Hello,

I trust you're safe, fit and well.

All strength to Ukraine 🇺🇦🇺🇦🇺🇦🇺🇦🇺🇦🇺🇦🇺🇦🇺🇦

​⇒ Apologies to those of you who jumped on board my rowing variations last week - exercise number 2 should have said "20-second sprint" every minute on the 40-second mark of every minute, not "40-second sprint".

In this week's newsletter, for the first time, I'm going straight down the line on one topic only - knees and knee pain. In particular, how to reduce wear and tear, how to strengthen the muscles stabilising the knee joint, and how to reduce or eliminate pain.

There are many misconceptions about knees, exercise and pain. I'll try to sort some of those misconceptions out for you.

There are proven biomechanical reasons that walking backwards is often less painful if you have knee problems - see item #2.

Squats are great for improving knee stability, but some squats apply much higher compression loads than others - see item #1.

⭑ Squat without the knee joint compression of back squats - try this ✔
⭑ Ankles absorb the compression forces of walking when walking backwards ✔
⭑ Reverse lunges can be knee killers - do these instead to strengthen them
⭑ Front squats are a knee joint-friendly exercise - here's how to get started ✔

01 Squats Are Not The Enemy of Knees, Especially Front Squats

As we age, we more frequently hear our friends say that they can’t squat because they have knee pain.

However, it is often a lack of exercise that is the root cause of the pain. As your muscles weaken, they fail in their ability to stabilise your knee joint, and bits that should be kept apart rub together and get over-compressed.

Squats strengthen all the muscles stabilising the knee joint, including those attached to your hips and lower back. With back barbell squats - if you can maintain a strong neutral spine position - you can move enormous loads with relatively low spinal compression.

⇒ However, back squats result in significantly higher compression forces in the knee joint compared to the front barbell squat, despite both squats being equal in terms of overall muscle recruitment.

What this means for you: This suggests that front squats are advantageous if you have knee problems, and for long-term knee health - if you are not seeking the ultimate muscular power possible with heavy back barbell squats.

⇒ See item #4 for how to safely do front barbell squats.

Heads-up 1: Be aware that the front squat requires much higher mobility levels if you want to complete the exercise with perfect form. The front squat requires you to hinge at the hip and knee until your hip joint actually dips below the parallel of your knee. You can start with a small range of motion and gradually increase it.

The back squat doesn't require you to have as much flexibility in your hips, knees, and ankles, so it could be a more straightforward exercise to perform. However, over time the back squat can cause pain in these joints, whereas the front squat is considered a joint-healthy exercise.

Heads-up 2: Using a leg-press machine is not a substitute for free-standing squats. The benefits for your knees are minimal as the machine does not strengthen all the necessary knee joint stabiliser muscles.

Leg-press machines are designed to limit the range of motion and stability, leading to an increased risk of injury to your knee joint when doing real things, such as standing on your own two feet. Additionally, they are designed to limit the recruitment of muscle groups, leading to decreased neuromuscular activation. This leads to decreased strength and balance, which is highly detrimental as we age.

Related: The Surprising Way Hip Flexors Pull You Down Into An Elderly Stoop And ​Shuffle, And How To Avoid It​

​

02 For Your Knees, It Is A Forward Move To Walk Backwards

This is pretty simple - walking backwards generally helps ease your knee pain.

Walking backwards is a different movement pattern from walking forwards, as the forces and joint power patterns of the ankle, knee, and hip are very different.

When we walk forwards, the main propulsion and shock absorption joint is our hip, with the knee and ankle joints providing stability and control.

⇒ In contrast, when walking backwards, the main propulsion and shock absorption joint is the ankle, with the hip and knee providing stability and control.

This means there are low compression forces on our knee joint, thus reducing pain caused by higher compression forces when walking forward.

Walking backwards also shifts the force of our weight to the back of the knee joint, rather than the front. This transfers the strain to the structures at the back of our knee, such as the hamstrings and the Posterior Cruciate Ligament (PCL).

However, since it is usually the Anterior Cruciate Ligament (ACL) that has suffered decades of pounding and compression, the PCL is in relatively good condition and less likely to be the source of pain while walking. Thus it does not hurt while walking backwards and the load is taken off the ACL.

What this means for you: When you can take the opportunity to walk backwards - where it is safe to do so.

The glutes and the posterior hamstring muscles are the primary muscles we use when walking backwards. As these muscles are rarely used in this way, they will be less efficient and tire quickly.

In addition to the primary muscles used for walking backwards, the lower back and abdominal muscles are also used. The lower back muscles are used to keep your body in an upright posture and the abdominal muscles are used to maintain balance while walking backwards. These muscles are also used more when walking forward, so they, too, will fatigue more quickly when walking backwards.

You will feel all these muscles tire quickly, especially if walking backwards up an incline. Practice walking backwards for short periods of time to build up strength and endurance, and take care not to overdo it in the early days.

By activating all these muscles through a new form of movement you will not only experience less knee pain immediately - while walking backwards - but also over time as a result of better balance and knee stability when walking forward.

Related: Walking Backwards Benefits So Much More Than Your Knees​

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​

03 "Strengthening" Your Knee Joints With The Least Risk

We can’t "strengthen" our knee joint but we can strengthen the muscles and tendons which stabilise our knees.

However, many of the exercises which are typically recommended for this purpose place tremendous strain on the knee.

For example, reverse lunges activate and strengthen the quadriceps, hamstrings, glutes, and calves. An alternative exercise to lunges with similar benefits but which creates lower shear forces on the knee joint is a step-up.

A study published in the Journal of Orthopaedic & Sports Physical Therapy found that step-ups created significantly lower posterior shear forces on the knee joint than reverse lunges.

The study concluded that step-ups are a safer alternative to reverse lunges for people with knee issues or those looking to reduce shear forces on the knee joint.

What this means for you: It is important to work on strengthening all of the muscles and tendons which stabilise our knees. Here are three which do this while avoiding the high forces of more common strengthening exercises:

1. Calf raises: stand with your feet hip-width apart and slowly rise up on your toes. Make sure to keep your knees slightly bent and your back straight.

Keep your body weight evenly distributed between your feet and make sure to keep your knees slightly bent throughout the exercise. Do not lock your knees as this can cause strain and injury. Repeat this motion for 10-15 repetitions and then rest for several seconds before beginning another set. Hold weights as you get stronger.

2. Single-leg Romanian deadlift (RDL): Research shows that the RDL exercise creates less anterior and posterior shear force on the knee joint than a backward lunge or other high-shear force exercises. RDLs strengthen the stabiliser muscles attached to the knee, which further reduces shear forces on the joint.

Watch this very good video on how to perform proper single-leg RDLs. Note the crucial tips, especially with regard to the active leg and foot position and the need to keep the hips closed, not open.

3. Step-ups: stand with your feet together. Place one foot on an elevated surface, such as a step, bench, or box. Keep your chest up as you press through your heel and drive the other leg up and onto the step. Keeping your weight on the heel of your standing leg, slowly lower your other leg to the floor in a controlled manner. Repeat the motion on the same side or alternate sides.

Hold weights as you gain strength. Avoid over-extending your knee joint during the step-up.

​⇒ Doing these exercises 2 or 3 times a week will improve the stabilisation of your knee and could result in less pain, and will result in a lower likelihood of future injury from knee joint instability.

Related: Rebuilding Your Fast-twitch Muscles Doesn’t Require Fast Movements. Rebuild Your Balance in 2 Minutes Daily​

​

04 Safe Front Squats To Stabilise Your Knee Joints

Front squats are effective for stabilising your knee joint, without incurring the compression forces of a front squat.

You do not need a heavy weight for front squats to be effective.

What this means for you: Here are progressions to reach a full front squat capability with the least risk. Firstly, let's set up the fundamentals of the squatting movement.

Front squats are initiated by a hip swing, driving your hips back and down, not by starting with bending your knees. This hip swing should result in a slight forward lean of your torso with your feet remaining firmly planted on the ground and your knees bent but not excessively forward.

In the classics, they say to not let your knees extend forward beyond your toes, but this is not as important as keeping your knees in line with the direction of your feet.

Once your thighs are as low as is comfortable, push through your heels and drive your hips forward until you are standing upright. That's one rep.

That's it. Here is how to get started and progress:

1. Start with an isometric hold, which means holding a standing position with your feet shoulder-width apart and arms crossed over in front of the chest. Hold this position for 1 minute and focus on engaging your core and maintaining good posture throughout. Next, rest for 1 minute, and then begin to squat as described above in gradually deeper squats while maintaining your stability. Keep doing this 2 or 3 times a week until you are comfortable to weight, and try to lower until your thighs are parallel to the floor.
2. From the isometric hold, progress to a goblet squat by holding a light weight (2 or 3 kg) with both hands in front of your chest. Keep your feet slightly wider than shoulder-width, toes pointed slightly out, then push the hips back and down and lower down until you feel a stretch in your hips and thighs. Push back up to the starting position and repeat 8-10 times, twice a week.
3. When you feel stable and strong enough, you can begin to perform the front squat with an unloaded barbell. Start by standing with your feet about shoulder-width apart and the barbell across your front deltoids (up high on your chest). Ensure that your elbows are raised and pointing out to the side. Your hands should be just outside your elbows and your wrists should be straight. Push your hips back and down and lower into the squat. Push back up to the starting position and repeat 8-10 times, twice a week. Increase the weight when ready.

Watch this very good video illustrating a barbell front squat. The video demonstrates the crossed-arm barbell grip, which is more advanced and used with heavier lifts.

Thanks for reading!

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>> My Latest Blog Post: How Many Pistachios Should I Eat For Sleep and When?​

About the newsletter: Do you think it can be improved? Have a story idea? Want to share about the time you met Chris Hemsworth, or your questions about how to live longer better? Send those thoughts and more to me at walter@bodyagebuster.com

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