The definitive guide to knee pain during lunges.
Make no mistake about it. Lunges are one of the best lower body exercises you can perform.
The problem?
A lot of people complain about knee pain when doing different kinds of lunges.
So, do lunges hurt your knees, or is there some more mysterious afoot? Let’s investigate.
Let’s get some housekeeping out of the way first. There are basically four different kinds of lunges.
Back lunges.
Forward lunges.
Lateral or side lunges.
Walking lunges.
This discussion is going to primarily focus on the back lunge. A lot of the ideas discussed will also apply to the walking lunges as well.
Forward lunges, in my opinion, are not that great of an option. I don’t do them or prescribe them for any of my clients.
Lateral lunges are good but they are very technical and difficult to progress.
Let’s begin our investigation by looking at which knee hurts when you lunge.
Pain in the back knee
Pain in the back knee when performing a back lunge is usually the result of too much pressure on the back foot.
This typically happens because you keep a vertical torso position which shifts the weight from the front leg to the back leg.
Check out the video to see what that looks like.
Pain in the front knee
Let’s say that you are feeling some pain in the front knee when you are lunging. What does that mean?
This one has more potential suitors than the back leg, so let’s meet the contestants.
Interestingly, the same vertical torso position can cause pain in the front knee as well. As you shift your weight back on the back leg, your front knee starts to fall behind your ankle joint more.
This leaves the front knee in a compromised position when trying to get up from the bottom position.
Check out the video below to see how this position can contribute to front knee pain.
Pain in the front knee can also be from a poor ability to hinge at your hips and to engage the glutes.
This tends to show itself as too much pressure on your toes and not enough pressure through your heels.
Once your heel comes off the ground, your glutes are essentially shut off and cannot help you.
See what your poor hip hinge looks like in the video below.
Lack of the hip and glute involvement can also lead to poor stability at the hip which leads to a fancy term of knee valgus.
This basically means your knee collapses in towards the other knee.
Knee valgus. Check.
Even though the term is knee valgus, this movement is NOT a knee motion. Your knee is a hinge joint so your knee bends and it straightens.
When it dives in like that, there is a lot of stress put on the knee joint. By the time it starts to hurt, you have probably been doing it for years.
If knee valgus shows up when you are doing lunges, I am willing to bet it is happening when you are doing a lot of other things as well.
Friends don’t let friends knee valgus. See what I mean below.
One other consideration, especially if you would describe your knee pain as coming out of nowhere, is the role of the IT band.
If you didn’t know you had an IT band, you are in for a treat.
The IT band runs from the crest of your hip down to your knee cap and the top of your shin bone (tibia).
When it gets tight, it can pull on the knee cap and interfere with proper tracking of the knee cap. You see, when you bend and straighten the knee, the knee cap should slide up and down a little.
Instead of the knee cap sliding up and down in its groove (think of a train on train tracks) it gets pulled to the side so it drags along the side of the groove.
This can also cause some of the structures on the inside of the knee cap to be stretched which can also be a source of pain.
How do you fix knee pain when lunging?
We have discussed some of the ways you may experience knee pain during lunges.
Now we are going to discuss how to get you out of pain.
Foam roll IT band
Deload the movement
Hip hinge/hip stability
Motor control to limit knee valgus
[1] Foam rolling the IT bands is the easiest entry point. It just requires some consistency on your behalf and an insanely high tolerance for pain.
I kid, I kid.
But seriously. If your IT bands are locked up, this is going to hurt. But it is the good kind of hurt.
While we are discussing soft tissue work, which is a category rolling the IT band is a part of, there is saying that I repeat to my patients and clients.
“The more it hurts, the more you need to do it.”
If you roll your IT band and you see stars, start sweating and time seems to stand still when you are on the roller, you would think it is a horrible thing and you should never do it again.
Actually, you want to do it often. Usually 2-3 times a day but for only a minute or two each time. Keep this up for 7-10 days and you will notice significant improvements.
It is damn near impossible to stretch the IT band. I wouldn’t even bother trying. And, sometimes tight muscles are not tight because they are short but because they are already overstretched. I have written about this before HERE.
Check out the video to see why the IT band is such a key player in your knee pain during lunges.
[2] Deloading a movement can be used both as an assessment and as a means to work on improving the quality of your lunge and increasing your leg strength.
If there is pain in your knee(s) when lunging, deloading the movement can give you insight as to the potential cause of the pain.
If you deload and the pain goes away, there is a pretty good chance that your knee joint is ok and the pain is more muscle and movement-based.
This would be the perfect way to start working on your lunge technique.
One of the first steps to getting out of pain is to reduce or eliminate the irritating factors. Deloading can do both.
Check out the video below to see if deloading lunges might be right for you.
[3] The ability to perform a proper hip hinge is kind of a big deal. I could write an epic novel on the topic but will just hit on some key points now.
I have seen people struggle with this concept for months. I only mention that to offer perspective.
It will take time to master this idea if it is new to you.
You should really be focusing on keeping your heels anchored to the floor and initiating the movement at your hips.
Your hips and knees will bend together, but you want to initiate the movement with the hip, not the knee.
Doing this creates a forward lean at your trunk. Doing this allows your spine to maintain its position throughout the motion because the forward motion comes from your hip moving, not you bending your spine.
If you are still struggling to get the movement down, use a foam roller to help with balance and to help facilitate the hip hinge.
Check out the video below to see how it all comes together.
[4] The motor control idea is intertwined with the hip hinge but warrants a separate explanation.
I know plenty of people that are strong but have poor motor control. Motor control is how your body coordinates all the movements you ask it to perform.
Your body won’t do a movement correctly just because. You have to make sure it does which is different than just pure strength.
Motor control, with the hip hinge, is how you start to correct knee valgus.
You have to spend retraining HOW you do the motion. Using the foam roller, as mentioned above, can help with this.
Another strategy that can help is to improve your transition from the lower down to going back up.
To that point, the hip hinge needs to be part of the entire motion, not just the start. When you hit the bottom position and start coming back up, you need to keep all the tension in the muscles you had on the way down.
The transition at the bottom is where a lot of people struggle. If you get to the bottom and the knee dives in and you come up without correcting it, you are reinforcing the problem.
But, if you stop, or pause at the bottom, and make any corrections to the knee position, you start to address the problem and will influence the motor control.
Check out the video to see what I mean.
BONUS STRATEGY
One of the ways I help people improve their knee pain when lunging is not to perform lunges. I know that sounds dumb, but hear me out.
Lunges and split squats are terms that are often used interchangeably. They are similar but they are not the same.
During a lunge, one leg will move back on each rep. During split squats, your feet are set and stay in the same position until all the reps are completed.
Why does this matter?
The act of stepping back and forward on each rep increases the complexity. The motor control is more dynamic.
This is neither good nor bad. It just is.
When trying to learn the motion, removing complexity is not a bad idea. Work with the spits squats to address your hip hinge, torse position, depth, and knee valgus.
Spend some time with the split squat, then come back to some lunges to reassess your technique.
Split squats can also be done deloaded so that strategy can be combined quite nicely.
The big finish
The strategies I have listed are time-tested and have worked for clients and patients alike. They will work for you too.
Do not expect this to work over the weekend. Making these changes will take time.
You will be working on getting out of pain, changing how you move, activating different muscles, and improving the neuromuscular control (motor control) with this movement.
None of that will happen quickly.
Be consistent. Be patient.
Before you know it, you will be a lunge champion.
Until next time,
Dr. Tom
