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Performing Step-ups without Knee Pain

Knee pain when performing step-ups is a common complaint amongst knee pain sufferers who like to work out in the gym.  The location of knee pain may 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 (IT Band syndrome).  It may be from a meniscus injury across the joint line.  It may even be on the inside of the knee (knee bursitis).  Sometimes, the kneecap does not track properly and may result in patellofemoral syndrome.

To obtain an accurate diagnosis, an examination would be needed.  Although there are differences in how you should treat each of those conditions, there are basic principles that will help you overcome knee pain when performing steps ups.

If your knee is irritated and painful, the first common-sense recommendation is to take a short break from the activity that aggravates your knee further.  This may include step-ups, lunges, or squats.  This will allow irritation to settle down and pain to subside.  If your pain persists, receiving hands-on therapy can be effective to help your pain subside more quickly.  Soft tissue mobilization of the thigh and calf muscles and joint mobilization of the knee cap, leg, and thigh bones can have a profound effect on pain intensity.

Once your pain is under control, you can now address the root causes of why you're experiencing knee pain when performing step-ups.  Some factors that contribute to knee pain with step-ups include an abnormality in the way the lower leg lines up with the hip, knee, and foot and improper tracking of the kneecap.  Sometimes, pain with step-ups may be a result of movement compensations associated with poor mobility of the hips and the ankle.  In addition, if you have weakness in your hip, thigh, and buttock muscles, you could be putting stress on your patellar or quadriceps tendons or knee cap.  Furthermore, if you have difficulty stabilizing your trunk, you could have faulty knee mechanics when performing step-ups.  The best way to know what is contributing to your knee pain when performing step-ups is to undergo a movement assessment.

If you have weakness, learning how to activate muscles that are not firing well is key.  Sometimes the quadriceps muscle is weak and stiff and may result in knee pain.  On the other hand, your posterior chain (hamstring and calf muscles) may not be quite strong enough to assist with the step-up movement.  If this is the case, your step-up will be quad dominant and may result in knee pain.  You could also have combined weakness in multiple muscle groups.  Exercises that tend to be good places for most people start include the quad set, the bridge with adduction, and single-leg calf raises.

Once your muscles engage better, you must restore normal movement of your hips, knees, and ankles.  Your hip must be mobile enough to assume a step-up position without compensating.  "Box hip flexion" is a great exercise to work on this part of the movement.  Your knee and ankle need to bend enough to initiate pushing on the box.  "Box Ankle Mobility" with a kettlebell can help you develop mobility in this position.  It is important to remember to engage your foot muscles when performing this exercise.  When you step up on a box, your knee should be able to lockout completely.  TKE's, banded raises, and partner assisted hamstring curls should help you develop full knee extension.

After you have restored movement, you need to develop strength in the step-up pattern.  This will enable you to prevent the reoccurrence of pain when you perform step-ups.  Exercises that are helpful in building strength in the step-up include the front step-up, step-downs, and lateral step-ups.  Resistance can be used in the forms of barbells, dumbbells, or kettlebells.  Being able to generate tension through your hip, thigh, and foot muscles when stepping is key to stay healthy and enjoy an active life.

Most of the exercises mentioned above can be found in our video library.

When addressed with a specialized physical therapy program, overcoming knee pain when performing step-ups is possible.  However, ignoring pain and engaging in repetitive activity can result in a further decline of your knee health.  If you're worried about your knee pain, the physical therapists at Movement Solutions would be glad to help you.

We invite you to request a knee consultation with one of our specialists.  This is an opportunity to ask questions, obtain clarity about your knee pain, and foster confidence that we can help you.  If you’re certain that we’re a good fit to work together, you can decide on the next step.

If you’re in knee pain but unsure about what you should do, call us at (864) 558-7346 and ask how we can help.

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