5 Ways to Modify Knee Pain in a Session

Posted on December 20, 2021 Michael Hughes

Imagine you have a really awesome workout that you’ve designed for this client in front of you, you’re super excited about it, you’ve really spent some time on it, and it’s gonna be awesome. And you’re one exercise in and your client is already experiencing some knee pain and talking about it. It’s in this moment, as a trainer that we all have, I really don’t care how good of a training you are, it’s sometimes not about your intelligence. So for example, it’s just the fact that they are a sedentary client, and trying to move their body in a way that their body is really not ready to move yet. Well, what do you do in this moment? Well, in my experience, you can have a change exercise and never really go back to it, basically ignore it, navigate around the pain and just continue on with the session, or after the session, try to refer them to a specialist, or try to convince them about another session with you to get rid of the real underlying issue, which definitely takes a degree of prior investment on your part. And it’s something that a lot of our trainers that go through our programs really want to do that route, because they want to get that specialized knowledge. Or you can do what I’ve been doing, and training coaches to do for years, which is in that moment, how can you figure out their pain without making it worse, and give them some relief, as a way of building a bridge of trust and credibility with you and that client, our entire focus ashmole’s is dialing in the lifetime value of your client. And these are the moments that matter. So let me show you just a few quick wins that you can have with your client, if they’re experiencing knee pain, where I would go as a coach to help them navigate through that in a way that builds trust with me with you, right as their coach and loyalty with my brand. And of course, your brand.

The clients ready, the workouts bit written, you’re psyched, you’re amped and that knee goes sour, that motion that you had pre planned isn’t working out for that client, and the clients now suffering for it. What do you do about it? Well, let’s talk about it from two different scenarios. Let’s talk about from the one on one training scenario, which most of us are probably coming from or started with, you have the ability to stop the workout, right you are you control the entire session, and you have the ability to press play, or press pause and deal with him. So I’m going to talk about scenarios of how I would deal with it in that session to give that Clinton the most value for that joint. So they can be more sessions, not just that single one great workout. However, if you’re in a group scenario, you don’t really have the ability to press pause and fix that one particular person because the sessions going, it is a it is a rock going down the hill, and you have to keep up with it and stay managing the expectation of all people, not just the person in front of you. So I’m gonna talk about a scenario of what I would do in that different session. So the workout can continue, and that client can get through it. And then you can address it later in an upsell potentially in another session, or later on in a video that you give them or after the workouts over. It’s however you want to provide more value for that customer for that client. In that group setting. Let’s let’s take the first scenario where that need doesn’t appreciate the loading or the East centric capacity that the body is going to give it. And that could be with a forward lunge or the sideways lunge with cases that could be with a squatting pattern that could be within the verta motion landing, but against the loading East centric capacity of the knee going through major flexion and other motions as well. And let’s talk about how I would work around it. And then how I would actually go into start fixing it. So I’d work around it by first grabbing some sort of, well, basic little pad, this is about an inch or so you can go more or less a wedge, and I put that right underneath that person’s heel on that knee that would be affected. You can certainly do both to make it equal. But I’ll certainly test one at a time. Now my heel is lifted a one inch off the ground. And if that’s lifted off the ground and this hurt before, right, get that off the ground. And that hurt before if I go lifted. And that decreases pain significantly. As I squat down decreases discomfort significantly, then I know that I’ve just given the soleus muscle the deep aspect of that calf, I’ve given it more room to play before it reached its elastic threshold. So basically, if I go off this I go into a squat and it hurts on the way down. Ooh, then there’s a possibility a big possibility that that soleus was too immobile. The connective tissue was to bound down and as it went forward, the tibia was being decelerated backwards as the femur went forwards causing a shearing at that needle. and that the connective tissue, saying I don’t really appreciate that, well, of course it doesn’t, I don’t like being pulled one way then be pulled out. So I like to go in the same direction as him moved. So if you lift that heel, now you have more movability of that tibia and fibia joint before the soul this connective tissue runs out of elasticity and starts to decelerate. So that means I can go down further before the knee joint is put at risk. Did I fix anything? No, of course not. You just gave it compensation that gave more motion. But eventually you keep going down further and further, that knee pains gonna pop back up. But for the workout sake, they can now delete to a medium range of motion squat, they can do a medium range of motion lunge, as they land that heel on that. And they can do a landing second sequence if they prefer to. Well, how would I go about fixing this issue? Well, fixing an issue is very, very complicated. But I’m going to break it down to make it as simple as possible for the short video. It’s taking the connective tissue and mobilizing it and opening up well, how can you do that? Well, there’s many different ways that you can do that hands on soft tissue, foam rolling, etc, etc, etc. Then after you do that, you’re going to want to stretch the tissue. Well, how do you stretch the soleus? Well, that’s an easy way instead of going here, you just put it on the opposite way you lift the forefoot and start doing drives or stretches to make that happen. And then how do you retrain the neuromuscular patterning, to get that going? Well, you put it in the position that it was most successful, and start to put it in positions where it was least successful, and start adding functional movements to it

that starts progressing that are in essentially all the different ranges of motion, that the body can go through that the ankle go through that the hip and go through, and that the knee says I’m good with. But that is essentially the protocol or the equation of taking that solace and revamping it into its healthy state. Or let’s jump into snare number two, which is just the opposite of snare. Number one, the knee doesn’t appreciate the concentric, the exploding the extension of its to lower lower and upper halves, it doesn’t appreciate the body’s ability to rise up and do some activity that could be coming out of a lunge, that can be coming up out of a squat, that can be the lift off of any verta motion drill. And what do we do about that one? Well, if I’m going to work out, and the and the athletes just like I just can’t stand that push up, I can’t stand that ability to get up and to drive home. Well, there’s a few things I would do to first mitigate that. And as I would do that, I would start to understand that there’s a few different ways that more than likely the posterior chain, particularly the hamstrings are not giving us enough load. Therefore they can’t give enough explode. Think about us like I can’t pull the bow back on the bone arrow. Therefore, when I tried to produce force, the Buddhists the air doesn’t go that far, I have to recruit more friends, more connective tissue tugging at the knee to produce that force to come back home. So I’m gonna start to engage and ask for more friends to help. And one of the big friends is this sucker right in the back the glute max, and the posterior pelvis musculature, if there’s a lot of beef in there, and it’s a good one to ask well, I’m going to do is I’m going to try to recruit it more. So when I go into that lunge, I’m going to ask the body to reach forward more and to get into much more flexion. Therefore asking this glute to say can you please load therefore, bone arrow go back. And therefore when I let go, I have more friends helping out. So I’m just simply have the hands reach forward more, you can see how the pelvis will go into more flexion. When I do that, if I’m in a squat, I’m gonna have the hands reach forward more, if I’m going to jump, I’m going to have the hands reach forward more. And I’m going to propel and go back behind me. That’s one of the easiest ways that I can do that to allow the glute to give help to the hamstring, the hamstring gives more help to the connective tissue of the knee. Now, if I can pause the workout and fix it right then and there, I’m gonna start to mobilize and give that hamstring some more elasticity, therefore to give the strength that it may already have, if it doesn’t have that strength, we have to strengthen it, but the activity itself should strengthen that hamstring. Once it has the mobility to do it the flexibility to do it the elasticity to do it. So again, it’s grabbing onto our formula. Critic giving it the soft tissue care that it can’t break up those dense elastic fibers. Then to start stretching it in any way that you can. An easy way to do it is to throw your heel up onto something anything, stabilize yourself and go into a nice fold. flexion at the hip and start driving that hip in the different planes of motion that it has access to, to start pulling on that tissue to open up, and then progressively work it back. So to we can go to this range of motion, and I would start to decrease my reaches. So the hamstring has more help less help from the posterior hip. So eventually, I can reach way back overhead, when the glutes are really helping out very little. And therefore the quad and hamstring have to work in much more unison, from the knee joint to come back home now is a very fast progression, but at least gives you the mindset to start thinking about how I start to turn this wheel to re categorize this knee from a painful, from a painful up to a very smooth and exciting or powerful up. In our third scenario, we’re gonna do something that I love to do is throw stuff, and we use a medicine ball. And think about the scenario where you’re next to a wall and you’re getting into rotation. Or maybe it’s not throwing a medicine ball, but you’re just taking a modality and ripping across the body, it could be even grabbing onto a viper, and then that Viper motion, you’re going through a particular Swing pattern, up high down low, but anything that that requires that rotational motion that the body loves to do, and drives most of its power from, well, it may be love to do it. But the nice thing, I don’t really appreciate that. So there’s two different scenarios that I want to talk about within this third option that I really want to share with you.

And it’s first one is taking that medicine ball, let’s say you’re throwing it this way, and it’s in across your body. So it’s going to my left side, and my left knee doesn’t appreciate when I let go of that medicine ball, and I get it into that wall is Ooh, I’m not a big fan of that, well, if I can change it right, then in there, I’m going to give the body a little bit more range of motion to get to that release point, to get to that follow through point. Because you seem how my body moves into the left, and I’m going to try to keep my left foot relatively stable, it can roll open, you see a lot of golfers do this, to really get that extra little bit of motion through their club head. But it’s not enough. So we’re getting we’re talking about a lateral posterior lateral chain of musculature, that more than likely isn’t giving the strength isn’t giving the mobility isn’t giving the elasticity to me to get that range of motion. So if I take my toe and simply just toe open about 20 to 45 degrees, I have now given my femur, and therefore my pelvis 22 to 45 degrees more and even more through my because it’s through my arms. Because it’s an it’s an expanding kind of number system. As I give more and more and more compounding interest, basically, I have more rotation through and I can release that ball. I never reached my end range of this posterior chain, lateral chain. And I’m ready to keep on rocking and rolling. Now what about the opposite? What if I am in pain as I go and rotate, and as I throw it this way, it’s the same part. But my other knee hurts. My back knee hurts my trail knee hurts? Well, this one’s fairly easy, because you can just bail out, quote unquote sooner. And you can bail out sooner by simply pivoting and releasing through that heel. It’s basically like heel rotation or toe pivot. Because then as you do that, the knee is going to be in line with the femur and allow the TIB fib and align with the hip much sooner and much easier to go through that. Well what if the drill is not about rotating through it? Well, if the drill is about keeping that foot there and making it happen, because you’re maybe lifting and spinning and catching a kettlebell on the opposite shoulder, well, it could be that you just take this foot and internally rotate it 22 to 45 degrees in that range. And now as you rotate and throw, again, now the medial hip, the adductors, they don’t reach their end range of motion elasticity, lack of strength, lack of flexibility, soon enough for the pain to initiate or for the range of motion to run out and then for the knee joint to take the hit. So you can just toe in and go through it. Now if I was going to try to fix those, if I was going to try to release an causes prompt to go away, well, the easiest thing I can do is you can just start to mobilize, start to mobilize, start to lengthen and stretching and give more range of motion. And then start to retrain the neuromuscular patterns that these are going to go through to start to give that extra bit of control, an extra bit of awareness that they can now say I can move to that pattern. And I have the ability I have the elasticity. And now I have the control to make sure I can get through it. And that’s the equation that I want you to really get out of this video is that you want to mobilize the tissue, you want to gain more range of motion through the tissue. And you want to retrain the tissue to manage that exact same motion through progressions that are not painful. Alright, in our fourth scenario, we’re going to talk about stepping down from a box or stepping down from stairs, very, very common, and not in our facility. But definitely outside of one’s facility, I mean, use this box right right here, which is a six inch box, which is technically the same distance of a step, going down six inches from the first step to the second step, or so on. And I’m going to talk about the trail leg. So if I step down, and I get knee pain on this trail leg, right as it get through this flexion and this unloading to come through, what do we do about in that scenario, as I come down off that step? So if I’m doing a box, step down, and repeat, and hurts on the way down in even potentially on the way up? What do I do about that in a session. And this is also, again, a huge takeaway for people who have pain walking down stairs, well, if I’m in a session, I’m thinking about this, I’m analyzing what’s going on from a lack of capability, and the knee joint is getting is getting basically picked on, I’m gonna start thinking about, wait a minute, if I can step down this, and I really probably have an anterior chain issue, again, not enough strength, potentially, not enough mobility, none of flexibility, the elasticity is just not there through that pathway,

how can I help that person change that up? Well, the first thing I’m gonna have them them them do is when I step down as them to change the angle at which they step, step down, so instead of a straight forward step, I’m gonna have to maybe do a lateral step off that, especially during a workout, when I can control the environment very, very well. If you’re going down stairs, you may want to ask them to potentially toe open or toe close their foot, to change the angle at which the stress is going through the knee. If you’re too open, you’re going to have much more abductor, if you choke close, you’re gonna have much more IT band and TfL. And as they change that motion, they can at least get down those stairs without that pain. But again, with every tweak, there is a compensation, this would not be an end, an end all tweak, this would just be to get through that moment. So they can progress to the next. But what I would really really do is I’d say, in a personal training session, stop the session. And again, start to understand what’s going on to this anterior chain, as the body needs to get through that extension, but also flexion, and the quadriceps expecially, the one right down the center, is a one that I would definitely look after first and sort of say, What do I do about it? How can I mobilize it, get all the connective tissue in a healthy spot? Decrease all that tightness, all that congestion? Then how would I start to lengthen it to make sure it can go through its pattern? And I’ll start to do that in three different dimensions at the very least. And then I start to say, Okay, let’s rebuild that scenario, where I start to progress that maybe take it down from six inches, and just start to go to a deeper squat with that knee bend, going going down on a level playing field, and start to build up that neuromuscular patterning, that reprogramming to start to use those those muscles in those joints and that system much more effectively. I know this last scenario, the fifth scenario is what about locomotion? What about when you’re running, and you have that good kind of range, that good speed built up, and you go to decelerate and change positions, or you just can’t even keep that constant acceleration, because every acceleration requires a little bit of deceleration to reload to the acceleration. So let’s talk about like a lateral shuffle something we see very, very often. And let’s talk about in the landing on that landing of that front leg, the knee just on the lateral side doesn’t appreciate that flow of energy through it. And it says, Ooh, there’s a little bit of a cool, there’s a little bit of a pain through that. Well, my first thought is going to be in a session, what do we do about that to make it change? Well, if I’m going through lateral and I’m thinking, Gosh, I’m gonna look into that TfL mug that it venom of that lateral chain, and it’s just not giving the help that that knee wants. Then I’m going to say, well, if I go more into this for position, and I get a split stance, shuffle, where my left leg or my fourth leg is in front, and I shuffle through, I’m going to therefore be requiring more energy, more elasticity through this and if that decreases that person’s knee pain, I think there was a lack of control. There’s lack of awareness here. The strength is there, but it needs more attention. However, if I put the foot behind it, the leaf up behind it and I do a shuffle with a split stance that way, and that decreases its pandemic. Ah, I see what’s going on. There was too much tension, there was too much control, and therefore is yanking the knee out of alignment. And then he says, I’m doing my best to stay there. So then it’s the this the opposite way, but it’s still the same muscular system. But it’s the opposite approach. But what do I do about it? Well, we go back to our equation, we’ve made sure that the connective tissue is healthy and hydrated. And we make sure that has the elastic qualities that it needs, then we need to start pulling it through that range of motion in as many dimensions as possible to give it the well roundedness of access to movements as possible. And then we’ll search on to feed in that neuromuscular patterning. So it can start to control that range of motion, whether it be with more tension, or with less tension, and then slowly getting our way back to its actual patterning. And again, that’s the formula that I want you to think about. And take all these concepts, these five different concepts. Think about how is the removing whatever arts friends doing around it, how can you understand it, work around it, and then potentially, actually fix it. And that’s going to be that lifetime value, that you’re giving your clientele so they don’t leave your doors, they stay with you. They continue to be in your establishment and you start and you continue to serve them. It’s not about just serving them for that session. It’s about serving them for lifetime. hope these help out. Continue to work through it continue to see motion better, not just deliver motion better, and we’ll talk to you soon

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