a dynamic valgus during a squat is due to poor control of the lateral gastroc and lateral HS's...do you agree? Ever encounter anyone with a flat butt that had proper glute activation?
IMO it's hard to say without seeing the person in person ... could be a variety of things. If I had someone who was caving in, I would assess glute function, ankle and hip mobility, and adductor strength. But I would also look at their feet (ie do they have flat feet?).
From a movement pattern standpoint, the why is relatively unimportant ... see if you can find a way to improve the pattern. Gray Cook says that sometimes worsening the dysfunction cues the person to fix it. So have a piece of tubing at their knees, crossed in front to accentuate the valgus.
IME, a flat butt generally means that the glutes are not living up to their potential. They might not have a timing issue or non-functioning glutes, but I'd bet that their lumbar extensors are doing more than their fair share of the work.
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Can you give me a link to this blog entry? It does make sense since both of those muscles crosses the knee joint, but why would they be weak?
I understand that sumo's stress the medial posterior thigh more due to the already shortened positioned abductors relative to the adductors. A number of people suggest doing squats with bands or band walks in the athletic position to correct this issue....anyone found success with this?
What do you mean by toes spread out and knees pointed forward? Are you talking about your feet being externally rotated, while the knees point straight away? It sounds like genu valgus...which could be from body alignment (foot/hip), or tight adductors, medial HS, and internal rotators pulling the knees inwards (my guess on this one).
recommend lower body exercises, please
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