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How to Help Knee Pain with Lunges

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Jessica Bento, Physical Therapist (Co-Creator DVRT Restoration, Pelvic Control, & Shoulder Courses)

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Probably the number one thing I hear from my patients or clients when I first start working with them is they can’t lunge, they just can’t do it. When I ask why, they simply say because of pain. I will ask if they ever had knee surgery or an accident that involved injury to the knee and nope nothing, they just don’t lunge, never have lunged and don’t want to. They just know it’s going to hurt. This usually goes along with squatting as well but for the purpose of this write up we are talking about lunges.

Don’t get me wrong, there are some people that have a hard time lunging due to actual pathology occurring at the joint like OA or post surgical patients. Get this though, there really hasn’t been a person I worked with that I couldn’t get to lunge without pain. Maybe if I go back far enough there was one, ok maybe two, but generally those individuals that tell me they have never lunged without pain I get them to that point of pain free lunging. 

So what’s the secret? Well, lets go over three main things when it comes to lunging without knee pain. 

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1. Picking the right progression. You might be saying, “isn’t there just one type of lunge?” Nope! I see it all the time, people in the gym finding that long hallway or isle so they can grab their dumbbells and get to work on walking lunges. That’s typically what I see when it comes to lunges in the gym and people don’t realize that’s actually a rather advanced lunge when you break down. With the forward lunge your center of mass travels further over your base of support vs with a reverse or drop step lunge. Just give it a try, one feels easier than the other. So starting people with a forward lunge is not really the best place to start because it places way more stress, load, and need to deceleration strength on the body and knee.

It’s really about knowing where to begin with people. So if you are someone that has experienced knee pain in the past while performing lunges such as those walking lunges I was talking about, lets switch it up to a reverse lunge. Yes, there is lateral lunging, step down lunges, cross over lunges, you name it but again, you have to know where to start and people tend to jump through progressions too fast and don’t work on the foundations when it comes to lunging. 

Understanding what is the intent when we perform lunges is a big part of how we create great DVRT progressions for better lunges like you see above. 

2.  Cuing, this tends to be one of the biggest issues when it comes to coaching or teaching someone to lunge properly and it its one of the easiest fixes. I rarely see anyone cue the foot when it comes to lunging, and that is the most important area to cue in order to make that connection from the ground up. What do I mean? Simply cueing grip the ground with your foot will make a world of difference when it comes to the lunge, as well as pressing the ball of foot of the rear leg into the ground. A solid ground connection will improve the overall control of the knee joint.

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Understanding foundational concepts of the body are key. The Joint by Joint approach is a great example and you see the foot creates stability, ankle mobility, and knee stability, well what if the foot isn’t creating stability. People like to start at the hip, but even the hip is above and based on what the foot does. 

This is also where bands coming in handy, and I see it all too often people placing the band around the knee, either trying to stabilize or pull in a certain direction where they think that person might need assistance. The issue with this is that we are not engaging the right area, we need that foot to be active, and by doing so this will automatically stabilize that knee and get the areas to fire up. So instead of a band around the knee to pull into some sort of direct you think it needs to go to, lets place the band at the foot in order to get people to really become connected. 

3. Load: People that experience pain when lunging typically are afraid of adding any load to the movement. Load can be a great feedback tool as well as a way to make better connections with the entire body, as way to “turn on the core” in order to help stabilize the movement. What do I mean? You see it a lot not only in the squat but the lunge too, people just know how to move through space and need some sort of feedback to help stabilize, so starting a person with a reverse lunge while utilizing a suspension trainer is a great feedback took and can immediately decrease any discomfort. If we can hold onto something and not have knee pain, we know it is more about intent and control of the body that knee pain itself.

However, relying on external support doesn’t allow our nervous system to learn how to control our body as we move. So, such strategies either have a very short lifespan or should be more of an assessing tool.

Split Squats can be very useful in teaching progression and having people learn the value of using the feet and engaging the load they are holding with more purpose. We are loading people in their lunges with a very specific goal!

We can use load like I had mentioned to get that core to turn on more which inherently helps to stabilize a person as they move in to the lunge. We are fortunate to have in our DVRT is endless possibilities when it comes to how we load the body. The use of our core strap allows for use to have even more feedback upon the body as well as the multiple ways we can hold the Ultimate Sandbag.

So when working with anyone that tends to have knee pain make sure to go over these three key points, choosing the right lunge for the person, cuing the foot and ball of foot, utilizing load for better feedback. How well do these concepts work? Well, if you see the work the crew of Fitness Lying Down does with REAL people that have these challenges, it can be very inspiring.

Check out Jessica teaching our upcoming Northern California Restoration Certification HERE and save 25% all throughout DVRT for a few more days with code “holidaysale” HERE