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Inside Knee During Hamstring Exercises

Recently I have been experiencing slight pain after hamstring exercises in the inside of my knees.

Tonight I trained hamstrings and paid close attention to my form to ascertain any potential problems. One thing I noticed is that durring my rack pulls and leg curls my knees (and lower leg) angle inwards. To illustrate, imagine you are standing and doing a quad stretch (bringing your heel to your ass). Instead of my heels each finishing towards the outside of each glute, they travel slightly inwards towards the middle of each glute when I do leg curls.

I suspect I have been doing leg curls like this for a long time because when I consciously tried to contract my hamstrings whilst keeping my legs ‘out’, the movement felt quite different.

This tendency may be linked to the fact that my ankles/feet roll inwards (flat feet).

  1. Any possible causes for pain in this area?

  2. Could what I have described be the cause?

  3. Possible remedies beyond consciously correcting form?

Thanks in advance.

Bump


By “inside of your knee” do you mean the internal part of your knee or the medial side of your knee (part towards the midline of your body)?

Also, I am unsure of what you mean when you say during rack pulls your knees angle inward. See the below picture and say which one you are trying to describe.

Apologies for the confusion.

Part of knee: medial side.

Angle of knees: genu valgum.

Is the pain on the medial part of your hamstring or on the medial side of your knee?

If you have genu valgum during the deadlift, that shows a poor gluteal function. With the knees in a genu valgum, extra stress will be placed on the ligaments and tendons that attach on the medial aspect of the knee, which is likely causing your pain. Flat feet can also be a factor into genu valgum.

Suggestions: Glute activation to keep knees out of the genu valgum during deadlifts, squats, and other exercises. Foam roll and lengthen your peroneal muscles/evertors of your ankle and strengthen your tib anterior/invertors to help improve your flat feet.

Thanks a lot for your help.

I find that the pain is greatest when doing leg curls. I didn’t think the glutes were involved in this movement?

Interestingly, I noticed the pain tonight when training the tibialis. The exercise involved attaching my foot to a cables and doing a dorsi-flexion movement at the ankle.

I should have mentioned earlier that the pain is not really experienced during an exercise, but more so afterwards when I stand.

I have marked the spot roughly with a blue circle.

Now that you mention it, it may in fact be more the hamstring than the ‘knee’. The pain is not near the patella and is closer to the back of the leg. I may have to take a photo when I get a chance.

If this was the inside of the leg, it would roughly be in this position.

Great advice, Level.

I would try foam rolling your medial hamstrings/adductors, as they could be getting beat up by the excessive load.

Then, as was mentioned above, work on the glutes/lateral hamstrings - push the knees out, even on exercises such as deadlifts, RDL’s, pull-throughs, etc.

Good luck!
MR

It sounds like a probable strain to one of your medial knee flexors. Could be a hamstring or gastrocnemius/calf strain. Both work to actively flex the knee. You are correct that glutes are not directly involved with leg curls, but I wasn’t saying that it was the glute itself that was in pain. It is the glute being inactive as a hip rotator/stabilizer during the deadlift, other exercises, and general activity. Also, as I said, the flat feet will alter the angle of stress at the knee as well causing the genu valgum.

What position are you in when you are doing the tibialis anterior work that you described - knee straight, hip in a flexed position? If that is the case, when you are doing that exercise, you are placing the hamstring and gastrocnemius/calf on stretch with the knee already straight, hip flexed, and then actively pulling the foot into dorsiflexion. If the tendons are already inflamed due to the strain, it will cause you pain over those tendons with that movement just due to the stretch and extra tension being placed on the tendons.

The locations of the dots on the pictures and description of discomfort (pain after standing up from exercise and during certain exercises) would lead me to believe it is a strain and/or tendinopathy of the medial knee flexors. The location of the pain doesn’t seem to be over any ligaments or where you would expect pain from a meniscal issue.

Again, I would address any glute inactivity and work on correcting your flat feet as I had suggested in my earlier post. Make sure to warm up really well before activity, foam roll the hamstring and posterior groin, and ice after activity. Probably wouldn’t hurt to work on your hip flexors as well with SMR and mobility since that can be a factor in glute inactivity.

[quote]Mike Robertson wrote:
Great advice, Level.

I would try foam rolling your medial hamstrings/adductors, as they could be getting beat up by the excessive load.

Then, as was mentioned above, work on the glutes/lateral hamstrings - push the knees out, even on exercises such as deadlifts, RDL’s, pull-throughs, etc.

Good luck!
MR[/quote]

Dangit Mike,
Beat me to the punch. I started writing up my response and had to go pick up my uhaul and after I got back, finished my response, and posted it showed yours. Sorry for the repeat information, but I guess too much information can be a good thing in some situations!

EDIT: Also, to the OP, if you want a great resource for strengthening and fixing some pathologies within the knee, check out Mike Robertson’s Bulletproof Knees! Great resource.

Thanks a lot for the advice, guys! Much appreciated.

When doing the tibialis anterior exercise tonight, I was stting with my heel on the ground and knee bent.

Any pain with resisted plantarflexion, calf raises, etc?

You also may want to explore the possibility of

‘anserine bursitis’

Google it and see if you have pain the described region.

beef

I doubt it is pes anserine bursitis, but again can’t be completely certain without physically seeing him. The Pes Anserine is a bit more anterior and inferior than the locations of pain he marked off on his photos. The semitendinosis may be involved (which is only one of the muscles involved with the pes anserine), but from the descriptions and information the OP gave, I don’t think it is likely to be pes anserine bursitis. Doesn’t hurt for him to read up on though.