In the latest edition of Functionally Fit, Brian demonstrates an exercise that you can use to address side-to-side differences that lead to hip, knee and ankle pain.
Affix an elastic band around a stationary object and around the stance thigh so that the resistance provided by the band pulls the thigh into adduction. Stand far enough away so that you are somewhat challenged to maintain neutral alignment against the pull of the band. However, you should be able to maintain static alignment of the knee with the second toe prior to squatting.
Next, slowly squat down, allowing the other leg to trail behind while keeping the desired alignment. Pause at the lowest control point and then return to upright. Avoid letting the thigh move into adduction or internal rotation by consciously activating the hip abductors (think about pulling against the band). A cadence of 2/0/1 or 2/1/1 is sufficient.
Repeat this cycle for 10-15 repetitions and then switch sides. Perform two to three sets on each side. Keep in mind the motion should be performed smoothly and deliberately attempting to facilitate consistent dynamic hip and knee stability. Do not attempt to lower beyond a point at which proper hip/knee/foot alignment is compromised.
It is no secret that the adductors are naturally stronger and overpower the abductor muscles groups. Additionally, the hip external rotator muscles often need strengthening to aid the body in achieving proper hip and knee alignment with activity.
The idea behind this exercise is applying progressive gradients of resistance that encourage the faulty motion (pulling the leg into adduction and internal rotation) to facilitate increased activation of the gluteus medius/minimus and small lateral rotators to create an anti-adduction/internal rotation force. Decreasing such moments at the knee will reduce IT band issues, patellofemoral pain, ACL injury risk and overuse problems often seen in running.
In my experience, people develop hip, knee and ankle pain asymmetrically in many cases. In addition, running, jumping and cutting are often asymmetrical and unpredictable. Using the bands with a single leg squat will allow you to attack any side-to-side differences more effectively. If people struggle, adjust the resistance or allow slight upper body support and/or balancing corrections as needed from the non-stance leg (foot) until the motor pattern becomes more natural.
A few simple regressions include:
1. Split stance leg activation squats using the same set-up as the single leg version but with the trail leg fixed on the floor (most of weight on front leg)
2. Double leg activation squats using the same setup as above, focusing on the outside leg (band is still around just one leg with the other leg just in front the band to avoid the knee hitting it during the squat)
For clients with a history of patella instability, be aware that too much pull will position them in a position of higher instability if there is too much valgus loading in the 30-0 degree range of extension. I suggest having these clients master single leg squats and lateral step-downs with no resistance and stationary split lunges with manual intermittent adduction resistance first prior to progressing to this exercise. It is also worth noting that clients with patellofemoral arthritis may have pain at certain positions and especially beyond 60 degrees of knee flexion, so adjust the depth accordingly based on dynamic control and knee discomfort.
Brian Schiff, PT, CSCS, is a licensed physical therapist, respected author and fitness professional. Currently, he serves as the supervisor at the Athletic Performance Center in Raleigh, NC. Brian presents nationally at several professional conferences and seminars on injury prevention, rehab and sport-specific training. For more cutting edge training information, subscribe to his monthly Training & Sports Medicine Update at

Topic: Functionally Fit

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