Do you have knee pain? Have you tried changing your movement mechanics when performing a squat? Did you know there are different ways to squat by using a knee strategy versus a hip strategy? A knee strategy has been shown to increase the risk of tibiofemoral joint injuries, patellofemoral joint pain, patella tendinopathy, ACL sprains, as well as IT band syndrome. Utilizing a hip strategy with movements such as squatting, stair climbing, and jumping will reduce demand on your knees, which may reduce your knee pain or help prevent you from having knee pain in the future! Read more to understand the difference between a knee vs. a hip strategy, and how to fix knee pain with squatting!

 

Why Newton’s Laws Matter With Changing Your Mechanics

Let’s bring it back to Newton’s Third Law: For every action (force) there is always an equal and opposite reaction “Ground Reaction Force”, which is the force equal to and opposite to the force which we impose on the ground. Based on this ground reaction force we will be able to distinguish the lever/moment arm of each joint. What is a lever arm? It is the perpendicular distance from the line of force to the axis of rotation. The larger the lever arm the greater the external moment/torque on a given joint.

Basically the larger the moment arm -> the larger the external moment is, which induces a larger internal moment arm, thus creating a larger demand on the muscles at that joint to work!

 

Knee Pain Due To Squatting? Overcome Those Obstacles With Our Program!

knee rehab fix squat the prehab guys

It is common for individuals to experience knee pain with squatting; however, our program can help optimize your knee function so that you do not run into this issue any longer! The Knee [P]Rehab Program is a physical therapist-developed, step-by-step program that teaches you how to optimize your knee health. Learn more HERE!

 

Understanding Knee vs. Hip Strategy

Here Arash is performing the squat with a hip and a knee strategy: A HIP STRATEGY is used during the first two repetitions, where the work is primarily being done by the hip extensors. This has been shown that this movement is roughly controlled 50% by the hip extensors, only 25% by the ankle plantar flexors, and 25% by the knee extensors During the last 2 repetitions he performs with a KNEE STRATEGY (knees forward), which will put a LARGE demand on the knee extensors AKA quadriceps. It has been shown this movement is controlled by approximately 50% by the knee extensors (20% hip extensors and 30% by plantar flexors). Unfortunately, we live in a knee-dominant world, we are here to tell YOU to start sitting a little bit deeper into your squat (by using a hip strategy) whether you are plopping onto your chair/couch/toilet or squatting at the gym.

 

Improve The Mobility Of Your Squats!

 

Lunging with a Knee Vs. Hip Strategy

There are three primary things to consider when looking to bias either the GLUTES or the QUADS in the lunge.

1️⃣ Tibia Angle: A tibia that is forward = more forward knee migration. This translates to a greater degree of knee flexion and thus a longer lever arm on the quadriceps. Essentially, the more forward the knee travels past the toes, the greater the demand on the quadriceps while decreasing demand on the glutes.

2️⃣ Trunk Angle: A forward trunk = longer lever arm for the glutes. In the same fashion in which a forward knee increases the quad lever arm, the trunk does the same thing for the glutes.

3️⃣ Hip extension vs Knee Extension: This is one of the harder ones to see. Even if the biomechanical setup is correct to hit either the glutes or quads, if your control over which muscles you are firing isn’t right, it doesn’t make a difference at all. In the ascent phase of the exercise, you ideally will be using your quad to drive knee extension and glutes to drive hip extension. They should both be occurring.

However, many times people tend to focus on just one – many times knee extension – and miss out on hitting the glutes. Notice how my knee “snaps back”, that’s a tell-tale sign that I’m initiating my lunge movement primarily with knee extension. Stay on the lookout for the knee snap back if targeting the glutes!

LISTEN: LUNGING VARIATIONS WITH [P]REHAB

lunge prehab guys knee pain squatting

 

Master The Hip Hinge

The first step in mastering a hip strategy is understanding how to appropriately hip hinge. The video below will help improve your ability to hip hinge! Understanding how to hip hinge is a pre-requisite in understanding how to change your mechanics to improve knee pain.

 

Hip Hinge – Dowel

Sample Knee Rehab Program Exercise Video

  • HOW: Begin in a standing position with your feet about hip-width apart. Place a dowel behind your back with one end making contact with your head and on your tailbone with the other end, the middle of the dowel should also be in contact with your mid-back. Make sure you keep in contact with these three points for the entirety of the movement. Next focus on hinging primarily at the hips. This is achieved by bringing your torso forward and pushing your butt back. Lower yourself as far as you feel comfortable while maintaining all three points of contact, then pull yourself upright by using the muscles in the back of the legs. Squeeze your butt once you are upright to ensure that you stand fully erect.

 

  • FEEL: You will feel the muscles in the back of the legs work with this exercise. As you hinge over you will feel a pull in the hamstrings, the back upper thigh muscles.

 

  • COMPENSATION: Avoid rounding the back as you lean your torso forward. Movement should primarily be at the hips. Don’t allow the knees to go forward past your toes with this exercise. Maintain the 3 points of contact during this exercise, (tail bone, mid-back, and back of the head).

 

Prehab Membership The Prehab Guys

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Hip Hinge – Hand Behind Back

Get set up standing with your hand resting behind your back in a comfortable position. Begin the exercise by performing a hip hinge followed by standing tall and reaching out and back behind you with the other arm. This exercise is a 2-for-1 movement, in which you are also improving the functional internal rotation of the shoulder by having the shoulder in a static position and moving from a differing joint in the body! It could be a good way to start acclimating yourself to IR movements if you have more symptoms with this movement.

READ: HOW TO PROGRESS LOWER BODY EXERCISES

How To Progress Lower Body Exercises The Prehab Guys

 

Closing Thoughts

The Big takeaway from this article is that learning how to perform hip dominant squats can help fix your knee pain with squatting! With that being said, it is NOT bad to squat with a more knee-dominant form, and there are many times when our knees must go past our toes with activities of daily living. However, if you are trying to work on your squatting mechanics and are having a difficult time with this activity, starting with more hip-dominant movements may allow you to continue this form of movement while avoiding knee pain! Eventually, when your body and your knees can handle it, you want to work into a strategy where the hips and knees hinge at the same time and it is an equal strategy and contribution from both areas!

 

Take Control of Your Knees On Your Own Terms

knee rehab fix squat the prehab guys

The knees are true hard nosed blue collar workers! They get the job done when the hips and ankles may be taking some extra rest breaks. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle.

 

About The Author

Arash Maghsoodi, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Marketing Officer

Arash Maghsoodi received his Doctorate in Physical Therapy from the University of Southern California. For his undergraduate studies, he attended San Diego State University and studied Kinesiology. After sustaining a career-ending ankle sprain while playing collegiate soccer, he realized how disabling and life-altering injuries can be. Arash currently resides in beautiful Santa Monica, California. His clinical experience is primarily in the orthopedic and sports setting. He has treated a wide variety of conditions ranging from the post-operative individual to the professional athlete. Arash is keeping the family legacy of becoming a physical therapist, as his mother is a practicing clinician of 30 years in the Orange County area.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Arash Maghsoodi PT, DPT, CSCS

2 Comments

  1. Anna October 15, 2018 at 8:20 pm

    Thank you guys, enjoyed the smiles in this one as well as the amazing content, thank you! Could you do some info on meniscus prehap/rehap please?

    • Michael Lau October 23, 2018 at 11:27 am

      We have a whole section on our exercise library devoted to meniscus prehab and rehab, check it out!

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