One of the biggest problems clients run into with lunging is anterior knee pain. This is especially prevalent in middle-aged females. Patellofemoral joint pain is a consistent issue on this population. In light of this, I have gone away form forward lunges with programming to avoid irritating the knee joint. Instead, I will routinely use rear foot elevated split squats or a stationary lunge position with modified range of motion centered on the client’s capacity.
In a 2008 article published in the Journal of Orthopedic & Sports Physical Therapy, the authors conclude that the best way to minimize patellofemoral joint pain and stress is to perform the lunge with a long step compared to a short step and without a stride compared to with a stride. Research has shown that patellofemoral joint force and stress is much greater with a short step (front heel and back toe closer together) compared to a long step at higher knee flexion angles and were greater with a stride (stepping forward) compared to being stationary without a stride at lower knee flexion angles.
Therefore, using a stationary lunge (or stationary split squat) with a greater step length and no forward stepping pattern may be the optimal choice to increase strength and reduce knee stress.
Execution:
Begin standing upright with both feet facing straight ahead and a reasonably greater distance between the front heel and trail leg toes while slowing for a good base of support. The arms can rest by the sides, or the hands can be placed on the hips.
Next, slowly lower down in a full and pain-free range of motion. Repeat for 10 repetitions. Switch lead legs and repeat on the other side. Perform 3 sets for each leg.
Progressions:
1. Use slower cadence, especially on the eccentric (lowering) phase
2. Perform a pulsing lunge at a greater depth to increase time under tension
3. Add external load using a weight vest or holding dumbbells, kettlebells or a sandbags
Application:
Strengthening the lower body with ground-based hinging patterns is a preferred method in the gym. However, patellofemoral joint pain is very common in middle aged females and can actually be exacerbated by lunging with and without the presence of baseline pain over time with repetitive loading in certain positions and ranges of motion. The stationary lunge with a long step and no stride is a great alternative for strengthening without adversely impacting the patellofemoral joint.
