Chalk Talk #5 – Addressing Knee Pain

Knee pain is common in lifting, and it’s nearly 100% caused from a) poor mechanics and b) some sort of hip dysfunction. This Chalk Talk doesn’t get into lifting or movement mechanics, but instead addresses some palliative treatment and soft tissue work you can do to alleviate some of the pain.

Generally speaking, knee pain should tell you to work on hip mobility, especially with the rectus femoris. This muscle crosses both the hip and the knee, so if it’s tight, it’ll tug on it’s lower attachment near the knee (i.e. all of the quadriceps flow into a common tendon that attaches to the patella, which then attaches to the tibial tuberosity) and cause pain in the center of the knee, usually under the knee cap.

One thing we can do to try and alleviate tension is soft tissue work on the rectus femoris itself, and then on some of the other quad muscles.

Note that this precision soft tissue work works well when it occurs before stretching; it’s difficult to stretch a muscle that hasn’t had tension worked out of it. I like to follow this soft tissue work with the couch stretch, like in this video.

Lessons From McGill

Dr. McGill also has an admirable mustache

Dr. McGill also has an admirable mustache

Dr. Stuart McGill is a professor of spine biomechanics in the kinesiology department at the University of Waterloo and is renown as being an expert on back health. According to his academic profile, his department is concerned with (my paraphrasing) a) understand how the low back functions, b) understand how it gets injured, and c) create prehab and rehab methods based on their findings.

McGill is an expert with a variety of textbooks used in academia as well as folks in the fitness or strength and conditioning fields. This .pdf titled “Designing Back Exercise: from Rehabilitation to Enhancing Performance” from his website provides a collection of useful information. Points of emphasis in the article include:

- A proper history taking of a client
- Analyzing a client’s movement and determining faults (pg 4-5)
- A sequence of events for rehab (pg 6)
- The “big 3″ stabilization exercises (pg 7)
- And developing athletic ability (pg 9)

McGill’s work is logical, easy, and effective. It has made me consider the importance of proper spinal function and positioning in lifting and athletics, and I’ve implemented them in my coaching in barbell mechanics. You’ve probably seen recent videos where I keep referring to a “strong, stable trunk” with an emphasis on “contracting the lower abs”, and I now teach it as a fundamental concept for barbell training.

Proper spinal mechanics in all movements is vital in order to prevent unnecessary injuries. I pay close attention to how trainees and athletes move, sit, stand, and lift, but in the past I have not put as much of a focus on “active spinal awareness”, which is basically making a concerted effort to align the trunk properly.

What does this mean for lifters? CrossFitters? Strength and conditioning athletes? It means that by utilizing contraction in the lower abs during lifts, we can maintain a neutral relationship between the trunk and the pelvis. If that relationship changes via too much lumbar extension or flexion, anterior or posterior pelvic tilt, or other instability, then it can at best not transmit force effectively and at worst result in an injury. It also means using spinal stabilization exercises in order to create endurance and habit for good spinal position.

Dr. McGill’s “big three” exercises can train help train this endurance and habit. In this video, he talks about four total exercises — the curl up variation, the bird dog, the side plank, and a moving plank on a ball. I know what you’re thinking: it looks like silly conventional fitness crap. These exercises aren’t supposed to build back strength, but instead they increase endurance in the back’s postural muscles so they can maintain a good, neutral position. The key to these movements is proper position, then endurance. They also teach the “skill”, or motor program, of what a correct spinal position is. Most people are in a perpetual state of instability with their spine; sitting in flexion or standing in hyperlordosis, for example. Ideally the trainee would work on their posture throughout the day in congruence with these prehab/rehab exercises, and they would improve their spine’s default position.

A for effort, but this spinal position is problematic.

A for effort, but this spinal position is problematic.

Given the increasing participants we have in lifting, CrossFit, powerlifting, Olympic weightlifting, and other related activities, there will always be injuries, particularly in the lower back and sacral area. Usually these injuries can be prevented with better awareness, coaching, and physical preparedness. By using the “big three” exercises in a warm-up and/or cool-down in training, trainees can be taught what is “correct” and self-diagnose what is “wrong”. Compliment it with improved coaching of the barbell lifts and it’s possible to prevent injuries, or at least the severity.

Give these movements a try in your training. Don’t expect them to have immediate impact, but look for long-term improvement. Start being self aware of what your trunk and pelvis are doing throughout the day, especially when lifting.

PR Friday – 22 AUG 2014

PR Friday — Post your training updates, PR’s, and questions to the comments and the 70′s Big crew will respond. 

Weekly Q&A gives you a chance to ask anyone from the 70′s Big Crew a question in the comments below, on Facebook, or Twitter. Follow 70′s Big on Instagram

Recap: On Monday I introduced Category Programming, a method that works well for very busy or beat down trainees like SOF personnel. Chalk Talk #4 came out on Wednesday, and it focuses on actively contracting the lower abs to stabilize the trunk while pressing.

Here’s a video that talks about Usain Bolt’s difficult training regime. He says that race day is the fun part, but all the hard work is miserable. His own dad even says he can’t go to his practices anymore because he doesn’t like to watch him suffer.

Being a professional athlete isn’t the same as our training. Bolt dedicates his life to that one moment in which he displays his prowess on the track. There’s nothing corny in Bolt’s presentation. It’s simple and brutal: being great is a trying, vomitous affair that makes you want to quit every step of the way. Anything good or successful in life demands the same.

What do you think is the worst part about training? Pushing through a set? Doing mobility work? Eating right? 

Chalk Talk #4 – Trunk Stability When Pressing

The press is a fantastic exercise because it integrates the entire body and creates the largest kinetic chain exercise; everything from the feet articulating with the ground to the hands holding the bar overhead. It’s a significant trunk builder, but press mechanics and strength are better expressed when the trunk is purposely contracted and tightened.

In this video you’ll see an example of a press without trunk tightness followed by reps where an emphasis is placed on tightness.

There’s something I cued her to on a few days later that made an additional impact: I cued contraction of the quadriceps after explaining the importance of making the entire body stable. If the quadriceps have tension, it will prevent the knees from unlocking. If the knees unlock as the press rebounds out of the bottom, the lifter loses some of that force application in the soft, unstable knees. Maintaining quadriceps tension prevents that force loss, but also helps provide a very strong, stable base to press from. Contracting the quadriceps with the entire trunk (with an emphasis on the lower abs) made Aly’s reps much faster and easier, even compared to the final reps in the above video.

Note that this emphasis on trunk stability via tightness and keeping tension on all relevant joints and muscles should be applied into every lift.

Category Programming

Some times life gets in the way of training. Whether it’s a surprise work project, family issues, or forced physical activity, it can throw off a well-intentioned strength program. The best way to mitigate the damage is by trying to hit the most important lifts the way the program wanted (i.e. getting a bit of volume if it was supposed to be a volume day). This might mean performing an abbreviated training session by cutting some exercises. Other options include removing a whole training day, shifting the entire week forward or backward a day, or having some light or medium sessions before getting back into heavy training.

But there are some of you out there that can’t even commit to a regular template because your schedule is so erratic — like parents with a newborn baby, shift workers, nurses, fire fighters, police officers, and military personnel. I see this the most in special operations guys; training, missions, or scheduled physical training will interfere with training templates.

The following is what I like to program for these populations — especially SOF guys — that need to tack quality strength training onto their demanding schedule.

Categories

There are three or four categories that will comprise a strength training session. There is the Main Lift, a Pressing Movement, Assistance Work (or Pulling Movement), and a Trunk Builder. The trainee will pick one exercise from each category for a given session. The more deficient a trainee is in a given area of strength or muscular balance, the more they should emphasize that weakness in their week.

Deadlifts don't have to be back breaking to be effective

Deadlifts don’t have to be back breaking to be effective

Having categories allows the trainee to pick what exercises they can do based on what other stress they have had to endure in the week. For example, if there has been a lot of pounding on the knees via running or rucking, then squatting or cleans may not be desirable and will only limit recovery. Instead, that trainee may choose to do medium deadlifts.

Also, each session doesn’t have to be “balls to the wall”. Even doing a light or medium session with basic barbell exercises will maintain or build strength, muscularity, and prevent injuries. Hard charging athletes and SOF guys typically need to be taught the concept of rest or lower stress training.

The category method is essentially an organized autoregulation of strength training. It still provides a good systemic stress and if two or three sessions are preformed a week, then strength can be maintained or built on top of a rigorous schedule.

Main Lifts include squat, deadlift, power clean and jerk, and front squat.

Presses include press, bench press, and push press.

Assistance Work includes pull-ups, chin-ups, barbell rows, and RDLs.

Trunk Builders include side planks, Turkish get-ups, and spinal stabilization exercises (e.g. Stuart McGill stuff).

Note the exercises are all compound movements that work lots of joints and musculature. If you have limited time to strength train — as SOF personnel often do — then make the most of that time with movements that use large muscles that take the major joints through a full range of motion. Prehab/Rehab and Mobility work is not included here as it should be a separate, yet consistent, element in a training program.


Mike uses front squats in his program to build his squat and stone lifting strength. 


The trainee can vary the above exercises (i.e. they can perform cleans by themselves or clean and jerks instead of the power variation), but exercises don’t need to be cute. Chains, bands, or weird-ass partial movements are unnecessary for most athletes. Once a good strength base has been established (in the barbell lifts as well as balanced musculature), training can shift into more explosive or speed training to maximize the strength-to-weight ratio, but most athletes and SOF guys are in a perpetual state of being beaten down and recovering that a shift in training usually isn’t necessary.

Generally the Main Lifts and Presses are done for three sets of three to five reps whereas Assistance Work is done for three to five sets of five to ten reps. Certain exercises will require a different set and rep scheme – like deadlifts, clean and jerks, power cleans, and Turkish Get-Ups — but their inclusion is more important than their rep schemes.

I keep referencing SOF guys because I made this template when programming for them, but this can work for any person who has a crazy schedule or simply wants more freedom and variation in their program. If you’re busy or getting beaten down throughout the week, try this Category Method of programming and choose exercises you want to focus on for a couple of months. Even if your schedule isn’t crazy, this type of programming may give you some stimulating variety in your training yet still focus on a handful of lifts you want to improve on.

This kind of template will allow someone to be consistent in their training regardless of what else is going on in their life. And with strength and muscularity, consistency is the first step to success.