Knee-dominant strength training for runners and hikers with knee pain

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. This is a continuation of some of the other shows that I've done about strength training for runners.

The first one was about an overlying general philosophy of why we strength train and why you would add mobility based upon changing the individual and changing their physical abilities so they can do more and they can tolerate more and they can run better and longer and suffer less injuries. So essentially our decrease in risk. And in the other podcast, we talked about hip dominant exercises and how they can help out with knee pain associated to running. Now we're going to talk about knee dominant exercise and break that down just a little bit. I'm glad that doing this third podcast today, I feel a lot more calm with it because I felt like the need to shove so much into the first few podcasts because it all comes down to providing some context.

Now I feel like I've laid some good foundation and we can go more into some of the nitty-gritty of the knee dominant work. Now in the other show, I talked about how you can offload some of the knee forces that you experience while running and especially downhill running and hiking. All trail sports, basically. And we figured out that using a hip dominant pattern can help out or hip dominant lift can help out with taking work away from the knee. Not in the case that the knee doesn't ever need to do work, but we're taking some work in a rotational and lateral bend standpoint. We're taking some of the other forces away that the knee is not super tolerant of.

It can tolerate some, but over time, it doesn't really like a lot of it. So now we're going to go more into the knee, like strength of the knee itself. I know that there's been a term thrown around with bulletproofing your knees. Just know that there is no bulletproofing of anything. That is a fallacy. And every sport, every hike, every run, and all of that has an assumed risk. You could develop a problem associated to that sport or activity over time. It doesn't mean you shouldn't do it, but don't be surprised if your knee symptoms come back periodically. That's what happens. They're called flare-ups.

And they happen just more frequently when the first in is physically unprepared or the knee is unprepared. So there is no bulletproofing, but let's see if we can build a tolerance to things. So normally what I tell people, when they first experience some knee problems and they want to make sure their knee gets better for an activity that's coming up, say they have a run or a hike coming up soon, as they say, you know what? I'm just going to shut it down. I'm just going to take some time off. I need to do some rest. That's pretty much wrong. Now, the only types of knee conditions that are really more surgical are ones that are physically locked in place.

I mean, you cannot extend. You cannot flex them. All the other ones where it feels stiff or painful or a little tweaky or poppy or grindy and things like that, usually they're rehab cases. And they respond really well to strengthening of the aforementioned areas that I talked about before and the other podcasts, but also the things we'll talk about today. So the first thing that we need to make sure that we do with a grumpy knee is that we need to challenge the musculature around it to maximum contraction. Maximum contraction. That's right. You need to go pretty hard on them. But the caveat to this is that people who have sensitivity in their knees don't tolerate certain ranges.

And so you need to be almost like a detective in this and you take note of, you know what? My knee doesn't like really when I sit on, sit my butt to my heels. It doesn't like when I do full squats, but you know what? I can initiate it or go partially into a squat and I feel fine. And you know what? My knees feel a lot better when I lift my heels up or something of that nature. Like there's all these different little variables coming down to shin angle and thigh angle and so on. And the basics are, you find a position you can tolerate and you hold it. This is called an isometric. And this is an isometric where you're really not moving anything.

So you're just hanging there and letting them toast. Now, a good golden rule with this is going to be you should find a position that is non-painful but hard enough to where it's very hard to hold for about 30 seconds. At that 30 second point, you should hit pretty much failure, which usually comes with a noise, but not pain, just hard. And then you walk around and you start cursing at somebody and say, I can't believe someone suggests this to me. It's too freaking hard. And then you go back to it again. And then you do a few rounds of that. Now, a good rule is again is you work towards about two minutes of total work time, not rest time.

So if you want to take a longer rest in between, you can. Some people suggest a couple minutes in between. I'm kind of very loose with this number, but I do try to make my time productive. And so last time that I had a knee issue, but I wanted to go do some squats at the gym because I know it helps me in the long term. My knee really didn't like the starting point of the squat. I didn't really like it. So I'd walk up and I would do like my, my warmup at that time was I'd walk up to any old machine, but the one that's typically open is called a lat pull. And so I just go to the lat pull and I start pull, pull, pull.

I feel pretty good in the arms a lot. So I'm pull, pull, pull, pull, pull, which takes, you know, like 15 reps or so in the beginning. I just kind of lightly do it, but go and do a challenging amount still. And then I do my knee quad isometrics and I hang there and get toasty, toasty, toasty, 30 seconds. Man, that's hard. And then I just go to pushups and then I go to lat pull and I go to wall sits, if you will, and then pushups. And so I make a little circuit out of it. I'm kind of watching the clock all throughout and I'm spending about 30 minutes per, 30 seconds per time, but I'm worrying about other things at the same time.

And so eventually later, I am going to get to my squat. Now, can I do this with a split squat hold? Yeah, I can do that. That's another version of a great isometric you can do when you have a grumpy knee and you're building, you're starting to get the neurological system of the body to keep its stronghold on maximum contraction of the quad muscles. Now, I don't know if you guys haven't had an injury before, like there's this feeling of kind of like the muscles around it are kind of lazy. It feels kind of sloppy and loose, not even painful all the time, but it just doesn't feel fully engaged, right?

Some people feel like the quad really isn't really working super hard. It just feels like it's just dormant in there. And so one way you can offset that is doing these isometrics very soon. You could do them every day. Normally, when I have people do them, I realize that if I suggest that they do them every day, they won't. And so I try to play a good happy medium here. I say, you want to do it two or three times a week? And they say, I'll do it too. Great. Now, during those times, I expect you to go full bore, like nothing left in the tank by the time you're hitting the fourth round or so. Does that sound good?

Yes, it does. Some people, when they end up going through the third day, they just very go lackluster on the other day. So they're like, oh, I'm doing this so much and, you know, I'll just, the volume will count. In this case, the intensity is important too. So the full circuit you could do if you really wanted to go to town on the knees, which takes a very long time, is you do the wall sits, you do a split stance hold where you're in a low position where you get more quad. You can do a hamstring, like almost like a bench support and you put your feet up and then like a long lever bridge. Some physical therapists call these other versions called heel digs.

And so there's various different ways to do this, but on a foam roll is really nice with the heel elevated so you can lift those babies up and those things start to smoke pretty quick. And then usually doing something hip dominant to get the hip online too, like leg swings or bowlers or like light versions of RDLs or single leg RDLs. And those are, those ones you can do the same type of intensity. 30 seconds of work, take a little break, go back and do two minutes total. Now, again, that does take a very long time. So I don't do all those anymore because my knee's feeling pretty darn good. So the, ideally you keep those things around until you graduate into the real lifts.

So the lifts that I would perform are going to be probably a split squat. I might do a lateral squat, which is with a lateral drive and I'll explain it a little bit later. I'll do a goblet squat at that point if my knee was really sensitive, but if I feel fine, I'll go to a back squat. I can go to a leg press. I can go to a hack, a hack press and even, even pushing a sled you could do, but it's all going to come down to what did your knee currently tolerate at that time. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try.

We're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity. The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Foot position can matter on some of these things. So imagine you're doing squats and you, like your heels stay on the ground, your toes stay on the ground. Like it's kind of like you only get to a certain death because you'll fall over.

With some of these other machines you can manipulate, you can manipulate your foot position a little bit more just because you're in the machine itself. You won't fall over. A leg press is one of them where you can slide the feet up towards the top of the platform which is a little bit less knee dominant and or you can bring them back towards like underneath your hips which would be more knee dominant because you see the shin angle is a little bit steeper and neither one of them is wrong. They simulate something like a sissy squat which is going to be way knees over toes which people say don't do, right?

But you can do it. We all know you can do, hopefully all you know you can do knees over toes if you don't have any knee symptoms. That is a complete fallacy that your knees will not explode. But if you do have some knee pain and it hurts to go knees over toes then yeah, don't. But you cannot survive in life going downstairs without going knees over toes. It won't work. When you bike your knees go over your toes. When you step down off of a step when you're hiking the knees go over the toes. You have to go knees over toes so you might as well condition it. Now those are some of my favorite lifts.

Again, I blend those up with other exercises and things to stay productive at the gym and I think one of the hard things for people when they first start going to the gym or doing some resistance training is they don't know where to start. I really look at the gyms like a buffet. I walk in and honestly there was a period where I didn't have a gym membership for like five years or so maybe more because I had gym I went to a friend's gym which didn't have any machines or anything and I have my own gym at work which I don't use because I don't like doing my lifting at work and I had some weights at home which I don't like doing because I want to go somewhere and so the gym is like my third place I like going there and doing some lifting and I walk in but you know there's people there so then you look around you're like well shoot the machine the lat pole that I did every time is occupied so what do I do now?

Well there's another lat pole by it well it's different so what? Try it see how it goes figure out your adjustments you know and if you're doing that wall sit as a warm up you got to figure out well maybe I can do a hip one at the same time as my break maybe I can do a push up or I can do a bench press like you can do literally anything that you want but it's probably not going to be a squat maybe you don't do squat, squat, squat, squat, squat in a row with one circuit like circuits you usually blend up like quad like different body parts like quad, calf hamstring, glute like those are like different exercise biases a question I've got a lot is that well how do I do a squat when should I be concerned that it's working like my hamstring or my glutes well there are predictable target tissues for every lift or every exercise if you walk over to some of those exercise machines that that are targeting say the hamstring like you see it lit up on the machine it's gonna be the hamstring if it was your shoulder that'd be really weird right and so ideally you find exercises that work the target tissue of interest most squats are gonna be quaddi if it starts feeling it's like at your hamstrings or your back or your glutes like maybe you choose a different version of that not to say that you can't do that version that you're doing but it's really not super green light it's a little bit we call them yellow like yellow is a little bit like well maybe it's not working super super well so we just change the lift at least temporarily but I like going to the gym and looking at it as a buffet and especially if you haven't done any lifting or resistance training before like try all the machines go over to the weight rack test out the weights which weight should you use for a squat I don't know pick one up oh it's too light pick a different one up and this seems really simple but I think there's a lot of apprehension of people going to the gym and doing some resistance training if they haven't before like our major our major goal with beginners is just to get them to do something and feel comfortable navigating the gym and just doing something challenging when you have more advanced people yeah you have to get a little bit more specific with their programming but all those things that you see you know throughout the internet about the science of lifting and you know the periodization and do this for six weeks and that for four weeks and that for seven weeks and like forget all that stuff that's not really important if you're a beginner you just start doing stuff later on it becomes a little bit more important and I can tell you from my own personal training too I still am not super diligent with all of those periodization blocks and prioritizing things and so on because I only really go two to three days a week like I'm not going to try to be a a power lifter as my profession I'm not I don't care about that I'm just trying to expose myself to some resistance every week multiple times for the rest of my life so I can play baseball and you guys probably want to do it for running so those squat lifts that I just mentioned are a good go-to but again go through the machines try them out and I think that you'll see that when your leg is tired you'll have to do something else which is going to be a different machine for a different body part so what this does for your leg is it builds up good strength to tolerate downhill forces or eccentric lengthening contraction quad strength also the muscles around the knee as I mentioned before the quad the hamstrings the soleus muscles which is down your calves like those have to those are really important to train because they end up having the ability to control shear force and rotational forces at the knee and the hip does too that's why you can't really just ignore one body part and just a last few notes on this is that I've noticed that people who have past knee injuries don't like lifting their knees or they had been told that you shouldn't be lifting with a hip dominant lift like a deadlift because someone scared them out of it a long time ago that is pretty incorrect at this point I'm sure there's special circumstances but if you're worried about integrating a type of lift or exercise back in you should talk to somebody a good coach a good strength coach can figure out variations of exercises to do that are non-threatening that are still hard that still get the job done a deadlift and a back squat is not the only way those are just some ways so you need to find someone who can help you program a little bit if anything in today's episode resonated with you visit the link in your podcast player there you'll find any free resource that we mentioned in the show any guest links and a link for a free discovery call with us we're licensed to work with our outdoor active people via telehealth across many states in the U.S.

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