Got issues with your knees? Think you’ve done everything you can to address the issue? You’ve performed eccentrics, improved mobility and muscle quality by foam rolling, rested for months on end, just delaying the inevitable cortisone injection?
Yeah, I had some issues with that earlier in my career as well. The doctor told me to rest, and that made it worse for me. When dealing with athletes that have these issues, I always make sure they adhere to a fairly strict program. My whole goal is to assure that inflammation does not occur, otherwise, it’s a step in the wrong direction. With any kind of strength training there is going to be some kind of inflammation, but the idea is to avoid overuse inflammation that causes pain and eventually tendinosis. Obviously you need to progress yourself in a conservative fashion. Better off slow-cooking than burning your food right?
Start off with a 5-10 minute walk or jog, and if that’s too intense, feel free to heat the area then go right into this video:
Start with the exercises that cause the least amount of issues with your knees. Make sure the intensity is low, keep your reps moderate to high, and once you experience any pain, stop what you’re doing and try something else. The goal is to be able to workout without having pain. Health is first and foremost, and then comes aesthetics and ego.
Be sure to address glutes and adductor strength and make sure muscular flexibility is constantly being addressed. Stretching is key. Increasing flexibility will allow you to cross another potential issue off the list. Sometimes muscle stiffness will lead to tendinitis. Once these aspects are covered, you can move onto bigger exercises. You want to increase the work capacity of the muscle without causing pain. Progression will go as follows:
- Increase Time Under Tension under a limited range of motion
- Increase Range of Motion
- Decrease Range of Motion, Increase Intensity, Decrease Time Under Tension
Here’s an example of how to do this with split squats (see picture)
- Partial ROM Bulgarian Split Squats
- Bulgarian Split Squats
- Front Foot Elevated Bulgarian Split Squats
- Bulgarian Split Squats (Increase Load)
The partial range of motion will keep the movement in a pain free zone. Gradually, a pain free range of motion will increase. Once a proper range of motion is achieved, it is appropriate to start loading the exercise.
Also, never underutilize recovery techniques. Massage, ice, compression, heat, contrast showers are all critical for achieving optimal results. These techniques will help with inflammation, pain, regeneration, increasing flexibility, increasing muscle suppleness, blood flow, etc.
Just make sure you stick with basic, closed chain exercises. Stay away from ballistic movements until normal pain free ranges of motion are achieved. And when you progress things, make sure you progress them SLOWLY! If tendinitis stays too long, that’s when tendinosis develops. Once that occurs that’s when degeneration starts happening; muscles and tendons will tear and things will only get uglier from there.
One overlooked aspect of rehabilitation is positive reinforcement. The mental aspect is HUGE in rehab. Always insist that your client is progressing, that you know what you’re doing, that this is the right way to go about doing things, that you’ve done this before (even if you haven’t). Positive thinking yields positive results. It allows the client to suppress any anxiety present and decrease catabolic hormones associated with anxiety.
*This article originally appeared on VPXSports.com. *