How to train around knee pain/injury

How to train around knee pain/injury?

Most bodybuilders have experienced knee pain at some point in their journey; personally, it’s something I’ve had to deal with frequently over the years, but I’ve always found a way to train around the pain and still grow my legs. Given my first-hand experience, I’d like to use this article to discuss ways in which you could adapt your training around knee pain, and lay out some of the considerations you might need to make within your program.

Obviously, if you do have some sort of pain then please go and get it checked out by a professional such as a physiotherapist or sports therapist. They will be able to help you identify the source of what’s causing the injury/pain, which will then allow you to program around it accordingly. Any time I have had a niggle or slight pain, the first point of call is to go get it assessed/treated before I do anything. Without a proper diagnosis, following the advice below might not be in your best interest, so please do ensure that you discuss any changes to your training with a designated professional.

Drop the load, slow it down

We all love to go heavy and put as many plates on the hack squat as we possibly can: I get it! However, this might not be best thing to do if you’re experiencing a little discomfort. Although your ego might take a little bit of a hit, dropping the weight and performing higher rep sets with lighter loads can reduce the amount of force going through the knee joint.

There will always come a time in my training where I must go through phases of higher reps because the heavy weight has simply become “too much” for my knees to handle. If I try to persist, then I usually just get injured so whenever I start to feel some soreness, I back-off immediately with the heavy work.

What tends to coincide with heavier loads and progressions is a loss in tempo and control of the movement. You can find yourself in a scenario in which your top set is looking less controlled, more based on momentum, and less based on muscle contraction. Therefore, as you switch towards higher rep ranges and lighter loads, you could place a larger emphasis on relearning the movement pattern and keeping your control throughout. This might look like ensuring you are initiating with your quads out of the bottom of all knee flexion/extension dominant movements and feeling every fibre in your quads.

Although it can feel weird, the higher rep ranges and slower tempo will provide you with a new stimulus to grow from as you’ll get more muscle fibre recruitment, so it’s a win-win scenario. I often program in a 3010 tempo for most lower body movements, meaning you’d take three seconds on the way down. The next time you’re on the hack squat, video your set and ask yourself: how long are you taking on the way down?

Remove squat work or certain movements

This can often be the first thing I suggest when clients tell me they are experiencing a little bit of pain. If you were to look at your lower workouts across the week, one simple solution could be to avoid all squat type movements that week and instead rest or replace them with glute/ham work. This can usually do the trick in alleviating some sort of pain, and although it won’t be the full solution, I do believe it to be 100% necessary. I usually suggest adapting the plan as opposed to taking a week off from training legs, as if you’re anything like me, time away from training can be hard to take mentally.

When the time comes to load the quads again through squat patterns, you may want to look at the removing some of movements in your program which might be the problem or aggravating the problem. If I use myself as an example, the thing that triggers my knee is the pendulum squat. Now don’t get me wrong, I love the pendulum squat, but any time I have a stint of training on it, I end up with slight pain in my left knee. My biomechanics are just such that the angle of the machine, the length of my femur (leg bone) and the forces going through my knee simply don’t agree with each other.

I had to drop this from my training towards the tail end of 2021 and replaced it with the smith machine. This works far better for me and causes me no discomfort. Look closely at the movements you are doing, does the discomfort happen after one specific move? If so, you could try switching to an alternative movement.

Utilise bands and occlusion work

You may have seen myself and others use a band on the hack squat and wonder what on earth that is for. Incase you need a little reminder, let me explain.

If we attach a band to the hack machine from the top, the band will pull upward right as we enter the bottom range. In doing so, the band will create and/or allow for a drop off in load at the point where our quads are weakest – that is, the machine becomes lighter at the bottom, matching the weaker point of the muscle’s contractile range. As such, this creates an increased ability to initiate with the quads and, critically, means less force going through the knee joint itself.

So, although that band might be making the movement slighter “easier”, your knees will thank you for it the heavier you start to go and the stronger you become. I can say this from experience that the minute I started implementing reverse band work, my knees got that little bit better.

You could also implement occlusion work into your training. What occlusion training would force you to do is to have to massively reduce the loads you are currently performing. This is due to restriction of oxygenated blood to the working muscle, but also the build-up of waste products in the muscle as you are lifting. You will take limited rest and the body’s ability to clear lactic acid is decreased therefore you will be experiencing a ‘burn’ like no other.

What you have again is a new stimulus the body has never been exposed to, giving you another new stimulus to grow from. If you were to combine this with reverse band work and different machines to the ones that were causing you pain, you can see how the knees might start to feel better sooner as opposed to later.

Get your glutes/hamstrings strong

Your pain might be stemming from an imbalance between how strong your quads are relative to your glutes/hamstrings. Having played basketball for many years prior to bodybuilding, this was one of my problems. However, I go onto rectifying that in 2017 and never looked back.

Without thinking, I would put most of my load through knee extension (straightening the knee) on squat movements and less through my glutes. All it took was a slight change in programming, more emphasis on hip hinge work and leg curls, and my squat patterns got stronger, and my knees felt that little better.

This certainly isn’t a solution by any means, but it can help as you will no doubt have to drop some quad work to allow for an increase in glute and hamstring work. Combine it with the strategies discussed above and it could help you continue to work around an injury you have.

In summary, if you experience knee injury, ensure you see a medical professional to figure out what is causing the pain. If you can continue to train, you might be able to work around the pain by dropping the load, going higher rep ranges, removing movements and incorporating alternatives. It might also help to utilise reverse band work, occlusion training and focusing on getting your glutes/hamstrings strong.

Vaughan Wilson Bsc Hons