Contributed by Coach Becky
“I can’t squat. I have bad knees!”
What exactly does “bad knees” mean? Well in my experience in both a rehabilitation and exercise setting, it usually all boils down to the same thing: muscle imbalances.
There are several structures that make up your knee. First, you have the bones: femur (upper thigh), tibia (inside lower leg), and fibula (outside lower leg). They are joined together by four ligaments: ACL (front to back), PCL (back to front), MCL (inside), and LCL (outside). Then you have the muscles that surround your knee joint: quadriceps (in front), adductors (inside), hamstrings and calves (in back), and TFL, IT band, and glute min/med (outside). You have a meniscus and bursa sacs that provide extra cushioning, along with your patella (kneecap) and the patellar tendon that it is attached to.
When all the pieces of the knee are working well together, you can squat and lunge and jump without any problems. However, when one of those pieces begins to fail, things start to do downhill and then the “bad knees” develop. Here is an example of what I will typically find in someone complaining of bad knees: The VMO (inside quad muscle) is not firing very well or even at all + the IT Band and lateral quad muscles are shortened (too tight).
These two things alone result in your patella being pulled toward the outside every time you squat, lunge, or even walk. Over time, this lateral tracking of your patella will create too much inflammation in your patellar tendon (because its no longer fitting into the grove it was meant to), and you will begin to have pain and tenderness in the front of your knee. This problem can be even worse if your glute med/min aren’t firing well. If you ever notice your knees falling inward while you squat, then chances are those lateral glute muscles aren’t doing their job. This creates even more inflammation in the knee joint, and it can begin to affect the other structures and lead to further problems. Throw in weak hamstrings and tight calves and you can see where this whole “bad knee” thing comes from.
So the next question is how do you fix it? Well the simple answer is this: squat more! Yes I said it, SQUAT. But you can’t…you have bad knees, right? Wrong. You can squat, you just may have to do some mobility first. Getting on a foam roll or lacrosse ball for your IT band and lateral quad will help to loosen up those muscles. Once they begin to loosen up, it won’t pull so much on your patella. Next up are the squats. Squatting helps build up strength in your quads, hamstrings, and glutes. If you focus on good form, it will also help create some muscle memory patterns that will get the right muscles to turn on when you need them. It won’t happen overnight, but I promise with a little effort, you can literally move past your bad knees and squat until your hearts content.
Need help getting started? Check out my mobility and recovery class Thursdays at 7:30 p.m. and Saturdays at 8 a.m. I go through a variety of techniques and exercises designed to correct common muscles imbalances, such as the ones creating your “bad knees.” Questions? Email firstname.lastname@example.org.