The #1 Key To Healthy Knees

Photo by Andrew Tanglao on Unsplash

Every so often I receive a text or an e-mail from a friend or current client asking about knee pain. The universe is funny this way because I then proceed to receive 3-4 more messages about knee pain.

It's going to sound like I'm not answering the question but when someone has a knee issue I don't actually focus on the knee.

The only caveat is if they've suffered any trauma to the knee i.e.- they felt a "pop" when they fell or got hit directly in the knee playing pick up Basketball. THEN the knee is the site of the problem. 

For the rest of us, the fact of the matter is that knee issues are typically due to problems in other areas of the body, not the knees themselves. The two most common reasons for knee pain are...

• Lack of Ankle Mobility (In particular sagittal dorsiflexion and plantar flexion)
• Poor Hip Mobility

If you said the key to correcting and preventing most knee injuries comes down to improving hip mobility...TELL THEM WHAT THEY'VE WON ROD!

They've won an all expenses paid trip to a lifetime of healthy knees!!!!!!!!

A lack of hip mobility in all planes of motion not only leads to knee pain but can also manifest itself in back pain as well. A lack of mobility in the hips also seems to coincide with an individual's glutes not pulling their weight.

Most who have patellofemoral pain do the Google search and wind up concerned about isolating the vastus medialis obliquus (VMO). Thus they end up performing hours of terminal knee extensions (TKE) and still wind up with fragile knees. Their anterior knee pain in many cases is due to soft-tissue imbalances between the stronger lateral knee structures and the weaker medial knee structures (which includes the VMO). This muscle imbalance leads to a lateral pulling of the patella into the femoral condyle which results in anterior knee pain.

Research has found that many athletes who experience patellofemoral pain had a significant decrease of strength in their hips, as much as 30%. So we need to get the posterior fibers of the gluteus medius and the gluteus  maximus to fire more effectively.

HOMEWORK

• Begin by foam rolling of the lateral structures. I'd focus on the vastus lateralis (think the area on top of your leg towards the outside but still on the quad) and IT band.
• Improving general quad strength (via quad sets, leg extensions etc.) TKEs could definitely be part of the program; just understand they aren't a true isolation exercise.
• Improving the motor control and strength of the gluteals
• Stretching the quads and calves
• Not really something that influences it directly but proper program design helps a lot as well.

The Mini band warm up series. Perform 10 lateral steps in each direction, followed by a forward and backwards 45 degree step at 10 & 2 o'clock. I would repeat the series 2-3 times prior to exercise.

Many individuals lack external rotation of the hips. Try the FABER (flexion, abduction, external rotation) test yourself by sitting down tall on a chair and place your foot on your other leg's knee and see if you can get that thigh to parallel to the floor. Most people end up with their leg hiked up like chicken wing. You can perform the actual test if you have a friend who you trust won't tickle you when they try to hold your hip down. 

The pigeon pose which is taken from yoga is one of the best static stretches for helping to open up the hips. The biggest takeaway from this movement isn't so much to mimic the pose but to also be able to square your body, hips and shoulders, so that you're not stressing your back or your knee too much. Elevate the front knee with pads until you can get to the floor as shown. 

Integrating all this into movement prep will be the squat to stand. If you can properly pull yourself down into the squat position, lifting the arms up and then stand without compensating; you'll be well on your way to achieving your fitness goals. 

NOTE: No two knee problems are identical thus you should listen to your body before plotting course on a corrective solution. I believe you should seek professional help if you can't figure out what's going on. 

And of course the only thing I ask of you is if any of this information was useful or insightful to please share this with a friend whom this information may be able to help.

How I Organize My Own Training Program

Lifting + Running = more calories. CHECK!

So you're trying to be a great long distance runner but still have biceps, pecs and 400lb deadlift? You're crazy! (silence) umm...Is that even possible?

The short answer is I don't know.

I've only started to take up running again. I'm currently tweaking my own programming adjusting under the bar volume, milage on the road and macros in the kitchen.

But I firmly believe this goal is very possible. Here are a few of my observations so far.

Strong legs in the gym= strong legs on the road too

The biggest thing I've noticed when running 8+ miles is not that my legs get tired; I got the legs just not the lungs for running faster. I recall back in high school and college that my legs would routinely get tired performing anything above 6 miles, add in any kind of considerable incline and my legs were fried.

Years of squatting and deadlifting have made my legs much more resilient to fatigue. This is interesting considering they're technically calling upon different fiber types: slow twitch vs fast twitch and different energy system: aerobic vs anaerobic.

No Cramping or Side stitches

Another common problem runners have is related to poor breathing mechanics. This often results in getting side stitches or cramps in their oblique area. 

As a weightlifter I understand how to properly maintain a certain level of tightness to ensure a stable midsection. This is a result of proper breathing mechanics to ensure not exhaling fully because this will destabilize the trunk (think a relaxing yawn, you draw in A LOT of air followed by fully exhaling). 

Also having a core strong enough to perform 20+ reps on a trap bar with 350lbs is a pretty strong transverse abdominis, it should be able to hold up to the fairly easy pounding running transmits. Here's Dr Quinn Henoch demonstrating a PRI technique of how to breathe using the diaphragm. 

How This Might Work For You

I suppose it's important to cover who this type of training WON'T work for:

• If you struggle with the core lifts of squatting and deadlifting, and you perform zero unilateral work. (Struggle like you can barely perform your bodyweight on these lift without looking like you're performing it during an earthquake)
• If you think a one minute plank is REALLY hard. (again without looking like there's an earthquake)
• If you're a physique athlete, you'll lose SOME muscle therefore distance running is counterproductive to your goals. (and there are better ways to whittle away that last remaining amount of fat) 

Related: Screw Cardio! Four Complexes for a Shredded Physique

Any lifter with a few years under their belt and a decent command of the core lifts would be fine and might even benefit from added C word...Cardio (GASP). 

Sunday: OFF

This is in anticipation of a BIG lifting day on Monday morning. 

Monday: Heavy lifting session

Here is where I push the envelope on my core lifts. I work up to a heavy single and back off for a decent percentage depending on how I'm feeling 70% ( I feel terrible)- 90% (I have the POWER!!).

I squat and deadlift on the same day. I bookend session with a superset of a chest supported back movement/rear deltoid movement along with anti-flexion core work.

I may or may not perform a light run afterwards, 3-4 miles at a sub-maximal pace 60-70% Max HR. 

Tuesday: Lighter lifting session

I'll typically perform hip thrusts on this day, weight is dependent on how I'm feeling of course. I'll typically superset 6 movements, move at a decent pace since I'm not looking to really move the needle on weights. Core movements include anti-rotation like payoff presses.

I will take the day off from running. 

Wednesday: No Lifting

Having not run the day before, this is usually my longest run of the week. So far it's been 8 miles. If there's a day where I want to push the distance it's on Wednesday. I move this along on a pace I deem fit, so far it's been slow and steady as to allow my joints to get used to lifting and running. 

Thursday: Upper Body

I'll perform 3 supersets consisting of a variety of pressing motions always with a pulling motion. Example: Incline dumbbell bench press and Chest supported incline dumbbell row, dips and a single kettle bell racked walk or standing dumbbell military press and inverted rows. Flexion based movements like reverse crunches and hanging leg raises comprise my core work today. 

No running.

Friday: Lower Body

This is my accessory day, depending on how my week went , I'll evaluate if there something that needs strengthening. Here I'll almost always perform some type of unilateral lower body move like split squats to start then move onto technique drive movements like Paused Squats and 1 1/2 rep style deadlifts.

Again I'll perform some type of back work. If Thursday had a lot of vertical pulling, I'll keep it to the horizontal variety on Friday or vice versa. Core is often more dynamic in nature like bear crawls, unilateral farmer's walk or a valslide body saw.

Running: Moderate milages if my low end is 3-4 and high end is 7-8, I'll perform a 5-6 mile pace run where I'm trying to lower my mile pace. If my 7-8 mile run is performed at 8:10, I'll attempt to perform these 5-6 miles at 7:55-8:00.

Saturday: No Lifting

I will run again, usually a really easy sub maximal 3-4 miles. Mostly a recovery run.  

Final Notes:

• Leading up to deciding to run again, I was performing some kind of squat pattern movement 4x a week and deadlifting 2x a week.
• I have upped my carb intake, around 3g per lbs now per day and upped my fat intake by 50%. I may play around with this and lower my carb intake. I'd like to see if I'm able to maintain performance and not have to eat 1-2 cups of starchy carbs at every meal. I LOVE rice but after a while, it's a bit much. 
• I still play Basketball occasionally. Ball is Life bro...
• I'm performing a crazy amount of soft tissue work to maintain proper muscle length and try to avoid injury considering the amount of added stress to my body. Hence the slow progression of adding in miles. Big milage is often associated with injuries in runners. 
• Speaking of recovery, if I don't sleep at least 8-9 hours on lift+run days, I'm a zombie the following day. This makes it even harder considering I'm working all day too.

Why You Shouldn't "Work Up" To Hiring a Personal Trainer/Coach

Every week I receive an e-mail or inquiry that goes something like this:

I'm looking to get serious about my training but would like to begin in a month. I'm trying to work myself up to working with a trainer.

Here's why you shouldn't feel this way and needlessly spend your time spinning your wheels. Even worse, you may put yourself behind the proverbially eight ball with poor movement patterns and reinforcing bad habits. 

We Already Made the Mistakes For You

Individuals become personal trainers after many years of trials and tribulation both mental and physical. We've failed and learned from mistakes. So why spend weeks or months making those exact same mistakes!

We want to help you get to your goal in the quickest way possible, so you can have the body you've always dreamed of. If you decide to hire a trainer, it's not for an hour of their time, 3x per week. You're hiring them for their years of expertise and knowledge.

I go into work every day with the goal of making you better. Your goals are our goals, if you succeed then we succeed.

We've Been Where You've Been

Nobody likes change. Why go through it alone. Part of why you hire a coach is that they've been in your shoes at some point in their lives. That experience is something that can't be taught.  

And even if they haven't been in your exact position, a great coach should be able to empathize with your fears and concerns. Sometimes you look at a trainer's physique and think they've never been fat or out shape. Which is simply not true. We all begin from the same start line. 

Hair good for the selfie. Now where's that "How to Deadlift video" again?

Trainers Are Usually Not YouTube Educated

What I mean by this is not that we don't occasionally peruse YouTube to learn from better coaches, but that the overwhelming majority of our expertise isn't only from the internet.  

They've often spent years either in school earning a degree, a CSCS or being accredited by reputable certifying bodies like ACE, NASM, NSCA, and ISSA. This is another aspect of what you're paying for. If all they did was open up a magazine or choose a workout from a website, wouldn't you just do it then!? (sadly the answer is no for a lot of people)

I've spent a decade reading countless books and watching video products to be the coach that I am today. I'm not only proud but can stand with my head held high that I provide people the best possible service that I can.  I really believe this, down to my core. 

"Speed" Ladder Doesn't Build Speed

A starting point would be discussing populations that would benefit from using a speed ladder: beginners, youth and/or out of shape deconditioned individuals. You know what else would improve their general fitness, strength, power and endurance? ANYTHING! 

There are "speed" coaches out there who use the ladder drills with their youth population and see great results. Likewise trainers who use them with the elderly population and see an improvement in movement and balance. But I would argue they could perform a rudimentary movement pattern for an hour once a week and produce similar benefits. This holds true for individuals who has less than a year of formal training. 

The speed ladder is often used as a tool to improve athletic performance including speed and agility. Lets go over what speed and agility really means in the context of athletics. 

Speed involves covering more ground in a shorter period of time. If you can run 100 meters in less time after 1 month of training, you've improved your speed. The basic principles to improving speed is increasing stride frequency to go with stride length as a means of quantifying speed improvement. It's often thought of in more linear movements like the 40yard dash shown here by NFL Running Back Chris Johnson. 

Agility is your ability to change direction rapidly while being able to apply more horizontal force into the ground at an angle different than your current direction. To do this effectively your legs must be outside the vertical position of the center of your mass. If your center of mass doesn't move, you won't change directions. All you'll do is move your legs and not fall on your face. Agility often goes hand in hand with change of direction.

Anything we perform in the gym is done to improve general physical preparedness for athletics. Any result to tie-in athletic performance to a drill is pointless since there is a lack of specificity to the activity. Sports in itself is chaotic by nature, and running a linear pattern won't do much to get you ready for the reactive nature of the beast.. 

Speed and agility are based on rate of force, meaning if you go through the ladder at a sub maximal rate, you'll only improve your conditioning. Likewise any true speed training needs to be done with adequate rest periods, anything less than that you'll simply be performing cardio. For any training modality to work, it has to replicate or produce fundamentally similar benefits as the end goal. The S.A.I.D (specific adaptations to imposed demands) principle applies here, your training needs replicate force, rate of force application, metabolic and neural demands of an activity to have true carry over. 

Ladder drills can be very effective as a warm up for true speed training. It can help load and unload the muscles, tendons and incorporates some cardio. Technique needs to be the focal point, so skip the fancy footwork you saw on youtube.

Agility training involves a rapid change of direction from the initial direction of momentum. The most effective way to change direction involves having the legs move well outside of the vertical alignment of the center of mass, and driving into the ground at as horizontal of an angle as possible to create a strong drive against the ground. Momentum can also be overcoming inertia if you aren't already moving. This rapid change from no movement to movement could be considered a “first step,” which does not fall neatly under traditional speed training. The best example of agility would be NFL great Barry Sanders, always amazing to watch!

While ladder drills involve a rapid change of direction from one position to another, the direction one applies force is more linear than horizonatal. As a result any movement outside the center of mass is usually pretty tiny compared to more conventional agility training. Ladder drills would work well as a warm up for the same reasons mentioned above for speed, but in terms of developing higher levels of agility, it may not be as beneficial. It could be incorporated in sub-maximal workouts to involve some change of direction with low loads to stay sharp.

Like with the smith machine and bosu ball, every tool has a job in the gym. The ladder is great when used appropriately. It does very little to build top end speed, agility or quickness compared to conventional training. Relying on the speed ladder as a main cog to your training might actually make the athlete slower.

It's great when used for conditioning, rehabbing and as a warm up for much higher impact movements but as a stand alone training tool, it won't make you an Olympic sprinter any time soon. 

Run Further & Faster: Strength Training for Runners

It's been almost a decade since I was consistently crushing half marathons at elite level times of 1:10:00. With that type of natural talent and success I of course took the logical next step to quit because I was tired of looking like a typical marathon runner! (sarcasm level 11) Below is a photo from high school and mind you I had been "lifting" for about 8-9 months. I think my wrists were the same size as my arms. 

2003

2013 , I look like a buff oompa loompa

• Competed in a physique competition
• Deadlift 3x bodyweight
• Bench press 2x bodyweight
• Squat 2x bodyweight

And while none of those numbers are going to win me a powerlifting competition, I'm very proud of the weight I've been able to move at 150 lbs. That seems to be where my body likes to maintain homeostasis. Alas I'm a very competitive person and the one thing that I continue to ask myself:

What if I had continued running instead of lifting weights?

In less than a month I will be 30 years old. And I remember vividly saying the day I quit running that I could always go back to running when I turned 30. The rationale was that I should take advantage of my prime years building muscles and getting stronger.* 

As 30 approaches, I've decided to seek out a new challenge in a familiar activity. Now armed with a decade of lifting and years of experience with a wide range of clients, I now want to know this:

Can I maintain strength and what relative size I've accrued and get back to running elite long distance times?

Strength is the basis for all athletic endeavors so it should include long distance running too. While there are diminishing returns on carrying more muscle as it makes you heavier, there is a healthy middle ground. Strength training is the missing component for keeping most recreational runners healthy.

A basic strength program has many benefits such as:

1. Building bone density, something many runners lack due to poor dietary practices leaving them at a high risk for stress fractures.
2. Maintaining muscle mass which is lost during endurance training. 
3. Improve functional strength and capacity which declines as you age.
4. Enhances endocrine and immune function which are compromised by endurance training.
5. Ability to rapidly correct muscle imbalances. Strength is a corrective exercise. The running joke with runners seems to revolve around what injury they're dealing with and how long before they can go back to running and ward off that same injury. 

What sort of strength training?

Free weights mostly and no machines DON'T count. Part of what makes strength training useful is the fact that you have to stabilize in multiple planes of motion as opposed to only working on a fixed track. A machine workout is practically pointless (from a functional standpoint) because running doesn't occur in a seated fixed motion either. 

When you do for example, a weighted step up, your body has to generate force in a single leg position. In order to perform the movement properly you'll need to force muscles like the adductors (inner thigh) and your abductors (outer thigh/butt muscles) to work together to stabilize your leg so you don't fall over. By training in this manner, you improve muscular balance and thus improve running efficiency and prevent problems such as lateral knee pain, hip pain, and lower back pain. 

I should add that many runners like to perform machine work in a slow controlled manner because it's somehow similar to running? Put simply, if you train slow, you'll be slow in competition. If you want to run a marathon, specificity of training is more important than mimicking what you think is hitting those "slow twitch" muscle fibers. When you run, focus on running. When you're lifting, focus on progressive overload and getting more athletic. 

Practical advice: Set tempo runs on days you lift and separate your longer runs at least a day apart from your strength days. 

Weight Training will make me heavy

Endurance training naturally is not conducive to growing muscles, especially in a female population with lower testosterone levels. Getting in enough calories is tough given the amount of volume performed. Any calories you take in will be used to improve overall efficiency rather than actual increases in muscle size. Add in the fact that in order to gain muscle, you need a surplus of calories, that's pretty hard if you're lifting AND running as well. 

Practical advice: A stronger muscle will get a little bigger, but make no mistake, you won't look like the hulk running 26.2 miles. Or JJ Watt.

Imagine if he could run a 2 hr marathon, there'd be no escaping him

Wrapping it up

Does every runner need to be able to squat and deadlift 2-3x their bodyweight? No, but you should focus on strengthening the posterior chain (glutes and hamstrings) to help balance out all the quad dominant work that goes on with running. Getting stronger in unilateral movements like lunges, step ups and single leg RDL's will help get the hips more balanced and thus making you a more efficient runner. And more core work like paloff presses, dead bugs and planks will help transfer energy to run faster and absorb the forces of the pavement. 

If you found anything I've mentioned helpful, insightful or funny I would request of you one thing, to hit that share button on the bottom and share this piece with another friends who runs or might be needed some guidance. Much appreciated!

*I've been running for about 45 days at 8:00 minute mile pace, with my best one mile at 6:50. I feel REALLY heavy, but I'm sure I'll continue to improve as I get in more miles. On a positive note, I've maintained strength and my physique fairly well while allowing myself to really up my carb intake to around 400-500g/ day which is pretty awesome.