Handling Steps and Box Step-ups without Knee Pain

Knee pain with steps and box step-ups are one of the most common problems that we see at our physical therapy office.  The location of knee pain can vary.  Sometimes the pain is at the patellar tendon (patellar tendonitis) or quad tendon (quad tendonitis).  It could be on the outside of the knee along the IT band (IT Band syndrome).  It may be from a meniscus injury across the joint line.  It may even be on the inside of the knee and results in knee bursitis.  Sometimes, the kneecap does not track properly and can cause patellofemoral syndrome.

To obtain an accurate diagnose, an examination would be needed.  Although there are differences in how we treat each of these conditions, we’ve found that common limitations exist when it comes to experiencing pain with steps and step-ups onto a box.

Some factors that contribute to knee pain with steps include an abnormality in the way the lower leg lines up with the hip, knee, and foot and improper tracking of the kneecap.  In many cases pain with step-ups is associated with poor mobility of the hips and the ankle. This can be combined with weakness of the hip, thigh, and the buttock muscles.  In addition, if there are imbalances at the core and hip muscles, the way an active person moves can be affected which may lead to faulty knee mechanics. 

However, the only way to know what is contributing to knee pain with squatting is to perform a movement assessment.

Once we know what the specific limitations are, our first recommendation that we usually make is to take a short break from the aggravating activity. This allows for an environment for irritation to settle down and healing to take place. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of the issue.

When pain and stiffness is found via the assessment, our approach includes manual mobilization to alleviate pain and improve mobility. Pain improvements can be made very quickly with soft tissue mobilization and/or dry needling of the quadriceps and calf muscles.

If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well.  In some cases the calf muscles are not quite strong enough to assist with the step-up movement.  This results in over-activation of the quad muscles and excess pull on the knee cap.   

Once pain is controlled and muscles engage better, our next step is teaching our patients proper step and box step-up technique with and without resistance.

When addressed with a thorough physical therapy assessment and plan of care, going up and down steps and performing step-ups without knee pain is possible. However, any sort of repetitive activity with poor mechanics can develop into a more serious knee condition.  If you have knee pain with steps, the physical therapists at Movement Solutions would be glad to be a resource for you. 

We have a free guide on relieving knee pain that can give you further insight into knee problems and help kickstart your recovery.  We are available for a free 15-minute phone consultation to talk about how your pain is affecting you and discuss your treatment options.

If your concerns warrant an in-person consultation, we offer a limited number of free Discovery Visits at our office.  This type of appointment of for those who are interested in working with us.  It is an opportunity to ask questions, obtain clarity about your condition, and develop confidence that we can help you.  If you’re in pain and unsure about what your next step (pun intended) should be, call us at (864) 558-7346 and ask how we can help.

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