Putting An End To Mystery Knee Pain

It’s easy to miss these often overlooked and easily fixable errors in your lower body training.

Knee pain… It happens. In powerlifting, it might have held you back from consistently training your squat or deadlift, or simply makes you compensate around it. Either way, it can hold you back from really making great gains in your performance. Maybe you’ve had it yourself, but have never been able to shake it, or it only hurts when you squat to a certain depth, or in a certain pair of shoes. Regardless of when you notice it, today we will be going through a very common cause of knee pain that gets overlooked all too often: tibial rotation.

This is not intended to diagnose your specific knee pain problem or supersede the advice of a doctor, but if you coach yourself or others, it might be a good place to start looking when you are dealing with knee issues.

Tibia Rotation
Tibia Rotation Details

When you train bilateral lower body patterns such as squats and deadlifts (for powerlifting), often times you can lose the ability to stabilize over one leg as you train on both all the time. As such, you will start to develop positions and patterns that are more efficient in those movements. At the knees and ankles, this often shows up as a lot of tibial external rotation (shin bones point outwards). Unto itself, this isn’t bad, but if you have an excessive amount of tibial external rotation, it can be challenging to keep a good foot and hip position as well, which can lead to “bleeding” of power in the movements and excessive torque on the knee.

To see how this works in the context of a squat, watch this video:

Our fix here is simple: learn to create hip external rotation and abduction (you need it for efficient squatting and deadlifting) while maintaining congruent relationshop between the tibia and ankle in order to minimize torsional forces through the knee. Even though the lunge drill outlined in this video is more squat-oriented, it still works great for deadlifting, particularly with sumo and hybrid styles.

Programming Considerations

When I use these drills with my athletes I will put them into one of two places in the workout:

  1. Skill Acquisition
    if the athlete in question is just learning to use this technique for properly loading the foot, ankle, knee, and hip, I will use the drill for a few sets of 15-30 reps per side as a lower body general warm-up. It checks all the boxes for what I would look for in an effective pre-lift routine: increases core temperature and joint lubrication, practices a skill development, and is specific enough to the lifts you are going to train so that you can be focused with your warm-ups and not have to do 20 different exercises to get ready to lift.
  2. Skill Practice
    After the main work in an athlete’s program, they will likely have some single leg training programmed into their accessories. Simply implementing this technique (with or without the use of bands) can be an excellent way to build up their technical thresholds so they can more effectively apply the skill into their competition squats and deadlifts.
    As it should be clear by now, there are a variety of causes for knee pain, but more often than not, a lack of active control and coordination between all the joints of the lower body can be a huge contributing factor. If nothing else, improving how you load these joints will get you moving more efficiently so you can lift bigger weights in the long term. At best, it gets you over that persistent “mystery knee problem” that has ailed you and lets you train as hard as you want to again instead of being held back by nagging pains.