Step ups and downs are amazingly simple, yet truly effective in lower extremity rehab. Adding variability to the classic step ups and downs is key to movement proficiency and developing a well-rounded athlete. Have you tried these step up variations before?!
Proper Step Ups and Down
Step ups and step downs are both amazing exercises for prehab and rehab purposes alike. But in order to truly maximize your gainz in the gym or clinic, you need to perform them correctly!! Yes, stepping up and down off an extremely tall box looks impressive and all, but can you actually control it? Unless your goal is to get in some cardio, you need to really focus on form and control in the step up and down.
First, don’t blaze through it; focus on an extremely slow and controlled descent (eccentric control). Your knee should never collapse and be medial to the ankle (unless doing a transverse step down which we’ll talk about later). You should feel the burn in your glutes and quads as you try and stabilize your pelvis during the descent. Developing eccentric control is crucial, especially for quadriceps or patellar tendinopathy prehab.
Second, only use a box height that you can control. You should be able to control the descent throughout the entire range of motion. Most of the time, you’ll find that you can control the descent initially, but as the quad demand increases (as knee flexion angle increases), you’ll lose the control of the descent. If you can’t control the end range of the descent, you’re using a box that is too high!
Finally, don’t cheat and push off with the opposite leg! The leg on the box should be doing all the work, both raising (concentric) and lowering (eccentric). Don’t push off the ground with that back leg!
Step Downs: What’s The Difference Between Going Forward? Sideways? Backwards?
Step downs are a stable in my lower extremity rehab progressions and for good reason. You can isolate/bias one leg without any “cheating” using the other leg like on squats, deadlifts, or lunge variations. Furthermore, depending on which direction ie forward, sideways, backwards the step down is, you can preferentially bias either the glutes or the quads, or work around people’s mobility constraints like ankle dorsiflexion.
It all comes down to simple biomechanics and lever arms – if you know your biomechanics you know movement.
If you want to:
Target the knee ⬆️go with anterior step downs
Target the hip ➡️go with lateral or ⬇️posterior step downs
⬇️Posterior step downs. With knee patients, I will typically start with posterior step downs as the demand is less on the knee and more on the hip. The trunk will flex forward naturally to keep your center of mass on the box, thus utilizing the glutes/hip more in addition to shortening the lever arm on the knee. For hip patients, this is a good starting place as well.
➡️Lateral Step Downs. Due to the step down occurring more in the frontal plane than the sagittal plane, this exercise will place more demand on the hip ABductors. The big keys here are to ensure your hips stay level and do no drop. Imagine wearing a belt and keeping it straight the entire time. Furthermore, do not reach to the ground. Lower yourself. Love using this for both hip and knee patients.
⬆️Anterior Step Downs. Opposite of the posterior step down, the trunk has to stay more upright to keep the center of mass on the box. Furthermore, there will be more anterior knee translation as well as ankle dorsiflexion required with this variation. Thus, this is a more advanced progression for knee patients. And YES, I want the knee to translate forward past the toes here as we need to build tissue resilience and load tolerance. For someone with ankle mobility deficits, I often program in some sort of anterior reaches ie an anterior step down to load the ankle into dorsiflexion after mobilizing it.
Cross Over Lateral Step Up
A recent systematic review by Macadam et al in 2015 highlighted cross over lateral step ups. They found that the cross over lateral step up produced one of the highest Gluteus Maximus muscle activity (103 +/- 63.6%) in their review. Some things to note in this exercise is that it does require a lot of gluteus medius activity as well, as you must be able to maintain good pelvis and knee stability. The elevated femur starts in a relatively adducted and internally rotated position and moves into abduction and external rotation. So we’re also adding a frontal and transverse plane component to the normally sagittal plane step up/down. All the same guidelines apply to cross over lateral step ups as the normal step ups/downs that we highlighted above.
Control the descent all the way to the ground!
Work on that eccentric control. If you’re having a difficult time controlling the descent, try a lower box. Man, all those IG girls really knew what they were doing!!
Do you like these variations? Check out our Exercise Libray with over 900 exercises!
Curtsey + Transverse Step Ups
Whether or not you agree with me on this post is okay – you’re entitled to your own opinion.
The notion that knee valgus is always bad must be put to rest and here’s why:
Yes, knee valgus is one of the more common positions of an ACL injury and during early rehab for an ACL, it’s probably best to avoid a valgus position and teach your patient “ideal” lower extremity alignment. But once they’re out of early rehab and in a more strength and conditioning focused program, teaching the patient to control knee valgus is an absolute must. It is a position that they will undoubtedly find themselves in during competition, no matter how well-trained they are in their cutting mechanics. Therefore, it is imperative to teach them to get IN and OUT of a knee valgus position with control.
While there are tons of ways to train this, some of my favorite exercises are curtsey lunges and transverse step up/downs. The curtsey lunge involves dynamically coming in and out of hip internal rotation and adduction. Learning to control the pelvic drop on top of the femur during the curtsey lunge is something that is imperative for advanced athletic movements. The transverse step up should start with pure hip rotation and minimize any transverse loads on the knee. Similar to the curtsey lunge, we are controlling the pelvis on top of the femur. I believe you can load this pattern, but when it comes to actually encouraging valgus in the step down, I believe this should only be done unloaded.
Teach your patient proper lower extremity alignment and cutting tasks, but also teach them how to move in and out of valgus as it’s a position they will 100% find themselves in during competition. Your job as a rehab specialist is to prepare the athlete for any demands they might find themselves in on the field.
Yoak Step Ups
If you want to challenge your balance, you need to add demands to the task that decrease your stability. Perturbations are an effective way to add instability to your exercise. Perturbations are awesome because they provide constant variability. Research has shown the variability of practice can lead to greater skill acquisition and retention. A perfect example of this is golf – it gets easier to hit the same shot after practicing with the same club over and over at the range. However, it becomes more difficult on the course when you change clubs, shot angles, and distances. I really like using the yoak with a step up exercise to add another dimension to the balance demands. Hikers can definitely appreciate this exercise and should add it to their training!
Quick tips for doing this exercise :
- The faster you move through the step up and step down, the greater the perturbation
- If this exercise gets easy, make it harder and speed things up!
- This exercise is meant to challenge your balance! You can only learn by adjusting your performance when it is challenged! As you can see, I even lose my balance!
Looking for more exercises or variations? Check out our Exercise Libray with over 900 exercises!