Latest / The Driven Athlete / Knee Pain with Squats? Listen To This | Ep 45

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Knee Pain with Squats? Listen To This | Ep 45 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:16
  Speaker 1: I want to deep dive a little bit into the squat, okay, and specifically knee pain.
• 0:22
  Speaker 1: All right, so front kneecap, knee pain, patellar tendonitis those are all very common things that we find in our patients and athletic population active people, active adults that want to exercise and do squats and lunges and all that stuff.
• 0:39
  Speaker 1: And they have knee pain with squats, stairs, step-ups, bulgarian split squats, lunges totally very common.
• 0:46
  Speaker 1: So I don't want you to think you're alone with that and it can be solved.
• 0:49
  Speaker 1: It's a matter of diving and investigating what's causing the issue, right?
• 0:54
  Speaker 1: So, as fellowship-trained clinicians, what we have to investigate is what's the cause of that cause?
• 1:00
  Speaker 1: The cause of the pain is your patellar tendon or patellofemoral pain, as in, like your kneecap is getting irritated and lit up, or the tendon is getting overwhelmed and lit up totally.
• 1:10
  Speaker 1: But what caused that in the first place?
• 1:12
  Speaker 1: And that's what we have to intervene, investigate and ultimately tailor our plan of care around to fix the problem.
• 1:20
  Speaker 1: Otherwise it's just going to come back.
• 1:21
  Speaker 1: We're just resting and taking Advil and icing it and then getting back to what you're doing full go, and then it comes back again.
• 1:27
  Speaker 1: That's a rollercoaster we can avoid.
• 1:29
  Speaker 1: That's really frustrating.
• 1:29
  Speaker 1: I've been there.
• 1:30
  Speaker 1: But there is a solution.
• 1:31
  Speaker 1: We have to figure out what was the cause of that problem in the first place.
• 1:34
  Speaker 1: The underlying compensation patterns, ultimately right.
• 1:38
  Speaker 1: Disparities in strength or recruitment of muscle, recruitment activation or disparities in joint mobility and joint play and dispersing the forces equally and throughout equally as best as we can, or lack thereof causes compensation patterns.
• 1:50
  Speaker 1: Otherwise it's going to cause things to get lit up and that is a target that tells us what the story right.
• 1:56
  Speaker 1: So, as an example, knee pain with squats all right.
• 2:00
  Speaker 1: Something we have to really investigate is the ankle mobility all right Ankle range of motion into dorsiflexion, which is bending your ankle backwards or bending your ankle up towards the sky to ceiling.
• 2:09
  Speaker 1: Bend your ankle backwards in that direction.
• 2:11
  Speaker 1: Dorsiflexion is very important to allow your kneecap, your knee joint and your shin, your tibia, to advance forward without too putting too much shear and a lack thereof.
• 2:21
  Speaker 1: A person's usually what we find is active people the way to compensate if they're lacking pure ankle dorsiflexion range of motion, causing knee pain with squats is they rotate their feet outwards into external rotation.
• 2:32
  Speaker 1: So as they squat, they'll rotate their feet outwards, their toes point out and they come back up and they go back to neutral.
• 2:38
  Speaker 1: That just tells me that they're externally rotating their ankles and their shins on purpose to compensate for a lack of pure ankle dorsiflexion.
• 2:45
  Speaker 1: All right.
• 2:46
  Speaker 1: The other thing is they'll do is they'll heels will rise off the ground when they squat.
• 2:49
  Speaker 1: If they can't keep their heels flat when they squat and they're coming more, shifting their weight anteriorly or forward on their toes or their balls of their feet and their heels are rising as they squat at the bottom, that tells me they're lacking pure ankle dorsiflexion, all right.
• 3:01
  Speaker 1: So imagine someone you had both.
• 3:11
  Speaker 1: They actually rotate their toes and their heels come off as they go down and descend into a squat.
• 3:13
  Speaker 1: That tells me they're lacking pure ankle dorsiflexion range motion and that's a piece of the puzzle that illuminates why, alludes to why they're having knee pain.
• 3:17
  Speaker 1: Okay, so that's just something we got to think about.
• 3:20
  Speaker 1: Another very common thing with knee pain with squats is lacking posterior hip mobility, all right.
• 3:27
  Speaker 1: So towards the glutes, right.
• 3:28
  Speaker 1: It's not necessarily that glutes are tight, it's usually the hip capsule, the hip joint capsule, all right.
• 3:34
  Speaker 1: So every joint, every synovial joint, has a thin membrane called a capsule that encapsulates the joint.
• 3:40
  Speaker 1: For another layer of passive stability on the undersurface of that is a membrane called your synovium that produces synovial fluid and that helps with lubrication.
• 3:50
  Speaker 1: But that joint capsule can get stiff and with, uh, repetitive movements over and over again, like squats and running and everything, um, active people and athletes are the best compensators you can just get the job done right and that causes adaptations where some parts of the capsule, and the hip specifically, will get stiff and tight and other parts of the capsule get used to the mobility and gets more flexible and more open, right and loose, right.
• 4:17
  Speaker 1: So that allows the joint to flow and move in one certain direction more than the other and it drives it more in the same direction and usually anteriorly or forward is where the joint laxity and joint capsule laxity is, and posteriorly is where it's stiff.
• 4:34
  Speaker 1: So, just like water, joints take the path of least resistance right and it feeds more of the problem over and over again and that ultimately leads to compensation patterns, with squats as an example.
• 4:44
  Speaker 1: Okay, something that usually comes with that too is anterior hip pinching, like a hip impingement type symptoms with the bottom of the squat.
• 4:53
  Speaker 1: So with knee pain, it's very common that um, someone's lacking ankle dorsiflexion and also posterior hip capsule mobility.
• 5:00
  Speaker 1: So we have to intervene by mobilizing the posterior hip capsule, all right, getting that, that joint to posteriorly roll and move backwards better, to allow more freedom in the joint to move and not compensate by shifting the weight forward or the hip joint anteriorly or forward.
• 5:15
  Speaker 1: And if you add that in with a lack of ankle dorsiflexion, oh my gosh, it's a great recipe.
• 5:20
  Speaker 1: Where the ankles aren't moving well above the knee joint, the hip is not moving well.
• 5:25
  Speaker 1: What's the joint right in the middle that's going to take a lot of the stress and the brunt of the movement?
• 5:28
  Speaker 1: The knee.
• 5:29
  Speaker 1: And what's the joint right in the middle that's going to take a lot of the stress and the brunt of the movement?
• 5:32
  Speaker 1: The knee.
• 5:33
  Speaker 1: And what's the main muscle that's going to get activated with anterior shift and a lot of front shear pressure the quad and the patellar tendon.
• 5:36
  Speaker 1: What's the main thing?
• 5:38
  Speaker 1: We usually hear a lot with runners and jumpers and squatters and all that stuff Patellofemoral pain or patellar tendonitis, right Jumper's knee.
• 5:47
  Speaker 1: This makes sense.
• 5:47
  Speaker 1: The patellar tendon is the victim, not the problem.
• 5:50
  Speaker 1: So we're not going to treat the tendon.
• 5:52
  Speaker 1: The tendon's already lit up, it's already jacked up, it's already sensitive and lit up and the quad is already dominant.
• 5:59
  Speaker 1: Usually anterior dominance makes a lot of sense too, and they can't recruit their glutes because their hip capsule and their hip joint can't open up enough posteriorly to allow the hips and the glutes to be accessed.
• 6:09
  Speaker 1: So there's a lack of recruitment in the glutes, quad dominance, anterior shear on the knee cap and the knee joint, more pressure on the patellar tendon and a lack of ankle dorsiflexion.
• 6:21
  Speaker 1: That's a great recipe for knee pain and we see that all the time.
• 6:26
  Speaker 1: So, with that being said, hey, hope you could be fixed.
• 6:29
  Speaker 1: There is a solution and linking in these biomechanical faults and recruitment patterns, disparity, mobilities and muscle recruitment, movement patterns that we can fix and then wean back into aggressive activity and exercise again.
• 6:41
  Speaker 1: We can't jump in right away, right, it takes a little time to work on these things, but if we can, it takes a time to unlearn previous movement patterns, right, sometimes it's more difficult Actually take it back.
• 6:52
  Speaker 1: It's usually very difficult, more so than not to unlearn something than it is to learn something new the ingrained movement and recruitment neuromuscular movement coordination patterns that's been learned and ingrained for years is going to be challenging to unlearn and retrain something new.
• 7:09
  Speaker 1: So it takes a little time right Expectations coming into something like this what's like?
• 7:13
  Speaker 1: I want to finally fix my knee pain.
• 7:15
  Speaker 1: I've had knee pain for several months now and it sucks right, or like it's limiting my.
• 7:19
  Speaker 1: I can't progress like I want to and work out like I want to.
• 7:22
  Speaker 1: Right, it's a bummer.
• 7:24
  Speaker 1: I've been there totally.
• 7:25
  Speaker 1: I know exactly.
• 7:26
  Speaker 1: Nobody knew what was going on.
• 7:27
  Speaker 1: It's like man, I wish I had this when I was in college or high school.
• 7:31
  Speaker 1: You can figure this out right, because it makes sense and we've helped a ton of people resolve their knee pain with athletic activity and there is a solution, right, and as an example, this is a recipe that we find very common in anterior knee pain and knee issues, especially patellar tendonitis, patellofemoral pain.
• 7:51
  Speaker 1: This makes sense, right.
• 7:53
  Speaker 1: So there is a solution and there is hope.
• 7:56
  Speaker 1: We just got to intervene with the right things and we also have to investigate each person like why in the first place is this happening for you specifically, right?
• 8:05
  Speaker 1: We can't not cut corners.
• 8:07
  Speaker 1: We can't leave stones unturned.
• 8:09
  Speaker 1: We got to check out your moving patterns, like how your squat, what it looks like, why you're compensating.
• 8:14
  Speaker 1: Joint mobility, segmental mobility dysfunction, core stability, glute strength activation, ankle dorsiflexion, soft tissue restrictions in the calf, achilles and soleus All those things play a role.
• 8:24
  Speaker 1: That's part of the recipe and that's what we can investigate to really help people get back to like functioning at a high level and athletic activities Right.
• 8:32
  Speaker 1: So, um, there is hope.
• 8:34
  Speaker 1: We just got to check it out and then get to work, you know.
• 8:37
  Speaker 1: So if you're in that boat, we'd love to help you.
• 8:40
  Speaker 1: Don't hesitate to reach out.
• 8:41
  Speaker 1: Um, the best way to reach us is our email at team, at athlete rccom, or our phone number, five six,99-8725, and if you have any questions, don't hesitate to reach out.
• 8:52
  Speaker 1: We'd love to chat, help you, help active people, bring hope and restore hope that you can be active and functional again.
• 8:57
  Speaker 1: Versus like just don't run anymore, just don't squat anymore, it's bad for your joints.
• 9:00
  Speaker 1: It's like it's actually been fault, proven, all otherwise right, it's just a matter of not moving it and faulty moving.
• 9:06
  Speaker 1: Biomechanical patterns right, dispersing the load appropriately and also volume and intensity, totally.
• 9:11
  Speaker 1: But there is a solution versus just icing, resting, taking Advil or anti-inflammatories, steroid injections, again surgery, like we have to figure out why did it happen in the first place?
• 9:22
  Speaker 1: And the structural problems are just the victims and result because of the ultimate compensation patterns.
• 9:28
  Speaker 1: That's what we need to fix right, anyway, so don't hesitate to reach out Any opinions, comments, questions, concern ideas, conflicting opinions for the podcast.
• 9:37
  Speaker 1: I'm always open to having a discussion and don't hesitate to reach out for any questions.
• 9:42
  Speaker 1: Concerns especially knee pain with squats, and we'll catch y'all next time.