Do your knees hurt when you perform lunges? It could be reverse, forward, from a deficit. No matter what you do, either during the lunges or after your workout, your knees are cranky.
There can be many reasons why your knees may bother you during certain lunging variations. There can be limitations in mobility or flexibility in one or multiple joints or muscles in the kinetic chain that are causing compensations elsewhere and placing increased stress on other joints, ie. the knee. As seen in the figure below, the hip bone is connected to the knee bone and so on.
photo credit: nicktuminello.com
Also, a person could have adequate mobility at the adjacent joints to the knee, but there could be inadequate stability. Stability and strength are not the same thing. Think of a slingshot. Strength is being able to pull the elastic back to propel an object while the other arm needs to be motionless and resist any type of motion in any direction.
How does stability relate to the lunge? Well, if someone doesn't have adequate core, hip, knee, or ankle stability, this can cause compensations throughout the chain and in turn contribute to dysfunction and/or pain.
Another reason why there may be pain is due to poor form. Now, this may sound obvious, but many exercises including deadlifts, lunges, etc. get bad press because they are deemed "bad exercises." They are lumped into this category because either people did them, they know someone that did them, or their friend of a friend did them and got hurt or had pain with them.
Proper form is imperative when it comes to any exercise. There is risk:reward when performing exercises and if your form is suspect, then it is only a matter of time until that sub-par form will catch up with you and cause issues.
In the section below, I will go into a little more detail on how mobility can play a role in all of this and of potential fixes for each. Stay tuned for upcoming blog posts to find out how to fix the other potential problem areas.
In various lunging variations, an individual needs the ability to flex their knee and hip on one side of their body while simultaneously either flexing or extending their hip and flexing their knee on the opposite side of their body, depending on the lunging variation.
For example, with a reverse lunge, we need an adequate amount of hip flexion/extension and knee flexion mobility on both legs in order to perform the movement.
As seen in the picture below, the front side leg needs hip flexion and knee flexion while the backside leg needs hip extension and knee flexion.
A quick and easy way to determine if there is adequate joint mobility is to lie on your back and move your hip and knee through their ranges of motion.
Assessing Hip Range of Motion (ROM)
Assessing Knee ROM
When moving the hip through its flexion and extension ranges of motion, we want to make sure we aren't compensating through the low back to make up for a lack of true hip flexion. Make sure the low back is flat to the ground or table when moving the hip.
The hip needs anywhere from 90-120 deg of hip flexion and the knee approximately 90-110, depending on the lunge variation, in order to perform the movement properly. Any less than that and a different lunge variation or regression may need to be used.
If you don't have enough mobility at either the hip or the knee, seek out a licensed professional for further work-up on the reason why there isn't adequate mobility at either joint.
So now that we covered whether or not the joints have the proper amount of mobility to perform a lunge, we need to take into account whether or not the muscles have the proper tissue length to perform a lunging movement.
A major offender in lunging variations where lack of soft tissue mobility can wreak havoc on the lunge is hip extension.
There are multiple muscles that can limit hip extension, including:
Psoas Major and Iliacus ("Hip Flexors") Rectus Femoris ("Quads")
Now, trying to test the length of these muscles by yourself can be a little tricky. A basic test that can be used to determine if that is adequate hip extension mobility is called The Thomas Test.
This is a test taught to physical therapy students in school to determine if some of the muscles mentioned above have normal flexibility. Now, for the sake of this post, there are some flaws to this test and having someone perform this test on you may be more beneficial.
Without getting into too much detail on some of the minor flaws to this test, see below regarding how to perform the test and what normal and abnormal Thomas Tests would look like.
-Sit on edge of table or bench.
-Bring one knee up to hip height and hold there with your hands.
-Lie back and let the opposite leg relax and drop down towards the ground.
-Normal: thigh drops to level of table and ankle is directly below the knee.
Where the test would be considered "positive" or where certain muscles may lack the soft tissue mobility would be:
Knee Extended Hip NOT fully extended
Performing this near a mirror or by taking a picture with your smartphone can help determine whether or not the test looks normal or appears like one of the pictures shown above.
So, if you are like many other people and fall into one or more than one of the pictures above, here are some options to help improve the soft tissue flexibility of those tissues.
You can perform some type of Self-Myofascial Release (SMR) with a foam roller or lacrosse ball. See the video below for instructions on how to do that.
Psoas Major/Iliacus and TFL
*Attention*: Be careful when performing SMR to this area. There are internal organs, nerve, and vascular structures near this area and if you experience any type of sharp pain, radiating pain, etc., move off of the area.
For the Psoas and Iliacus, find your ASIS (Anterior Superior Iliac Spine) a.k.a. hip bone on the front of your body and your umbilicus (belly button) and go 1/2 way in between the two to work on the Psoas. For the Iliacus, find the ASIS and go just medial to that.
You can rest on a certain tender spot for a few seconds and work your way around to other spots as well.
For the TFL, find the ASIS and go down about 4 inches and 2 inches out to the side. You can also rest on that spot with the lacrosse ball to help improve the mobility.
Rectus Femoris, Vastus Lateralis and Adductor Longus/Magnus
For the Rectus Femoris, slowly roll up and down the front of the thigh from the ASIS to just above the patella (knee cap). Remember to breathe.
For the Vastus Lateralis, similar instructions as Rectus Femoris, but place your body at a 45 deg angle to the ground so that you are rolling just to the side of the Rectus Femoris.
For Adductor Longus/Magnus, you are going to place the foam roller perpendicular to your leg and roll up and down the inside of your thigh from just above your knee towards the top of your thigh.
Using the foam roller or a lacrosse ball is one option. If you prefer to use your hands, check out John Rusin's website here where he goes into great detail on how to perform his soft tissue technique "Hands-On SMR."
Now that we have improved the soft tissue mobility of those muscles, we want to expose that tissue to new ranges of flexibility.
For the Iliacus/Psoas Major, use the 1/2 kneeling Quadriceps mobilization or "Couch Stretch."
Place one knee down on a padded surface such as an Airex pad and your foot up on a bench/couch/etc. Place hands on the other knee. Press into knee, squeeze right butt firmly and gently lean forward until a stretch is felt.
This can be held for the typical static stretch for 30 seconds or can be incorporated into a dynamic mobility warm-up or superset and be held for 3-5 seconds.
For Adductor Longus/Magnus, try the 1/2 kneeling adductor mobilization.
Place one knee down on a padded surface and the other leg out to the side as shown in the picture. Maintaining a neutral spine/flat back, sit your hips back and away from where you started until you feel a stretch. Then move back towards the starting position.
Either position can be used for a stretch or mobilization. The same goes for this as well in regards to duration of stretch.
For the Psoas/Iliacus, try the 1/2 kneeling hip flexor mobilization.
Similar to the previous two correctives, place one knee down and one knee up. Place both hands on the up knee. Press into knee firmly, then squeeze butt firmly and gently lean forward until stretch is felt in front of down leg hip.
If lunges are giving you issues and causing your knees to hurt, try these soft tissue and mobility fixes to help address some potential problem areas.
Stay tuned for the follow-up post to this one!
Here I will be writing and posting about topics ranging from physical therapy, injury prevention/reduction, and strength and conditioning.