I know what you're thinking…
"I already do them before every run but I don't know if they're helping.
I don't feel like they're not doing anything because everything STILL hurts… I don't understand them."
I bet you've also tried foam rolling your quads.
Definitely your IT band.
And it all might have helped initially but now…you're not seeing any improvement.
So you took the next step, googled some runner's knee exercises that included a bunch of squats and lunges…
….and meh.
So does anything actually work???
Yes, I promise.
You're even on the right track if you've added those lunges to your strength work.
How do I know?
Recent research articles are backing you up!
So what went wrong then?
Together, let's find out and learn what small tweaks and adjustments we can make RIGHT NOW to your lunge so you can maximize your results and kick that knee pain and ITBS to the curb for good.
Sound good? Let's get started.
Back It Up....
Let's start with a little background information.
Most runners who develop some kind of knee pain, most commonly called patella femoral pain syndrome, assume that because their knee hurts, they should strengthen their knee.
*rewinding the tape sound effects*
Not so fast.
The knee is a joint.
We can't strengthen a joint.
What we can do, is strengthen the muscles that surround that joint and create support.
Great! So all we need to do is strengthen all the muscles directly around the knee joint?
Nope.
I know, sort of a trick question. But I don't make the anatomy-rules.
Let's pull some quotes from our research article (so you know I'm not making this up):
"Two of the most common running-related injuries are Patellar Femoral Pain Syndrome (PFPS; Runner's knee) and ITBS….
"Souza & Powers reported that runners with PFPS had greater peak hip internal rotation angles, reduced hip torques, lower (glute max) GMAX and (glute med) GMED isotonic strength and greater GMAX activation compared to pain-free runners. It has also been reported that female runners with PFPS had significantly less GMAX activation and hip extensor endurance which they speculated led to the observed increase in internal rotation.
"Previous authors also have suggested that the main biomechanical factors that may put a runner at increased risk for iliotibial band syndrome (ITBS) are excessive hip adduction and internal rotation, and knee internal rotation and abduction during the stance phase.
"Deficiencies in GMAX and GMED activation are potential etiological factors in injured runners who demonstrate biomechanical flaws linked to possible muscle weakness and/or inactivation…"
Despite all the science-y words and abbreviations, are you starting to see the pattern of the kinetic chain?
Knee pain and ITBS are all victims of a higher-up culprit: the glute max and glute med muscles.
But that doesn't necessarily mean those glute max and med muscles are weak.
"biomechanical flaws linked to possible muscle weakness and/or inactivation…"
They could be weak!
Or, they might have a hard activating at the correct time, for the right length of time, etc…
But what all this amounts to is:
those particular glute muscles can be strong in runners, but may not possess enough control to provide the support and stability needed throughout the entire motion of running, specifically during the moments when your leg is planted on the ground.
What does this look like, you ask?
Can you see how that knee and hip are caving in?
(the little yellow lines help.)
And how the opposite foot is kicking way out to the side?
This is sometimes called an egg beater gait (and I have a blog post all about that HERE).
But let's get back the knee pain, ITBS, and how these lunges can be your saving grace.
The Lunge
Nothing super fancy, right?
They added a resistance band around the legs, but otherwise nothing wild. (and honestly, if you want to add the band, cool. If you don't, it's not big deal. We'll get more into that in the Do's & Don'ts at the end.)
The results of the paper discuss how both glute max and glute med were roughly activated around same amount with both this lunge exercise and the single leg squat exercise we talked about in last week's blog, both in the concentric and eccentric phases.
"Although all…exercises had similar eccentric amplitudes, the Forward Lunge (FL; pictured above) and single leg squat with rotation (SLS; in last week's blog post) may be more effective for building muscular strength for both the GMAX and GMED... Despite the fact that these exercises produced substantially lower peak amplitudes as compared to running, they should still be taken into consideration when developing a rehabilitation program for runners returning from injury or seeking to gain improved pelvic control."
But it's this quote that makes closes the deal on WHY you need lunges and HOW they help reduce and eliminate and knee pain and ITBS:
"Additionally, single leg squats and forward lunges are performed unilaterally (meaning on one side, one leg) which improves the running-specificity of each exercise possibly improving the transfer to single limb support in running."
It's what we've been saying, running fit fam.
You're a runner and you need to train like one.
You need your strength exercises to replicate or mirror the movement of running in order to make you strong during the motion.
And lunging meets both of those requirements: activating those important glute muscles while replicating that running movement.
So let's talk about some possible mistakes you might be making and want to avoid while lunging.
Mistakes You Might Be Making:
Poor core stability
you're wobbling in the wind through your trunk and leaning forward (I've even seen runners tilted towards the right or left before)
Poor balance
you might be rushing through these or not concentrating on the motion, causing you to lose your balance (and also wobble in the wind through your core)
Poor eccentric control on the descent
this looks like hitting your knee on the floor. This is a big no-no!
Loading up on weight or a resistance bands TOO early, too soon!
You need that control first, and earn the right to add the weight
Ways to Fix It:
Slow it down!
Focus on that singe leg balance and core control that has to happen in order to do these right. Don't rush through these and stay tall, with a proud, puffed out chest.
If you need a little balance assist-use it!
There's no shame. Hold onto a railing, a wall, a squat rack, etc. Gradually reduce how much balance assist you need; this is a progression by itself!
Control that descent.
No banging that knee on the floor! When it doubt, take a smaller forward step (big steps aren't bad! But they require EXTRA control; and you need to earn that right!)
There's no shame in body weight; especially if you're lunging forwards and backwards
Backwards Lunging
Yup, I mentioned lunging backwards.
No, this isn't in the paper.
But it's important, nevertheless.
WHY? Because with running, we primarily move forwards.
But we know from the body of literature that cross training, moving in different directions, is what creates unstoppable strength and stability.
So the "work smarter, not harder" way to do this is to take the motion that looks like running (lunges) and add variations to it.
Even better, backwards lunging actually still looks like running, just running backwards.
Not to mention, it's still going to activate your glutes and quads muscles like discussed in the research article, but now, in a reverse order, strengthening in a new way, learning a new but similar sequence, working on that neuromotor control and activation in a different order.
It's not only about building strength.
During any workout, including strength workouts, it's also about neuromotor control, motor planning, and training your brain and body to adapt, by agile, strong in all directions.
Well, that's one hot way to end a blog post all about lunges. (didn't think there was that much to say about them, did you?)
But now you know, one simple exercise like this one, when done correctly, can create a transformative difference.
Time to get to work on that runner's knee or ITB, running fit fam.
Until next time, Dare to Train Differently.
Marie Whitt, PT, DPT //@dr.whitt.fit
P.S. Looking for a place to start when it comes to strength training like a runner? Grab a copy of my FREE Running Guide HERE!
REFERENCES:
Connelly, C., Moran, M., & Grimes, J. (2020). COMPARATIVE ANALYSIS OF HIP MUSCLE ACTIVATION DURING CLOSED-CHAIN REHABILITATION EXERCISES IN RUNNERS. International Journal Of Sports Physical Therapy, 15(2), 229-237. doi: 10.26603/ijspt20200229