T Nation

Glute Imbalance & Knee Issues

TL;DR: bum say ‘no’, knee go ow

Background: at the end of 2016 after a year or so of half-arsed training on a half-arsed program I squatted 95x2 and 90x3 as a high-bar max. Later that day I ran across the road to catch a bus, and as I climbed the stairs in the bus my left knee locked up and it caused me a lot of pain to straighten it.

After about 30-45 mins on the bus and hobbling off I was able to walk on it and limped around. It was OK a few days later but after a couple of physio trips including one misdiagnosis I was given a patellar tendinitis verdict, with an inactive/weak left glute as the cause.

This had me not really squatting or deadlifting for most of that year. Light squats were OK but as soon as I approached anything remotely challenging, my knee would be flaring up again the next day.

When I started this log I’d just begun again, having made the switch to low-bar which was much better on my knees.

However, today my left knee feels basically the same as it did this time last year - low-level, sharp pain under weighted extension e.g. squats, climbing stairs, etc. A low and manageable pain (maybe like 3/10 tops), but still concerning.

Don’t think it’s a coincidence that I’ve added front squats recently, which are much more knee-focused. I won’t blame them entirely, though; I’ve not really done anything to address my glute imbalance except to squat and deadlift more.

I had my girlfriend test my glute strength today, by my lying down and abducting my legs out against her resisting. She’s no physio but she reported that my left leg was significantly weaker.

So, pending consultation with an actual professional if I can find one here, I presume that my left glute isn’t firing properly in squats/front squats which is forcing my knee to do more work than it should and placing undue stress on it.

Moving forward

I will be looking to talk to a physio but until then this is the immediate plan for the rest of this Young Wendler cycle I’m running (next 2.5 weeks):

1. Swap out front squats for leg extensions and single-leg glute bridges.
High-bar squats made my knee flare up so front squats are likely doing the same. I still need to bring up my quads, and obviously single-leg glute work will help me out.

2. Do glute activation drills before squats/deadlifts.
After Flexible Five and before my KB squat/swing sets, I’ll add in some glute activation stuff and see if that can get them firing.

3. Do focused glute work each day.
I should have done this before, but I should have done a lot of things. No changing that now, so better learn from my mistakes. Clams/bridges etc. each day, using Brett Contreas’ 2:1 method of doubling the work on the weaker side to bring it up to speed. I’ll also be doing isometric wall sits as prescribed last time I had patellar tendon issues.

4. Potentially just do the prescribed sets for squats
I’ll see how my knee feels next Monday but it might be an idea to cut out AMRAP sets on squats for now with a view to really focusing on getting them balanced and solid.

5. Any further advice?
Very keen to get this sorted out so all advice appreciated!

I would look into a MRI just to make sure of what the issue is.
Leg extensions/leg curls can be very hard on the knees.
Single leg squat to a box not below 90o can be a good option.
I broke my knee in November (tibal plateau). I have been doing a lot of physio work (30 minutes per day at home plus 2 x week physio visit) Biking is ok for me. I used a lot of bands, body weight exercise, leg press. Now just starting to add front and back squat and deadlift

I’d probably drop squats completely and train my legs with single leg movements, keeping a vertical shin angle. If you can set up a leg press to use a vertical shin that’d work too. The shin angle is key.

Also more core work. Weak glutes and weak core (pretty much) always go hand in hand.

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Roger that mate. Why the vertical shin?

Was planning to do lunges/single-leg RDLs.

easier on the knees and more glute activation.

I think single leg RDLs are a circus trick but some people see a benefit. Unless your low back is a concern I’d just stick to the regular version. I understand you want to train the movement unilaterally because you have a side weaker than the other, but meh, I think with all the other unilateral shit you’ve got in there you’ll be fine.

you also need to be super conservative with your leg extensions.

I’m coming back from my second ACL rupture and alot of the rehab is glute related.

I’ve found the hip circles/ thermobands very use full and would recommend you invest in some.

Also i’d look into controlling the range of motion on you leg extensions as stated they put alot of pressure through your knees I wouldn’t go to lock out if i was you.

With lunges i’d recommend trying reverse lunges and it encourages you to kick backwards decreasing the likelihood of your shin going past vertical.

Finally with the glute activation i’d throw in some adductor SMR for good measure.