Why Knee Pain Gets Worse With Lunges And How To Ease It

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

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Why knee pain gets worse with lunges and how to ease it

Knee pain while performing lunges is very common and every day in the clinic I hear people say that performing lunges aggravates their knees. 

I find my patients either:

1. Push through the pain and keep going with them, ending up with an injury or

2. Stop doing them altogether and miss out on the many benefits lunges can bring.

In this post, I will show you how performing lunges can place excessive stress on the knee and a give you a simple way to avoid this from happening. 

What happens during a typical lunge?

See the picture above where the front knee travels along way forward past the ankle.

This is not a problem if you don't have knee pain. 

BUT, if you do have knee issues, there is a high chance this movement will aggravate your pain.

Doing a forward lunge in this manner plays into a common muscle imbalance that many of us suffer from - over-active quadriceps and hip flexors at the expense of the gluteals. 

Walking lunges are particularly bad at encouraging this quads dominance, as the center of gravity is traveling in forwards direction.

Quick anatomy review:

The hip flexors (left) that attach the lower back to the hip and the quads (right) that attach the hip to the knee. 

The effect of over-loaded quads:

Due to the fact that we are sitting, driving and walking a lot, our quads and hip flexors are naturally prone to tightness and overuse. 

Adding further stress in the form of lunges can push them over the edge.

When a muscle is repeatedly contracted in a shortened position, eventually this will lead to development of knots or trigger points in the muscles fibers. 

This reduces the flexibility in the muscle and also gives rise to referred pain, that often is felt in the knee.

Referral pattern of the quads:

When the quads develop trigger points (knots in the muscle fibers) they have a characteristic referral pattern. 

See below:

So....instead of the forwards lunge, try this simple but powerful change:

The Reverse Lunge

To obtain the benefits of a lunge, without putting your knees at risk, follow these 3 steps:

Step 1:

Maintain a neutral spine (think gently tucking the pelvis under and activating the core muscles) and then taking a big step back. 

You should feel a gentle stretch in the front of the leg that steps back (upper quads and hip flexors). 

Tip > you can use a foam roller to counter balance the backwards motion.

Step 2:

The key to the reverse lunge is maintaining a vertical tibia in the front leg.

At the bottom of your reverse lunge, take a quick look at your tibia bone (lower leg from knee to ankle) and it should be in a vertical position i.e. perpendicular to the ground. 

Keep your center of gravity back and over your hips. 

In this position, your glutes should be activating strongly.  The quads should also be working, but not excessively. 

The nice thing about the reverse lunge is that if you push back to far, you will only work the glutes harder, which is never a bad thing.

Progression: Reverse Lunge with medicine ball

Step 3:

Push yourself back up to the start position using your glutes to lift yourself forwards.

If you can do ten on each side without much trouble, adding some weight in the form of a medicine ball or kettlebell is a great idea. 

Aim to complete three rounds.

Between sets you can do some bridges or step ups which will also target the gluteal muscles.

If you're sore in the glutes the next day, you know that you're on the right track!

Please have a go and let me know how you get on in the comments below.

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5 Tips To Help You Recover Faster

When planning our athletic goals, so much time is dedicated to developing the correct training plan that we often forget to schedule in time for adequate recovery.  

What you do in the first 24-48 hours after your hard sessions can either assist your recovery or slow it down, so it makes sense to devote some time to getting it right.

Here are my Top 5 Tips:

1.  Hydrate.  Get your recovery off to a flying start by hydrating with water as soon as you're done exercising.  If you've sweated, it's best to add an electrolyte supplement.  I personally use nuun as it is sugar free. 

2.  Foam Roll.  Using a foam roller for a few minutes after your hard sessions has been proven to reduce soreness.  Roll over the major muscle groups such as the quads, ITB, calf, hamstrings and addcutors.  And be prepared for a bit of discomfort, just keep breathing and think of then many benefits!  Grab your free foam roller e-book here.

3.  Move.  Walking and doing some light core Pilates exercises will help promote blood flow through your muscles and help flush out the lactic acid. Getting oxygen through your muscles will promote recovery.  

4.  Stretch.  A gentle, restorative Yoga practice will help maintain the suppleness in your tissues.  This will avoid a gradual build up of tension and make foam rolling less uncomfortable :-)  Check out some yoga studios we recommend here.

5.  Breathe.  Spending 5 minutes focusing on deep diaphragm breathing after exercise will activate the para-sympathetic nervous system that's responsible for the healing process in your body.  Try putting your feet up on a chair so you can completely relax.  

Want to learn more?

Dan will be teaching a special 4 Week Ready to Run Workshops series starting October Saturday 8th 2016 at Power Living Yoga.  Please click here for more details.

3 Keys To Usain Bolt's Success

Usain Bolt is one of the fastest athletes the world has ever known.  His success at the Rio Olympics is reinforcing his legendary success and his consistency proves he is worthy of greatness.

Having read his autobiography recently, Faster than Lightning: My Autobiography I wanted to share with you a few points about what has lead to his amazing success:

1.  Good foundation

When he was a kid growing up, Bolt was always on the move, running around, exploring his environment in the Jamaican back country. 

In his book, he states he was a hyperactive child, and his parents were so worried about him they took him to see a doctor!  His incredible movement literacy developed at an early age. 

Bolt writes, "There was always somewhere to play, always somewhere to run and always something to climb.  The woods delivered an exercise program suitable for any wannabe sprinter, with clearings to play in and assault courses made from broken coconut trees."

“Forget sitting around all day playing computer games like some kids do now; I loved to be outside, chasing around exploring and running barefoot as fast as I could””

Complimenting all of this physical activity was a diet high in fruits and vegetables - that he would often eat straight from the tree.  "I never went hungry because it was a farming community and we lived off whatever grew in the area, which was a lot.  There were yams, bananas, coca, coconut, berries, cane, jelly trees, mangoes, oranges, guava.  Everything grew in and around the backyard."

2.  Bounces back from injuries

Injuries were a constant battle for him.  Early in his career, his doctor diagnosed him with scoliosis of the spine.  He was prescribed daily physiotherapy stretches and worked with a masseuse to help correct his posture - sometimes even before and after his training sessions. 

He also had numerous injuries to his hamstrings, very common for a sprinter, and had to go through lengthy physio and rehabilitation to get him back on track.  As part of his conditioning, he spent a lot of time working on his core - up to 700 sit-ups per day!

““If I was going to be a top runner, my core muscles had to be strong so I could generate serious power in my legs as I burned around the track. But doing them was tough.””

Bolt found a way to seek the positive from his injuries.  He writes, "There's something the training manuals don't tell an athlete about injuries in track and field: they're about self-discovery as well as recovery; learning the mind is as important as understanding the body.  Pain thresholds, patience and inner strength are things that's can't be found in a running magazine."

3.  Doesn't take himself too seriously

Usain Bolt seems to have perfected the balance of the professional demands of an elite athlete with a real sense of play.  He loves his fast cars, dancing and knows how to have a good time.  Supreme confidence in his training and his body leads Bolt into a relaxed state of mind that helps him get into the zone.

Here's Usain dancing to the Proclaimers at a race meet:

His balanced approach also extends to his diet - he doesn't follow any strict dietary practices and has a weakness for chicken nuggets. 

He writes, at the Beijing Olympics he didn't like any of the local food.  "At first I ate a box of 20 for lunch, then another for dinner.  The next day I had two boxes for breakfast, one for lunch and then another couple in the evening, I even grabbed some fries and an apple pie to go with it.  By the times the games ended, I must have eaten around 1,000 chunks of chicken. 

“Man, I should have got a gold medal for all that chowing down.” ”

One of his team mates eventually introduced him to 'Thousand Island' dressing that he added to salads to balance things out a bit.

Factors that Can Affect your Performance

Perpetuating Factors That Can Affect Your Performance

If it feels like you've always got tension and tightness in your muscles, you might need to look at some perpetuating factors.

Two common things I see in the clinic that delay the healing process are and contribute to excessive muscular tension are:

- dehydration &

- borderline anemia

Hydration:

If you an older adult, sweat a lot, have a chronic illness or are an endurance athlete you are at greater risk of becoming dehydrated.

Symptoms of dehydration include:

• headache

• tiredness

• dark coloured urine

• constipation

• dizziness

• muscle tenderness

• dry skin

• irritability

• inability to concentrate

How to stay hydrated?

Staying hydrated is NOT about just drinking enough plain water.

Although water is very important, if you are dehydrated, the most critical thing is restoring the electrolyte balance.

To replace electrolytes I don't recommend Gatorade which is full of sugar. Instead try Hydralyte* from the chemist that has the perfect balance of electrolytes that will re-hydrate you very quickly.  Hydralyte is a good option if you are medically unwell and suffering dehydration.  Unfortunately Hydralyte still contains sugar.

Another option, (for athletes and otherwise healthy people) is Nuun* electrolyte tablets.

These are completely sugar free but still contain all of the important electrolytes such as potassium, sodium, calcium and magnesium that are essential for muscle function and recovery.

You can find these online or ask for a sample next time you are in the clinic. 

Personally I find Nuun the perfect portable hydration solution, especially for athletes who want to recover faster after training and competition.  If I have exercised for more than one hour, I will take one Nuun tablet with 500ml of water when I finish. 

Another source of electrolytes is found in coconut water that is very high in potassium.

*Please check with your doctor before taking any supplements, particularly if you have high blood pressure.

Anemia:

If you are an athlete (especially runners), vegetarian/vegan, pregnant, menstruating, have a chronic illness, have ulcers, suffer inflammatory bowel disease or donate blood regularly or take anti-inflammatory medication you are a greater risk of developing anemia. 

Anemia can interrupt the function of the muscular system, as well as the immune system putting your body under a great deal of stress.  Anemia commonly goes under diagnosed.

Symptoms of anemia are:

• fatigue

• headaches

• shortness of breath

• pale skin

• weakness and muscle pain

• dizziness

• heart palpitations

• tinnitus

• feeling itchy

• irritability

How to prevent anemia?

If the anemia is due to iron deficiency, have your ferritin levels checked. If it is due to Vitamin B12 deficiency you will need to try obtain greater amounts through your diet or supplements.

The highest know sources of iron are from clams, oysters, beef, chicken, eggs, grains, nuts and spinach.  If you would like more information from a qualified nutritionist please click here.

Summary

Addressing these two important factors will improve your recovery and most importantly keep you moving your best!

If you feel like you might be suffering from these two conditions, please talk with your primary health care provider. 

And don't forget to ask for a free sample of Nuun when you're next in the clinic.

Please let me know how YOU like to stay hydrated in the comments below...

5 Things Your Physio Does That May Surprise You

1.  Chronic disease management through Medicare

Physiotherapists are trained to assess and treat people suffering from chronic health conditions such as diabetes, arthritis and chronic pain.  Physios focus on optimising movement to ensure independence.  Medicare will refund $50.95 for up to 5 services per calendar year under the Enhanced Primary Care Initiative.  To be eligible for this benefit, you will require a referral from your GP. 

2. Stress relief

Check out this great TED talk that discusses the links between posture and mood.

Many people suffering increased stress would benefit from an assessment by a Physiotherapist.   We know that a lot of us carry stress and tension in the neck and shoulders.  This can be aggravated by poor posture and sitting behind a computer all day.

Physios can show you specific breathing exercises, provide massage and dry needling to tight muscles and prescribe specific exercises to improve posture.  When your posture is good and you feel pain-free and confident, your resilience to stress is increased dramatically.  Make a booking with us here.

3.  Weight loss

We see many people with great intentions to lose weight.  Early on, the motivation is high, and often there is a tendency to push the body past its physical limitations.  Unfortunately, this normally ends in pain and injury. 

If you are hoping to lose weight, we would love you to come in for a screening assessment.  We can help you keep your body safe and healthy while you embark on your weight loss journey.  Prevention is better (& cheaper) than cure!

4.  Running assessment

Are you trying to get back into running and things aren't quite feeling right?  Or maybe you are trying to reach a new PB?  A Running Assessment could be just the thing needed to help identity inefficiencies in your running.  We can help you minimise the risk of injury and achieve your potential as a runner.  Book online here.

5.  Save up to $150 yer year on exercise classes with a Physio referral

If you have health insurance, did you know you can claim approximately $150 per year for 'health improvement benefits'?

This includes activities such as Yoga, Pilates, gym, personal training, swimming classes e.t.c.

A Health Improvement Form needs to be filled out by your Physio or GP to show that a specific health condition will be improved.

For more details, please ask us at your next session :)