How to keep bad knees from derailing me?

[veggieguy]

Hi everybody. I'm in my last week of basic training (only two workouts left!), and I feel good about how I've done so far. I haven't missed a workout, have stuck to my "bulk up" diet goals, and things are moving in the right direction. However, tonight I hit a speed bump. Halfway through my first set of lunges, I started getting sharp knee pain and had to stop.

Back in my 20's, I used to run regularly. (I'm now 43) For the last 10 years or so, my knees have been "grinding" whenever I go up or down stairs, stand or sit, etc. It doesn't generally hurt, but it sounds scary and has put me off exercising for a good while, for fear of making it worse. I saw a doctor several years ago, and his advice was, "If it doesn't hurt, don't let it stop you. Not exercising is worse than the knee issues you currently have." When I decided to start Nerd Fitness, I was determined to do all of the exercises unless it hurt my knees. Well, I reached that point tonight.

A part of me knew this was coming, but I don't want to let it derail my progress. Are there any reasonable substitutes for squats and lunges that will put minimal stress on my knees? Any other tips to keep me moving forward without causing more knee problems?

Thanks!

[Timmy M]

squats and lunges are you're 2 main exercises for quads (there's step ups but they might be worse for you) with the lunges it could just be an issue of foot placement, maybe try to experiment with how far you plant your foot (just with bodyweight) to test if there's anyway of you getting round it.

with squats i'd say check your form (or post a video and let us check it) you'd be surprised at how bad your squat form can be without realising it

also just if you're looking for more leg exercises you could do different types of deadlift (definitely make sure you check your form with that... i've seen some fine examples of lunacy in my time with deadlift form) though with deadlifts you don't get much quad activation so biking could help with that if you really can't squat, lunge or any of their variants

[veggieguy]

I haven't had knee pain with the squats (yet), but I had generally lumped them in with the lunges as tempting fate with my knees. Maybe that was a mistake. I can continue with squats unless I run into a problem with them as well. For the lunges, I have been focusing on form pretty intently. I don't think it's purely a form issue, but I'm sure there is still room for improvement. Maybe I'll try to slowly re-introduce them after awhile.

[Elastigirl]

Have you gone to MWOD.com yet? It is the mobility workout of the day, and along with other stuff, has lots of great mobility stretches for knees,

Lunges are the hardest on knees, try reverse lunges.

[Waldo]

Squats tend to strengthen the knees in a way that reduces knee pain. If you have knee pain when squatting, as long as your squatting form is good the pain should subside over time as your legs get stronger. Stopping at parallel is a good bit worse for the knees than going all the way down as low as you can go. Parallel is the point of maximum stress on the knees, you don't want to stop there.

Lunges are tough on the knees, expecially front lunges. Back lunges (where you step back instead of step forward) are a little better on the knees. Lunges aren't really necessary to do. They are a good exercise, but if you have knee issues at all you aren't going to want to do them unless you are almost fully recovered from the knee issues.

[veggieguy]

Elastigirl: That site sounds interesting, but MWOD.com is not working for me. Did you perhaps mean http://www.mobilitywod.com/ ??

[oystergirl]

I have some knee issues too and my orthopedic surgeon put me on weighted quad extensions to strengthen up the muscle on the inner facing of the knee which is what tends to be weakest and causes tracking issues with the patella over the fermoral grove in an inappropriate way.

I use a five pound ankle weight, sit on the edge of a table with the back of the knee flush with the table and then contract to parallel with the floor. Hold a ten count and slowly lower--do 5 reps with toe pointed and 5 reps with toe flexed and make sure the toe is straight up in the air and not pointing out to the side.

while my knee still pops a bit going up stairs, it is in no way painful...another thing could be that your IT band is tight so you might want to google foam rolling. i do this and it does help release the tightness and pain in hip and knee...

[mandy75]

I have moderate arthritis in my right knee. my Doc told me, unless I am on the ground crying, do the exercise anyways. He said not exercising is worse for my knees than doing it. He told me to make sure I strengthen everything above and below the knee and to stretch. The muscles being tight, can cause the knee cap to not be on track correctly. i always wear a knee brace when working out and just move very carefully with lunges. Always make sure you are in proper form.

[Istra]

I've had knee problems since I was 13. Something I learned through great pain was I had to accept that my knees were the weakest part of my body, and I could not push them as hard as the rest of my body. I would frequently push myself to and through pain, and end up leaving myself completely immobilized, and farther behind than I was before.

I've finally been gaining strength over the past few years, although I still have to accept my knee's limitations (had to turn down a 5 mile hike this weekend - knew I could do 3, but not 5!)

*I* was in such bad shape that I had to start off with walking, not squats or lunges or anything. Now I can do some squats, but I have to be careful, and pay STRICT ATTENTION to my form. As soon as my knee has the "bad pain" (as opposed to muscles complaining), I have to stop.

I also learned that purposely engaging other muscles helped take some of the strain off my knee. (Like thrusting with my gluteous maximus, instead of the tops of my thighs), and not going as deep, while frustrating was a good place to start.

Being able to tell the difference between muscle complaint and damage complaint is pretty important. I have to listen really carefully so I don't end up worse than I was before. :3

Those are my two (more like five) cents. Good luck!

[andygates]

A left-field alternative: bike in a big gear (a fixie if you have one) and attack hills like Cthulhu is on your tail. Lovely big leg muscles with no knee jarring. Might work for you.

It doesn't do the core stuff that loaded squats do, but you can get that elsewhere.

[notanartmajor]

It's hard to say what's wrong with your knee without a professional opinion on the matter. About a year ago I had to stop squatting for a bit due to some acute injury that also involved sharp pain in the knee. Still dunno what it was, but after a week or so I went right back to squatting. I have a crunchy, achey knee (despite being in my 20's...stupid body) that has improved greatly through squats and deadlifts, but YMMV depending on what the actual issue is.

[scotticus]

Prehab/mobility and form check for sure.

As other poster have suggested, it's pretty easy to have whack squat form without knowing it. For instance I'm personally very sensitive to foot placement and it took me a while to dial that in (my knees were a bit grumpy until I did). Just one of many elements of the movement that could be an issue.

Also, based on your description it sounds like it could be patellofemoral syndrome (something I know all too well from my distance running days). If it continues to be an issue, some time with a physio might be in order. Rest and/or ice will also likely help a lot, but will slow up your progress some. That said, you know what they say about an ounce of prevention - better to lose a week or two now than a month or two later...

Finally, if you have chronic knee issues (grinding), taping or wrapping could also really help. Despite not being the most awesome squatter out there (I'm presently working at 230-235lbs for reps) I've been wrapping for quite a while because of my history with knee issues and I have no doubt that it has helped a lot.

Hope that helps.

EDIT: This might sound counter intutitive, but pay special attention to hip mobility in particular. Problems in the hip area often manifest themselves in the knees...

[Waldo]

EDIT: This might sound counter intutitive, but pay special attention to hip mobility in particular. Problems in the hip area often manifest themselves in the knees...

Off topic but related to this point, something I've been dealing with....

The same thing is true in the upper body between the shoulders/mid-back and wrists/elbows. A lack of shoulder mobility can/does show itself in back soreness. A lack of wrist mobility can/does show itself in elbow soreness.

[veggieguy]

Thanks for all of the options and advice, folks. As a related tangent, I'm feeling it would be smart to try getting a professional opinion on my knees again. I think I've determined from my last attempt that a general practice doctor is not the place to start. Any advice on a more appropriate choice? Would I go straight to a physical therapist, look for some sort of a "sports medicine" or orthopedic option, or something else?

[Sloth the Enduring]

I'd look for a sports medicine group that has PTs on staff. That seems like the most likely way to get a doctor that will consider all of the options before suggesting that he scope your knees.

[Shoshie]

I have bad knees from a large Q angle (I have gigantic hips...great for babies and sumo squats, bad for lunges and distance running). Lunges give me pain, but I love squats. I haven't gotten any pain from high rep body weight squats or from loaded back squats. But even a few body weight lunges means that I'll be in pain that day, possibly for the whole week. Definitely don't discount squats!