Why Social Media Advice Is Failing Your Knee Pain

This past weekend I was so fortunate, I had the opportunity to present twice at the prestigious National Strength & Conditioning Association national conference and then head out to Long Beach for the always great Perform Better summit. At both of these events I really wanted to help people filter the often confusing information that social media feeds and provide some actual evidence based strategies that can be so impactful. 

My knee presentation at the Perform Better summit was personally one of my favorites because I got to address all the common, but often misdirected concepts that social media puts out that only causes confusion. 

Like what? 

“Your quads are weak!”

Well, when you have a painful knee, your quads can absolutely appear weak. However, so do most muscles that impact the area. Why? This is known as the strength inhibition theory which says, “the phenomenon where pain reduces muscle strength and force production. This occurs due to a protective mechanism where the nervous system inhibits muscle activation to prevent further injury. The inhibition is often triggered by nociceptors (pain receptors) and can affect muscle strength even with minor injuries.

So, yes, your quads may seem weak because your knee is pain, but two things to remember. The first is that pretty much most muscles are going to appear weak so is there a need to prioritize the quads more than any other muscle? (Spoiler alert, no)

 It is more about progressions than it is individual muscles. 

The other point is that we don’t know the strength of the quads (or any muscle), before the injury took place and can’t say weakness now is the cause of the injury in the first place. 

“You have to put your knees over your toes and stress the patellar ligament”

While I subscribe to the idea that for certain people putting your knees over your toes is fine, the act itself has less to do with the functioning of the knee and other important structures around the knee. For example, in order to put your knees over your toes safely you have to possess good ankle and hip mobility, both are important for overall knee health. This means the ability to put your knees over your toes is probably a better indicator of the mobility of other structures that influence the knee than the knee itself. 

The other part of knees over toes is typically the idea that you need to stress the patellar ligament. Well, first, it is important that research that looked at decline, or wedge, squats for knee pain specifically looked at patellar tendinopathy, not ACL, meniscus, osteoarthritis, or other knee issues. So, if you aren’t diagnosed with patellar tendinopathy and try to use these strategies for you knee pain, then we have no idea if it will be effective at all. 

You are still intrigued though to try it? Well, I would like to let people know that there is no evidence that doing double legged squats in any form on a wedge helps problematic knees. The protocol that was studies was single leg, with much less load than most think, and to a much smaller range of motion than most think of performing. Maybe MOST importantly, all the research comments how this is often a painful technique. 

After all that, you might still be willing to try, but before you do have you looked at research that compared doing such wedge squats against just a pretty typical strength training program? Well, we have such research! 

This study (PMID: 19793213) found that just a basic (back squat, leg press, and hack squat) lower body workout was more effective than corticosteroids and the wedge squat plus it causes less pain and has higher rates of collagen turnover in the knee. 

“Jessica, why do so many people say it works then?” 

Hard to say as there a bunch of reasons. For one, in many of these programs there is much more of an emphasis on single leg work that can help many knee stability issues, there is a heavy emphasis on grounding with the feet (this too is impactful to the health of the feet). There are more reasons, but there is also the simple fact that if someone believes something is effective then it is more likely to be so. 

Yes, placebo is very real and can have upwards of a 50% reduction in someone’s pain of any kind. That means, just believing that you are doing something that will help may have a big impact on the pain you experience. 

Instead, it is probably more helpful to use evidence based strategies (like I show below) that we will dive deeper into in upcoming posts. 

If you don’t want to wait, dive into the great solutions that Jessica offers in her DVRT Rx programs that are 35% off right now HERE with code “corrective”