Today’s article comes from legendary strength coach Mike Boyle. This just might be my favorite article ever written for strength & conditioning. So simple, but so important.
I get asked rehab questions all the time. I have rehabilitated athletes in almost every major sport who were told they were “all done” by a doctor or a team trainer. Because people know my background, they often ask for advice.
Most of the time they ignore the advice because the advice does not contain the answer they want. They say “it only hurts when I run”, I say things like “don’t run”.
A famous coach I know once told me “people don’t call for advice; they call for agreement or consensus. If you don’t tell them what they want to hear, they simply call someone else”. His advice to me, don’t bother wasting your time with advice.
Here I go again wasting time.
If you have an injury and are wondering whether or not a certain exercise is appropriate, ask yourself a simple question. “Does it hurt”? The key here is that the question ‘does it hurt?” can only be answered yes or no. If you answer yes, then you are not ready for that exercise, no matter how much you like it. Simple, right? Not really. I tell everyone I speak with about rehab that any equivocation is a yes. Things like “after I warm-up it goes away” etc. are all yes answers. It is amazing to me how many times I have asked people this simple question only to have them dance around it. The reason they dance around the question is that they don’t like my answer. They want to know things like “what about the magic cure that no one has told me about?”. What about a secret exercise? I have another saying I like, “the secret is there is no secret”. Another wise man, Ben Franklin I think, said “Common sense is not so common”.
If you are injured and want to get better, use your common sense. Exercise should not cause pain. This seems simple but exercisers ignore pain all the time and rationalize it. Discomfort is common at the end of a set in a strength exercise or at the end of an intense cardiovascular workout. Additional discomfort, delayed onset muscle soreness, often occurs the two days following an intense session. This is normal. This discomfort should only last two days and should be limited to the muscles not the joints or tendons. Pain at the onset of an exercise is neither normal nor healthy and is indicative of a problem. Progression in any strength exercise should be based on a full, pain-free range of motion that produces muscle soreness without joint soreness. If you need to change or reduce range of motion, this is a problem. Progression in cardiovascular exercise should also be pain free and should follow the ten percent rule. Do not increase time or distance more than ten percent from one session to the next. I have used these simple rules in all of my strength and conditioning programs and, have been able to keep literally thousands of athletes healthy. I’m sure the same concepts will help you.
Strength Coach Mike Boyle
I’ve been suffering from patellar tendonitis for 2 months. I have finally realized that I have to take a break from running and high-impact activities, much to my dismay. However, the activity that hurts the most is going up/down stairs, which I cannot avoid. How does your advice apply to something that you must do in daily life?
Thanks,
Amy
No expert here, just a fellow sufferer of many years. What worked for me, and what still works for flare-ups is pressure applied to the politeus to remove tightness. This is something a chiro recommended to me. Hope it works for you.
Bret, thanks putting up this article. We all need to hear the truth about these errant thought processes every once in a while!
Truth is a very powerful guiding principle, like “True” North. It exists, and it is unwavering across all platforms, all situations. It is truth.
Should you train through pain? Opinion.
(I think I just started channeling my inner Yoda.)
“Do or do not…there is no try” Yoda
This quote seemed to apply 😉
If it hurts, don’t do it…if it doesn’t hurt, do it. As Mike says, basic common sense.
Perhaps some SMR or Trigger Point Therapy? Those quads and IT bands are probably jacked up.
Amy,
I understand your question was directed at Boyle but I had similar knee discomfort starting this past summer. The better question to ask is, “Why does it hurt?” and then work backwards from there. Figure out the factors – and movements – that are contributing to your pain.
My experience was to decrease quad-dominant exercises and intensity, cycle on a stationary bike for movement in my knees, and supplement with this: http://truenutrition.com/p-1078-joint-support-7875mg-capsules-120-capsules.aspx
The less intensity and medium volume of activities has benefit me.
Amy, I’m sure you can avoid much of your stair activity by taking elevators/escalators, and you may be able to climb/descend in a manner that doesn’t aggravate the knees such as leaning forward on the way up and focusing on relying on the hips. Just try to the best of your abilities to remove the insults and allow for healing. When pain subsides, gradually progress until you’re back to normal.
To Amy and Bret: Warning! Nerd alert…
You nailed it Bret. The quad is in a tricky spot here. Soften the knee. Just enough quad eccentric into isometric and finally concentric tension to stabilize the knee, and allow the hip to extend. We take simple moves for granted, but all movement at root is highly complex, as you know.
Amy, another cue might be to concentrate on driving through the whole foot as you rise. Lean forward at the hip and push down THROUGH each step, as though you would like to “break the stairs”. Visualize crushing the stair below you on each step with your entire foot, heel and ball. This may promote a nice posterior chain/anterior chain co-contraction and clean up the painful pattern straightaway.
This is why front lunges are sometimes painful. You have a CNS dilemma to sort out. When descending into the lunge, (or ascending into the next step), you cannot pre-tighten the quad! It must lengthen. Yes it’s counterintuitive as heck, that climbing stairs involves lengthening the quad, but consider that you must flex the knee to “grab the next step”. (Let’s dont tackle the RF, and it’s confusing dual role in hip flexion, this post is already a freaking guest blog, ha ha..)
I’m convinced that confusion, or mixed signals to the muscles in question as to whether to concentrically contract or eccentrically lengthen is a huge variable in joint pain. If the muscle won’t lengthen appropriately, the tendon will pay the price, as the force must be absorbed somewhere.
I have shared Amy’s problem. The pain can be your immediate proprioceptive guide, just like a baby that learns quickly from falling down trying to rise to stand, to wobble, to walk. Now clearly, if you can’t figure out how to take stairs without pain after countless “reps”, then you are going to have to regress the move to walking up a hill, etc., as you are just provoking further injury and inhibition. This is the fine line of knowing your body, and knowing when to stop doing the activity.
Where this gets exceedingly complicated is that pain going up and down stairs is not particularly different than any other training movement. It is, or has become, a pain provoking activity. Yes, you could avoid it, b/c it provokes pain. But you are never going to learn and groove a pain free technique without at some point wading directly into the painful activity. To what extent you should allow pain while learning and peforming movement is the subject up for debate.
Good luck, Amy! Your response below sounds like you have a good trainer, and are beginning to sort this out.
OK, sorry, one more thing. The importance of leaning forwards is not just to better engage the posterior chain. It is also to better center the weight over the foot where it can exert force more smoothly.
So for example, if you had to climb the stairs pulling a sled, this might provoke more pain than if you had to push a sled up the stairs.
Both moves necessitate leaning forwards, but the body seems to more intuitively understand that pushing forwards is going to require the lean.
So Amy, if you are ever helping your friend move a couch up the stairs, make sure that you are in the bottom “push” location.
Yes, I really do think about this stuff. 🙂
Wow–I haven’t checked this thread for a few days and missed the fantastic advice and responses. Thanks to Derrick, Bret, and everyone else who chimed in.
I most likely injured the knee doing heavy weighted step-ups, but I believe it was a “straw that broke the camel’s back” situation. I agree that my posterior chain needs strengthening. I’ve been following Bret’s work for about a year and have already seen positive changes in what used to be my under-utilized glutes. I am foam-rolling occasionally but will roll every day. I’ll experiment with the new methods of going up/down stairs. My trainer and I are focusing on better form for my activities and training me to stabilize through my core (which is also weak).
Also, thanks for the positivity. The psychological element (I’ll never run/squat again!) has been one of the hardest things to deal with. I’m planning a hike up to Machu Picchu in the fall and plan to be fully recovered by then!
Hey amy, I’m just a regular guy, but I’ve dealt with that in the past as well. What worked for me almost overnight is foam rolling my IT band alot. in minutes the pain i’d had for 2 years went away. just my 2 cents.
Amy,
Whilst it is almost impossible to answer your question without properly assessing your patella tendinopathy, it may well be HOW you are going up and down the stairs. Commonly I see patients with your condition who rely almost whollly on their anterior chain ascend/descend stairs. That is to say that they predominantly use their quadriceps to drive lower limb extension, rather than their posterior chain (Glutes, hamstring, trunk erectors) to drive extension, they will often also create increased shear loading in the knee by allow the knee to drift forward over the foot. The reliance on the quadriceps places significant load across the patello-femoral joint and into the patella tendon. .If this is the case in your situation then I would advise you to spend some time working on your posterior chain, and Bret’s site is the best place for that information.
One test that I try with my clients is to have them walk up stairs, but to place the whole foot on the step and pull up the big toe and push through the heel. This has the effect of loading posterior chain and if it changes your knee pain then my hypothesis may be right.
Of course all of this is specualtion and I would advise you to seek the opinion of functional movement specialist of some descripition so as to a full assessment and and appropriate exercise program tailored to you needs.
Good luck with you knee, and finally, think of your time off from running as time gettin fit enough for running, not lost training time…
ACDC
Amy,
Patella Tendonitis is usually caused by tightness of the quads, which result in tension on the patella tendon (pain). Try rolling out your quads, IT band and stretching hips to start. Tightness in the quads may not be solely a quad issue, as lots of crap connect to the quads and therefore affect them.
Also, make sure you are working your posterior chain (hamstrings, glutes, etc) to ensure your anterior chain (quads) are not compensating for a weakness anywhere else.
good luck!
Niel–thanks for your response. I have started working with a trainer. She believes the injury was due to bad form and/or muscular imbalances. We are working on those patterns and teaching me to stabilize through my core better. How long did it take for your knee to recover? I will try the supplement that you recommend.
My injury occurred mid-July and I’ve only recently seen major improvements after I took the supplement for 30 days. After the one bottle I bought ran out I did not continue it to see how I would fare. Overall my knee is better. I’m still testing the waters with light squats and marginally increasing the volume each week. I’ve also found terminal knee extensions to help for whatever reason (this wasn’t the case pre-supplement nor were my quads and hamstrings weak).
The best I can advise is to experiment with slight modifications to exercises, take it light, and gauge how your knee responds. You can form your own assessment from there on how to be approach things.
This process is all well and good for ‘exercisers’ as Mike puts it. What about competitve athletes? There are huge pressures to get players back on the field or to get lifters back in the gym; the simple yes/no theory doesn’t stand up (very well) here. I work in various sports including rugby, if the players had to follow this principle we’d struggle! Yes, we are selective in our choice of exercises, volumes and intesities for certain individuals but this is far too black and white for competitive athletes, unless they are returning from a long term/serious injury.
Also, I’m a compete in olympic weightlifting and my wrists, elbows, knees and hips hurt almost everyday. The pain eases once I’m warm but based on Mike’s theory I wouldn’t train due to squats/cleans/snatches causing pain/discomfort at the start of the sessions.
Thoughts?
O*
Agree Owen. But the point is to avoid exercise-induced pain whenever possible. I know a bunch of rugby guys who are always training around injuries, and this advice still applies in the weightroom. Sure they’ll likely reaggravate symptoms on the field, but in the weightroom they should avoid things that will exacerbate the problems.
Sometimes, people push themselves and perform exercises that can cause them pain and more injuries. Acceptance or by letting time heal all the pain, physically and emotionally, I think is the best way to address this kind of problem. There will be more consequences, that may become permanent if you push yourself too much.
“A genius is someone who takes a complex thing and makes it look simple. An academic does the opposite.”
― Robert Fanney
In the begining of March I had a knee injury on the ski slope: the lateral collateral ligament of my left knee was torn 🙁 Four weeks later i still can’t flex or extend my knee to the full range of motion, but it gets better every day.
Right after the injury I did only pull ups and push ups (btw increased my pull up max from 4 to 7!). I started doing bodyweight squats, as soon as I was able to, always going as low as I could without pain. First it was just above parallel, but now I’m almost back to my “ass to grass range of motion”. Luckily hip thrusts weren’t a problem two weeks after injury 😉
Yesterday I received my copy of Strong Curves via Airmail! And although my knee hasn’t 100 % recovered yet, today was my first workout from your book (without any pain)!!
Thank you, Michael Boyle, for this awesome, for many of us eye-opening post.
And big thanks to Bret – your book is wonderful!!
Thanks for the advice…you didn’t waste your time. You termed it perfectly. ‘discomfort’ after a set or workout vs ‘continuous pain’. Recovery happens a lot faster when you listen to your body.
A good coach can teach someone to do an exercise without pain. A bad coach has to tell his clients to stop doing the exercise.
Hi, So I aggravated my knee about 10 months ago from a sudden increase in walking (on vacation 8-10hrs with bad shoes). My knees hurt a lot even when I did no impact activities (elliptical etc). So I let it rest. For a long time. It got better and was fine, as long as I didn’t exercise or wear heels. But after 6 months I went to a doctor because it wasn’t going away. They did xrays and MRIs and just found some aggravation in one knee. Basically they said it was how I was aligned and I needed to strengthen my core so that less pressure was on my knee. It was about how my knee tracked. I haven’t had much physical activity in the last 10 months other than going swimming a few times (I’m not much of a swimmer).
Recently (3 weeks) I joined a training place because I’m tired of being out of shape. I think my knee is better but it still hurts if I wear heels but it doesn’t hurt when I do the elliptical etc. At this new place, the trainer has me doing a lot of squats, lunges, hip thrusts etc to strengthen my lower body. I am experiencing some pain in my knees again. It is manageable but I’m afraid of overdoing it. He says that I will experience some pain because I haven’t done anything in so long. It kind of makes sense but I’m not sure, especially with so much lower body movement. I’ve been going 4x/week and after this last time, I was wearing heels and felt like there was fluid in my knee and felt unstable. It was ok when I changed into sneakers but the pain was disconcerting.
When I’m jumping rope, it doesn’t hurt but I wonder if it translates to the pain I feel later. Sometimes I feel pain in my knees after doing so many squats. I think I’m quad dominant because I really don’t feel anything in my hamstrings. That’s another question I had, how to work on the hamstrings. Anyway, this post makes me concerned about my knee pain and if I should be listening to my trainer or not. Is working through some pain ok? Especially if it goes away after a day?
By the way, I thought the banded hip thrusts were ridiculous until I found this site. I guess I should have more faith in him. I only felt it in my quads until we but a tighter band on, and then I felt it in my glutes.