Strength is the solution.
Disclaimer: Wasatch Fitness Academy and our coaches are movement professionals, strength and conditioning specialists, and we’re skilled in our work. What we’re not, however, are physical therapists, orthopedic surgeons, or medical professionals. The article below is not intended to diagnose or treat any medical or underlying structural issues. This article aims to provide an understanding of underlying anatomy and function so you can make better use of all professionals you do interact with. Further, many issues of dysfunction can be addressed by improving strength and muscular balance; as movement professionals who specialize in strength and conditioning, this is exactly the way we can be most helpful.
In other words: if the pain is extreme and/or long-lasting, a visit to a physical therapist may be called for. You may also want to try the strategies presented below, which are intended to build strength in muscles often underused in people with movement-related discomfort. And if you do work with a physical therapist, when they say you’re ready to start focused training for your sport again, we’ll be here to support you.
Do you feel that?
The sun’s warmth as it shines down and warms your shoulders.
Do you hear that?
The songs of birds and the wind in the trees.
Do you smell that?
The smell of fresh cut grass and blooming flowers fill your senses.
Just makes ya wanna get after it and celebrate!
Spring is here and your favorite way to welcome in the season is to go for a nice run around the neighborhood. This run has been on your mind since the first snow storm hit the Wasatch mountain range last winter.
This run is your time to set your intentions for the upcoming year.
This run is your time to find your flow.
You want to feel your ribcage expand and contract as air comes in and out of your lungs with each step. When you run you know no limits and have no expectations, you can just be. You’ve been looking forward to this run for so long that you’ve even splurged on a new outfit to stay motivated this season. Today’s run is more than just a run, it’s the movement you’ve been craving since the last time you’ve felt the warmth on your shoulders.
This year, you’re going to run stronger and longer than in the past. Although you’ve experienced some twinges and slight pain in your right knee during your run in the past, it’s not going to stop you from reaching your goals. You’ve created a running schedule and by all means necessary you’re going to stick to that schedule.
You’re going to stick to your schedule. No. Matter. What.
It’s day one of your running schedule. You put on your new running outfit, grab your shoes and head towards the door. As you slip on your running shoes you reminisce on the past runs. These sparkles of memories then reminded you of your favorite running playlist.
You’re out the door and ten minutes into your run, you’re feeling your flow, loving every breath that fills your lungs, and every step you take moves you closer to your goal.
All of a sudden a stinging, shooting pain lights up in your right knee. It’s so intense it stops your flow. So you decide to pause, do some stretches that have given you release in the past, and continue your run.
Five minutes later the shooting stabbing pain shows up again, you feel your knee stiffen up. It hurts to flex and extend the joint. Frustrated and confused, you stop again and address the sensation. You try stretching again, and you plan to keep running.
The stabbing pain on the outside subsides, and you’re ready to give it one more go. This time you can’t even take ten steps without sharp sensations compounding every time you put weight on your right side.
Tears start to surface. The heart starts to race in a different way. You even start to notice your breathing pattern shift. You wanted so much to run today, yet your body isn’t letting you. Telling yourself it’s ok, and to push through the pain and to just keep going isn’t working this time. Feeling as though your body betrayed your intention for the day, you take one last look up to where you were headed, turn around and walk home.
You get home and you feel like crap. You think to yourself, “Am I just getting old? Is this knee pain on the right side just another one on the list of things that go as you age?”
And then you hear yourself make a commitment: “I’m going to (finally) get this thing dealt with so I can enjoy running this summer.”
This is where we do some learnin’.
Let’s dig into the knee a bit. Not literally of course – that won’t help – but to understand how it’s put together. The knee joint is supported by the muscles of the hip, thigh, and lower legs. The muscles that influence each leg’s motion the most are the quadriceps, hamstrings, and glutes. While we often use these terms to talk about muscles, each is actually a muscle group, with several different muscles that create both movement and stability across the knee.
IT Band pain is often the result of a lack of knee stability, caused by a weak or inactive glute medius.
So, the first part of your journey is to get your glute med working, and then make it strong.
Here’s where you have some work to do.
Let’s start with an assessment so you can see how your knees are working, specifically, if glute med is doing its job.
When addressing IT band pain the first muscle to test is the glute med using the single leg step down assessment. To make this valuable, you need to watch how your knee tracks throughout the movement. You can do this test in front of a mirror, or better yet, record yourself using your phone so you can refer back to it when you retest.
We’ve recorded a demo video for you to make this self-assessment easier:
For the set up, you need a 10”-12” box or step. Start standing on top of the box, and then take the outside foot off of the box. Slowly push your hips back as you try and tap your heel to the ground. Repeat this for ten reps per side.
When watching yourself perform these single leg step downs, pay attention to what your knees are doing. Do your knees cave in noticeably as you go down? How was your control on the way down? Could you perform another ten reps with the same quality but at a slower tempo? Paying attention to these kind of details when doing a self assessment is key. You have to know where you are starting from, to then set a plan to achieve your strength goals.
Maybe you totally owned that task: your knees went almost straight forward and back, and you kept a slow and controlled pace. Now what? Challenge yourself to try a higher platform.
But don’t get ahead of yourself: make sure that when you are deciding to retest on a higher platform that you have knee stability at the lower height.
Your knees were a bit wobbly? No worries, we just gotta find, feel, and build some muscles.
We’ve got to start with the core. You need stable hips before you start to feel the muscles engage around them, so start with an exercise to activate your core. When the pelvis is stabilized by the core muscles then hip muscles have a stable foundation to pull on. To activate your core, try the deadbug exercise for 2 sets of 20 reps.
Once your core is active and ready to perform, the fun begins! Now you get to search for the glute med. Start your search is by trying banded lateral monster walks. You’ll know they’re working if you feel a sensation on the side of your hips or on the top edge of your butt. The sensation should be felt in the muscles, NOT the joint. Your challenge is to try these and feel the muscles engage so well that it cramps. Yep, go towards a cramp. That cramp is a signal to the brain that the muscle is there and it’s able to work.
Note: If you have a hard time finding sensation around the hip area, try doing some side lying clamshells, with or without the band. Some key points for both of these exercises are to make sure hips stay aligned and stable and try going slow to minimize any potential hip hikes
Once you’re able to connect to your glute medius muscles, it’s time to make them stronger.
As you start your strength training regimen, keep this goal in mind:
You’ve got to feel your glute medius activate so it’ll keep working when your mind is elsewhere.
This means, actually feeling your muscles engage throughout each movement. Remember, when there’s IT band pain, it’s often because the IT Band has to do extra work to help stabilize the knee, because glute medius isn’t working well enough.
So during your next strength workout, your job is to find, focus and feel the glute med muscle. During your strength workouts, your goal is to feel glutes engaging through your workout. A good way to do this is to choose a weight that is challenging yet something you can control throughout your entire set.
Here’s what you should do: a box squat.
Box squats some in a bunch of varieties (check out the video), but for our goal of engaging glute med, we’ll work through this trio. First, you need a box or chair to sit on; when you’re seated, your thigh should be roughly level, or with your hips a bit above the height of your knees. Let’s start with a mini-band just above your knees. As you squat down and up, put tension into your knees out, into the band, to keep the band from being able to pull your knees in. Your knees should track over the centerline of your feet as you complete 15 reps. Rest for a minute and then go for another set of 15. Ideally, you’re feeling warmth or burning on the outside of your hip or thigh.
Next, let’s add some load with a kettlebell or a dumbbell. Start light – 15 or 20 pounds is a good starting point. With the band still in place, bring the load up to the goblet position, (refer to the video), and complete two sets of 15 squats, resting for 1-2 minutes between each set.
Finally, let’s go to the most challenging version: a goblet box squat without the band. Why is this the most challenging variety? Because you still need to feel and engage your glute medius, but you don’t get the feedback from the miniband. So you’re going to have to work even harder to feel those muscles – but that’s the point, that’s why we’re here in the first place.
Again your goal is to feel the glute med, so put the focus on the outside of your hips and thighs. If you’re feeling froggy, try for four to five sets of 15 – 20 glute med box squats. I’d be surprised if you didn’t leave your workout feeling stronger and better than when you started.
Want more exercises to find and build your glute medius? Check this out….. 6 Exercises to Build Glute Med.
Knee pain is kinda like a child who’s craving attention. It’ll whine, cry, scream till it gets the attention it craves. Keep moving forward and take care of your body by giving it what it craves…strength. Yes, technically you could do squats, deadlifts, and lunges all on your own, but you’ve already made the decision to try new things and do whatever it takes to address your knee twinges. Find the value of having a strength coach by your side, programming with your best intentions in mind. Hell, they have devoted their whole career path to learn how to move optimally why wouldn’t you want to learn from them.
-Yours in peace, love, and strength,