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3 Ways To Still Train Your Quads with Knee Pain

atlanta decatur dr. mike knee pain physical therapy quads squatting strength training Apr 11, 2024

A common issue that almost all athletes will experience at some point in their careers is anterior knee pain. In short, this is an umbrella term to describe pain that is affecting the front of the knee. While several different structures could lead to such pain, that doesn’t matter as much for someone who is still able to train and perform without significant limitations. Think of someone who is in-season, approaching a competition, or is on the final training block before a big race. Time isn’t on their side to make long-term changes in the likely culprit of pain, however, this person would benefit greatly from slight modifications in the training approach to continue along their progression without worsening things. 


  1. Shin Angle. One of the easiest and most effective ways to tweak lower body training is to alter the shin angle. Movements such as squats, lunges, step downs, and so on often utilize a positive shin angle, meaning the knee travels forward over the toes during the exercise. While the long-standing notion that the knees should never travel past the toes is thankfully a thing of the past, there is still value in this ideology for short-term symptom management. Let’s look at a few examples 


Forward lunge → Reverse lunge 

Pistol squat → TRX assisted single leg squat 

Downhill running → Flat ground running 


  1. Trunk inclination. The angle of the trunk plays a large role in how much the quads are being loaded vs the glutes. A forward inclination will naturally shift more load towards the glutes while an upright trunk will naturally require more load to be placed on the quads. Higher activation from the quads inevitably leads to higher joint reaction forces at the knee cap and tendons in the knee. Again this pertains mostly to short-term symptom management, whereas in a rehab situation, we may want to target these specific deficiencies for long-term performance adaptations.  Examples of this tend to resemble the previous modifications


Front squat → Back squat 

Upright split squat → Bulgarian split squat + forward trunk 

Forward step down → Lateral step down + TKE 


  1. Knee extensions. This is really one of the only ways to legitimately isolate the quads. That being said, there’s also a potential to contribute to pain in the front of the knee. In a traditional seated knee extension, the kneecap will have the most joint reactive force when the knee is completely straight, and the least at 90 degrees. Everyones symptoms don’t match these biomechanics exactly, however, usually you can play around with the joint angles and find what range of motion feels the best on the knee. Generally, that will likely be between 90-45 degrees. While the range is notably limited, there is still a great stimulus to be had in this range if we alter volume or external load accordingly.


If you or someone you know is seeking guidance to manage knee pain, call us at 470-355-2106 or fill out the contact form in the link below. 


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Thanks for reading,

Dr. Mike, PT, DPT, CSCS, PES 

Let us help you figure out to live your best active life today! 

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