Have you had ongoing pain at the front of your knee and are currently avoiding every second exercise that is programmed into an F45 class? No lunges, jumping, and on a bad day say goodbye to squats too? How frustrating! Avoiding these aggravating movements is a good place to start for your recovery but is not a long term solution. Instead you need to slowly start bringing them back in at a lower load or intensity and build them back up!
Why am I getting Knee pain?
There's a few explanations as to why you’re getting pain in the front of your knee. One of the most common we see is called patellofemoral pain syndrome. This is where the kneecap isn’t tracking like it should be within its groove in the joint. Another culprit is the patella tendon that attaches your kneecap to your shin bone, that can become a source of pain when it is irritated or over-used (increasing the amount of activity or intensity too quickly!).
How do I get back to full classes again?
The first step to get you back to an unmodified class is decreasing your pain levels. There’s a few ways we can do this. In the first instance you want to de-load these irritated structures in your knee. The more you push into pain the longer your knee is going to take to settle! Think of it as short term sacrifice for long term gain. Yes you might need to miss a class or two initially (or heavily modify it) but this is better than pushing through and turning it into a bigger issue.
Next we want to calm down the muscles around your knee that are currently on ‘protective’ mode and get rid of any tightness and spasm. This can dramatically reduce your pain and get some of that movement back that you’ve been missing! There’s a few things you can do to achieve this.
- Foam-rolling the quads (thigh muscles). The quadriceps attach onto the kneecap and so any tightness in these muscles is going to put direct pressure onto the knee joint. Don’t forget the outside part of your quads (lateral quads), you want to use that roller on the outside of your thigh too!
- Using a trigger point ball on hip muscles - glutes and TFL. The hip muscles help control the knee and need to be loose enough to be able to work well!
Once you’ve decreased your pain and loosened up the muscles around the knee classes we need to take some load off the knee to allow healing to occur. This decrease in load can be done in a few ways. One way is to modify classes so that the aggravating exercises are avoided, such as jumping or lunges. Another way is to decrease how many classes you are doing in a week and replace them with another form of lower level activity that doesn't bother your knee (we want you to keep active!). If you are currently doing a class a day and your body is missing out on that needed rest day it's craving? Then maybe it is appropriate to cut down on 1-2 classes a week to decrease overall load in the short term.
Modification is easy with a bit of creativity. Are plyometric or jumping lunges sore? Take out the jump and do stepping lunges. Or if thats still painful switch it for a squat or a dead-lift if its strength day. When it comes to jumping make sure you are bending your knees to allow yourself to absorb the shock. You’ll also find that single leg hopping will be worse than jumping, so back it off to two legs. And any lateral movement e.g. the hated hurdle jump will be more challenging. Instead of jumping sideways try forwards instead. Convert your box jumps into a step-up and jumping through ladders to high knees or the “sticky-icky”. You get the idea.
If you’re one of the unlucky ones who gets pain on squatting, it’s likely either your technique isn’t quite up to scratch or your body is only using your quads and forgetting all the big muscles on the back of your legs. We can alter both of these by adding a band around your knees just above your kneecap. If you’re a F45 veteran you will have done this already in some of the classes. This promotes the glutes to work harder and also helps stop the knees from collapsing inwards (reducing the amount of pressure going through them).
During your modified stage, this is the time to start getting your knee strong again! Just doing the classes isn’t going to be enough, you need to be doing a specific rehab program to get the injured structures in your knee and surrounding muscles strong again! The stronger they are the more load (and classes woo!) they’ll be able to handle. Now every rehab program should be specific to the individual, but here are a few exercises to start you off!
If it's your patella tendon that’s the problem an exercise to start off with is a wall squat, but don’t let your hips slide too far down the wall to start with. If pain allows start off with 45 second hold x 5. Tendons love these kind of exercises so your knee should feel much better after!
No matter if its your tendon or kneecap that’s the issue we want to get you strong and stable in your hips and trunk, as its the hip muscles that help control the knee. This can be done through a glute bridge or hip thrust. Try a glute bridge with your arms crossed over your chest or if this is too easy progress to a single leg glute bridge, but make sure you can feel those glutes working and it’s not just your quads!
As pain continues to decrease start adding things slowly back in to your classes. Be careful not to go straight back to a week of full classes though as this is where you’ll run into trouble! As long as you add things back in gradually your body will be able to cope with the load and adapt. So if you had regressed to body weight stepping lunges, try adding in weight next time and leave the plyometric lunges until last progression.
Once you’re back to returning to a full class don’t let the exercises and foam rolling fade into a distant memory. Keep these going to maintain strength and mobility, otherwise you might find yourself back where you started!