Inside knee pain on adductor stretches

[thejanitor]

I recently changed up my training from Xfit style strength and conditioning to more of the GB approach, incorporating a lot of yoga and mobility work into my weekly training. I've sat at a desk/laptop for far too many years already and have the mobility to show for it 

I've been making some good improvements with my thoracic spine mobility, overall posture, scapular health and hamstrings. The hips and adductors have seen much slower progress and I'm still chronically tight in both areas.

I've tried to do numerous stretches in order to loosen up the adductors. These include:

1. Straddle position against the wall

2. Wide side splits style stance with pnf contractions

3. Cossack squats

All 3 of the above all lead back to the same problem - pain on the inside of the leg just below the knee. This only occurs on the right side and when I get to the end ROM it turns from an adductor stretch into what feels like a ligament or some other tissue stretch where it is uncomfortable and no longer targets the muscles I'm trying to reach.

Does anyone have any experience with this and know what the root cause of this kind of issue is and how to address it?

The frog stretch is one that doesn't affect the knees at all. Likewise, the last time In tried the horse stance there was no pain around the knee.

Thanks for any responses.

[Nathan]

@thejanitor Welcome to the boards. Was just thinking we could use some cleaning up around here

I'm sure someone else will be able to chime in with details or scientific terms, but basically you're lacking the strength needed to properly stabilize/support the knee area in the straight-leg positions. Notice how the issue is evident in straight-leg positions, yet not a problem in bent-leg positions? You can stretch the adductors very effectively using bent-leg positions while continuing to work on building strength in straight-leg positions by working in pain-free ranges and progressing as you get stronger (ISO holds, C/R, dynamic movements like cossack squats will all help build strength).

This will take time, but with patience and consistency it will improve!

[Mark H]

Hi janitor,

I've seen tight, bound up adductors responsible for referring pain down to the inside line of the knee. Could be worth seeing someone for some good soft tissue work (while it is possible to self massage that area it's pretty tricky to do a good job of it).

You say the hips are generally tight and slow to respond. Are you stretching all around them? Adductors are one line leading in to a complex area, other lines might need looking at. Tight hip flexors (making sure to get the TFL), piraformas and QL may be holding the adductors back. 

To follow on from Nathan, knee stability requires both a well working hip and ankle. Probably worth taking a look at the performance of these areas.

However, in my experience, slow and steady wins the race. Just keep working away at it. You can feel like you're getting nowhere and then all of a sudden things fall in to place. Good luck.

[thejanitor]

On 9/17/2016 at 1:07 AM, Nathan said:

@thejanitor Welcome to the boards. Was just thinking we could use some cleaning up around here

You can stretch the adductors very effectively using bent-leg positions while continuing to work on building strength in straight-leg positions by working in pain-free ranges and progressing as you get stronger (ISO holds, C/R, dynamic movements like cossack squats will all help build strength).

 

Thanks for the reply Nathan. In relation to the strength building, what kind of exercises would you suggest? Is it strengthening of the adductors or the medial ligament (or both)? Is it normal to have the strength and stability to do a stretch on one side but not on the other? Unfortunately the cossack squat is one of the movements that causes pain around the inside of the knee when I do it (right side only).

[thejanitor]

On 9/17/2016 at 5:56 AM, Mark H said:

Hi janitor,

I've seen tight, bound up adductors responsible for referring pain down to the inside line of the knee. Could be worth seeing someone for some good soft tissue work (while it is possible to self massage that area it's pretty tricky to do a good job of it).

You say the hips are generally tight and slow to respond. Are you stretching all around them? Adductors are one line leading in to a complex area, other lines might need looking at. Tight hip flexors (making sure to get the TFL), piraformas and QL may be holding the adductors back. 

To follow on from Nathan, knee stability requires both a well working hip and ankle. Probably worth taking a look at the performance of these areas.

However, in my experience, slow and steady wins the race. Just keep working away at it. You can feel like you're getting nowhere and then all of a sudden things fall in to place. Good luck.

Thanks for the response Mark. I try to work on the hips as much as possible and the yoga classes I go to generally have quite alot of hip openers. They're just an area where I find it hard to see any major improvements. That's not to say there's no progress, just that the hips have been alot slower to respond to mobility work when compared to other muscle groups. 

I'll look at some QL/piraformas/TFL stretching sequences and try to work those into some of GST sessions each week. Likewise I'll try to do some ankle work too and see if they improve things at all. 

TYVM for the input.

[Nathan]

8 hours ago, thejanitor said:

In relation to the strength building, what kind of exercises would you suggest?

As I hinted at in my reply, all of the offending exercises are fine. You simply limit the ROM to avoid pain, and then use something like C/R, isometric holds, or perhaps weights while moving in and out of that range, progressing to further ROM as your body allows. What needs strengthening will depend on your own body, and imbalances are indeed overwhelmingly common.

Mark also makes an excellent point about looking up and down the chain as well. The calves can also certainly play a part in locking up the knee area. It would probably be a good idea to do some exploration of your body. Try stretching and loosening up surrounding areas and see how they affect the sensation. Just don't do them all at once or you won't know what changed what  

[AshwinT]

Dear thejanitor,

You describe yourself as “chronically tight” in the hips and adductors.  I will echo some of the prior advice given and offer some specifics.  DO NOT do many straight legged stretches.

1. The straddle position against the wall will cause a sideways torque on the knee since you're tight. That stretch is only appropriate for people who are already quite close to side splits (~160+ degrees).  I do not recommend it for you.

2. I do not recommend wide side split stances either.  Side split practice is not the best way to loosen super tight adductors.  There is too much apprehension reflex.  It’s much better to focus on quality horse stance practice since a) your knees are bent hence your body feels safer, it works your adductors well, c) it is a strengthening pose.  Here is a good Emmet Louis video titled “Horse stance for side splits”.

  https://www.youtube.com/watch?v=zvOPOuhtczg

3. I highly recommend the bent-leg version of the Cossack for you since it has many variables you can play with to FEEL your restrictions and gently address them without initiating too much stretch reflex or apprehension reflex.  Here is Kit’s tutorial titled “Bent-leg Cossack”.

https://www.youtube.com/watch?v=04jJsNuznWM

4. The two most important exercises to work on for adductor/groin tightness are the tailor pose and squashed frog.  Work on them diligently since they allow you to focus on the different lines of the adductors without involving knees, calves, hamstrings, etc.

Tailor pose, squashed frog, bent-leg cossack, horse stance.... that should keep you busy

Cheers,

 

Ashwin