knee pain while squatting

[Matthew]

If anyone remembers, I started my mom and sister on weightlifting programs recently. It's going well, but I'd like to address one concern.

My mother has had bad knees since as long as I can remember, with a history of it in the family - her father had to have both joints replaced. She begins to feel pain after anything more than a 1/4 squat, and she can't complete a lunge without pain.

On the program I have her doing step-ups, stiff-legged deadlifts, romanian deadlifts and rack pulls. She tells me she feels no pain during these exercises. I also have her doing squats, but have told her to go as low as she can without feeling any pain in her joints, so it ends up being a 1/4 squat.

I have two questions, first of all are the 1/4 squats ok to be doing, or should we avoid squats altogether? Second, are there any other exercises I should be including (especially quad dominant)? Lunges aren't an option, neither are split squats, and there are only so many variations of the step up.



This is the program I have them on, any other input is more than welcomed.
Compound exercises are 3x8-12, isolation are 1-2x8-12
Goals are to lose fat and gain overall strength, emphasis on core

Monday
bentover db (dumbbell) row
flat db (barbell) bench press
step up
rack pull
bicep curl
tricep ext.

Wednesday
bentover bb row
incline bb bench press
squat
stiff-legged deadlift

Friday
one arm row
standing alternating db press
push up
sister - lunge, mother - step up
romanian deadlift
bicep curl
tricep ext.



Ab. work is done after other exercises
includes: plank, side bends, twists, leg raises, birddog, McGill curl up, bicycle, not all on same day

[Lisa~]

Someone else might give you something more specific, but if I were trying to help them, I'd go back to Mike Robertson's article on knees and reread it with them in mind. Your questions will probably get answered there.

18 Tips for Bulletproof Knees

[Blackjack]

My first question would be how much experience does she have with weightlifting?

Those are some pretty advanced movements especially for a beginner. It was either in one of Alwyn's or Craig Ballantyne's newletters where they talk about progressing to advanced movements like squats, lunges, etc. You need to take that into consideration before putting them in a program like the one above.

If you can provide more details on their experience, I may be able to provide more help.

Ted

[Jimbo]

Originally Posted by Lisa~

Someone else might give you something more specific, but if I were trying to help them, I'd go back to Mike Robertson's article on knees and reread it with them in mind. Your questions will probably get answered there.

18 Tips for Bulletproof Knees

Not to highjack this thread..but wanted to say thanks Lisa for posting this link. I've had some recent knee issues myself. This was a great article.

[Lisa~]

Originally Posted by Jimbo

Not to highjack this thread..but wanted to say thanks Lisa for posting this link. I've had some recent knee issues myself. This was a great article.

You're welcome Jimbo. It IS a great article and while you're reading it, if you see anything that will help Matthew, post it up here.

Blackjack, I think you can have just about everybody do some type of squat/lunge movement right from the start, it just has to be done at their level. The bigger question for me was her family history of knee pain and if because of that she might have some medical reason for doing something different. I doubt it though. Most of the clients I've seen with knee pain can reduce or eliminate that pain through full ROM in their knee joint, greater recruitment of the posterior chain and learn proper squat mechanics. But some have to start at a very, very basic level.

[Lisa~]

Here's another article that might help. Krista Scott Dixon is an excellent resource for women new to training (well, really for anybody). She has a how-to-squat article that starts with holding onto the back of a chair. This might be just what your mom needs. Exercise Instruction

[Matthew]

Great articles Lisa, thank you for posting those.
Blackjack, as far as I know this has been her introduction to weight lifting. If she has done it before, it hasn't been for many years.

Lisa, you said that knee pain can be reduced or eliminated by using a full range of motion, but I've always heard not to work through joint pain. Can you expand on this?

She's told me before that she has a liquid buildup in her knee joint, I'm not sure if that's what the doctor told her or if that's just what she thinks it is. I'll have to ask her about it again tonight, but could that be it? and if so, what can be done about it? Should she see a doctor to find out exactly what it is?

[Tony Gentilcore]

She's not ready for full ROM squats. Remember, most injuries start ELSEWHERE and the fact that her knees hurt is just where the pain ended up. I am willing to bet she has super tight hips and no glute function.

If I were you, I'd focus more on getting more glute activation in the plan, some foam rolling (hips, IT band, TFL, etc).

Maybe try some isometric holds for quad activation. Doing so will have less stress on the joints for the time being. Low step ups. And MAYBE, teaching her to box squat (teach her to use her hamstrings and glutes when squatting). She's probably very quad dominant and just needs to work on her posterior chain strength. I'd steer clear of lunges and what not for the time being.

[Lisa~]

Tony is so smart.

Tony, how about ski squats as an isometric for quads?

Matthew, do you need a list of glute activation movements or do you already know?

[Tony Gentilcore]

Ski squats would work. Definitely

[Matthew]

When I read it I was thinking things like goodmornings, back extensions. Is that right? Either way I would appreciate a list very much.

[Lisa~]

more like glute bridging, fire hydrants, single-leg glute bridge, and single-leg RDL. You could use a single-leg back extension if she can keep her spine neutral.

And in thinking about it, she should probably be doing a lot of core stability work as well, like front and side forearm planks held for time.

Does a bodyweight squat give her pain? Even if she's holding on? And when she does try it, can she stay flat on her feet, or does she shift her center of gravity toward her toes?

And don't forget the foam rolling that Tony mentioned. I have become such a fan of the foam roller. It can really make a difference.

[Matthew]

Bodyweight squats give her pain as well. I tell her to push with her heels, knees follow toes, sit back and down, etc etc. and as far as I can see she stays flat on her feet. I'll have to try it with her holding onto a chair.

I have her doing front and side planks.

I don't know where to get a foam roller from around here, I've never seen one. But I will definitely look for one, for the both of us.

Thanks again, I really appreciate your help.

[Lisa~]

You can order a foam roller from Perform Better.

And here's an article about how to use it: Feel Better for 10 Bucks.

[Lisa~]

Oh, and stability ball hip extensions would be great for core work and glute activation.

[Matthew]

Great, thanks a lot.

Can you help me put this all together? How should I incorporate these movements into her program?