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So You’ve Got Knee, Hip, or Low Back Pain? Here’s How to Modify Your Workout Accordingly

Kells McPhillips

October 18, 2018

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Photo: Getty Images/Drazen_

When your sweat-inducing endorphins rush gets interrupted by knee or hip pain, a satisfying workout can quickly turn into a game of 20 questions: What did I do wrong? Was my form off? Whyyy? But next time the compromised state of these two all-important joints threatens to sideline your training efforts, Tony Comella, a California-based physical therapist, suggests making a handful of modifications to reduce the stress you're placing on them (rather than bailing on your training plan entirely).

"When considering an athlete or individual with low-back, hip, or knee pain, we can potentially continue to train these patterns while reducing overall stress to a particular area," the recovery expert writes in an Instagram post. To follow his rules, use his handy-dandy graphic representation of squat variations and deadlifts that place the most and least strain on your hips and knees.

Here's an example: If you're experiencing knee pain, skip the overhead squats (located on the far right side of the chart) because that version of your favorite butt-burning move requires the most work from your knees. Instead, Comella recommends a low bar squat, in which the you hold the bar behind your back, rather than overhead. The opposite side of the chart works the same way, so a sumo deadlift will be the very best choice for anyone experiencing hip pain.

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. HOW TO MODIFY TRAINING — ▪️This graph shows a simple representation of how much relative hip and knee dominance we use with common hinge and squat patterns. When considering an athlete or individual with low back, hip, or knee pain, we can potentially continue to train these patterns while reducing overall stress to a particular area. — ?Example 1: an individual experiencing knee pain with front squats could use high or low bar squats as an alternative. By moving the weight onto the back, we ultimately change the demands of the knee, thus potentially allowing someone to continue training the squat pattern without discomfort. — ?Example 2: an individual with hip pain or pinching during conventional deadlift, may prefer the sumo deadlift position. The sumo position can be more comfortable for some (variation among individuals) due to change in hip demands. — ?Example 3: As we move from left to right, the relative angle of the torso will go from more horizontal to more vertical. A more horizontal angle will require a higher demand of low back musculature. Therefore, an individual with low back discomfort may find sumo deadlifts more tolerable than RDLs, or a front squat more tolerable then a low bar back squat. — ▪️Other factors to consider include anatomical variations, shoe choice (i.e. heel lift, flat shoe), and changing height surface (i.e. box squat, elevated deadlift). — ⚠️ This is an attempt to simplify a highly variable topic. If you have a specific question about what option is best for you, find a provider to help! — Credit to @gregnuckols for original concept. Check out his website (strongerbyscience.com) for more great information!

A post shared by Dr. Tony Comella PT, DPT, CSCS (@tony.comella) on Feb 25, 2018 at 3:11pm PST

In addition to consulting the chart to see your hips and knees through recovery, the expert also says you can use it to protect your lower back. "As we move from left to right, the relative angle of the torso will go from more horizontal to more vertical. A more horizontal angle will require a higher demand of low-back musculature," he explains. "Therefore, an individual with low-back discomfort may find sumo deadlifts more tolerable than [Romanian deadlifts], or a front squat more tolerable then a low bar back squat."

Of course, Comello notes that this guide is a simplification of many types of injuries, so make sure to book an appointment with a professional if you're concerned about training through the pain.