Training With Bad Knees

People have bad knees for one reason or another; previous injury, chronic overuse, or overweight. In 3 Reasons Your Knees Hurt During Squats I explain how your mechanics could be causing your knee pain but I would be remiss if I didn’t touch on those who have true orthopedic knee conditions that limit their ability to exercise. Having bad knees can make the simplest things like running, jumping and even squatting painful but there are ways around it.

In my experience, it has been shown to that the stronger your legs and hips are the better your knees often feel. Check out Gluteus Medius: The Root of Leg Pain for more information on how having strong hips can prevent knee pain and other lower extremity injuries. By strengthening the muscles of the legs, they are able to stabilize the joint and better absorb forces. But how do I get my legs stronger if everything hurts??? With a few minor adjustments one can continue to train and hit their fitness goals

Hip-Dominant Exercises

Many people walk around with an underdeveloped posterior chain, or glutes and hamstrings. Is it because many of us sit all day?? Or is it because most of unbalanced workouts that focus primarily on the quads??

To flip the script it is time to start making our lower body training more hip dominant, or focus on training our backside. Most posterior chain exercises are well tolerated by people with bad knees. Why is this?? Most hip dominant exercises require little to know knee flexion, or often the insulting action of many knee issues.

What separates a hip dominant exercise from a knee dominant exercise? The hip hinge. Deadlift variations are a great way to get a training stimulus from the lower body when chronic knee injuries are an issue.

Box Squats

If you are like me, you are hard-headed (shocker for a Taurus right?). Problem with being hard-headed is we will stick with something even if it may not be the best option for us. Squatting can be one of those things that people just can’t let go of. They will squat and squat until they can barely walk because their knees are so inflamed. And look I get it, the squat is one of if not the best way to get really strong. But if you want to continue to train for the long-term, it is time to make a small tweak in your training for the sake of your knees.

This is where the box squat can come in for us hard-headed folks who just HAVE to squat. The box squat has been used by elite powerlifters for years and have made tremendous gains in their max strength. But for most of us we are not trying to squat 900 pounds we are just trying to get stronger, build muscle, and move better.

The box squat will allow you to continue training because it helps eliminate the forward weight shift or forward migration of the tibia often need during the traditional squat. The box squat teaches us to “sit back” but also allows us to maintain a vertical tibia. Where many people with knee pain struggle is when their knees begin to move forward over the toes and put all kinds of tension over the front of the knee.

Reverse Lunges

Traditional forward lunge can be absolutely brutal for people with anterior knee pain. The hard eccentric quad contraction of the forward leg creates a lot of strain and pressure on the patella and the patella tendon. Even if you have healthy knees, hundreds of reps of forward lunges can cause anterior knee pain. To save your knees instead go in reverse!

The reverse lunge turns the lunge from a quad dominant exercise to a hip dominant exercise. The activation of the posterior chain is much more significant with the reverse lunge compared to the forward lunge. The eccentric load on the quadriceps is also less, taking some of the strain off the front of the knee as well.

Below is a comparison of the front lunge vs. the reverse lunge video

Reverse Sled Drags

So you have bad knees but what strong, muscular quads? And all I have recommended so far is to train your posterior chain, so I guess you are out of lucky right?? Wrong.

Reverse Sled Drags are your answer to becoming quadzilla with bad knees. In fact, building strong quads without irritating your knees can actually be rehabilitative. Many anterior knee pain (tendinitis, PFPS, etc) rehabs include direct quad strengthening to help decrease the load that the anterior knee takes by being able to handle more load through the muscle.

The reverse sled drag eliminates the eccentric quad contraction that can be troublesome for people with knee pain. The lack of eccentric muscle contraction also limits the amount of muscle soreness that occurs post workout, allowing you to train them more often.

Try using these as a finisher to your leg day with a timed method. Set your timer to three minutes and go as far as you can in that time. Progress by either trying to get more distance within that time, increasing the weight pulled, or increasing the time of the drag. Don’t have access to a sled or prowler? You can also try walking backwards on a treadmill with the belt turned off and can add an incline to make it harder.

Conditioning Variations

Bad knees keeping you from running? Try implementing a few other training tools to get your heart rate up without the pounding on your knees.

Battle Ropes
Think of sprints, but for the arms. The variations are only limited by your creativity and transition from variation to variation is relatively seemless. The battle ropes also provide an unique stimulus to the core as well. Give 20 seconds as hard as you can go on the battle ropes and your arms and shoulders will be burning and your heart rate will be sky hight, all without any pounding on your knees. Here are a few examples of variations you can try.

Kettlebell Swings
The kettlebell swing is extremely metabolically challenging and puts no strain on the knees. Much like the deadlift, the kettlebell swing is a posterior chain exercise.

Check out Chicago White Sox pitcher Chris Beck doing some band-resisted KB swings

Prowler/sled Pushes
The prowler or sled is one of the most efficient conditioning tools you can have access to. A couple 20 yard prowler pushes and your heart is racing and your lungs are burning. The prowler/sled push is also easy on the knees, hips and ankles. Just load up the sled and start moving the weight!

The prowler eliminates long cardio workouts and you can get a ton of work done in less than 20 minutes. And like the reverse sled drags, due to the lack of eccentric contraction, they are effective in recovery and can be used frequently.

Please feel free to contact me below with any questions!