Best Step Exercise Variations

The Importance of The Step Up and Step Down Variations

Step ups and step downs are both amazing exercises for prehab and rehab purposes alike. But in order to truly maximize your gains in the gym or clinic, you need to perform them correctly!! Yes, stepping up and down off an extremely tall box looks impressive and all, but can you actually control it? Unless your goal is to get in some cardio, you need to really focus on form and control in the step up and down.

First, don't blaze through step exercises; focus on an extremely slow and controlled descent (eccentric control). Your knee should never collapse and be medial to the ankle (unless doing a transverse step down which we'll talk about later). You should feel the burn in your glutes and quads as you try and stabilize your pelvis during the descent. Developing eccentric control is crucial, especially for quadriceps or patellar tendinopathy prehab.

Second, only use a box height that you can control. You should be able to control the descent throughout the entire range of motion. Most of the time with step exercises, you'll find that you can control the descent initially, but as the quad demand increases (as knee flexion angle increases), you'll lose control of the descent. If you can't control the end range of the descent, you're using a box that is too high!

Finally, don't cheat and push off with the opposite leg! The leg on the box should be doing all the work, both raising (concentric) and lowering (eccentric). Don't push off the ground with that back leg!

The Step Up

The step-up explicitly demands single leg postural stability and coordination as well as dynamic control of the pelvis and trunk. The step-up also serves as an adequate stimulus to foster endurance and strength of the lower extremity and can easily be progressed or regressed depending upon the goal or ability of who is performing this exercise!

Curtsey + Transverse Step Ups

Yes, knee valgus is one of the more common positions of an ACL injury, and during early rehab for an ACL, it's probably best to avoid a valgus position and teach your patient "ideal" lower extremity alignment. But once they're out of early rehab and in more strength and conditioning-focused programs, teaching the patient to control knee valgus is an absolute must. It is a position that they will undoubtedly find themselves in during competition, no matter how well-trained they are in their cutting mechanics. Therefore, it is imperative to teach them to get in and out of a knee valgus position with control.

Cross Over Lateral Step Up

A recent systematic review by Macadam et al in 2015 highlighted cross-over lateral step ups. They found that the cross-over lateral step up produced one of the highest Gluteus Maximus muscle activity (103 +/- 63.6%) in their review. Something to note in this exercise is that it does require a lot of gluteus medius activity as well, as you must be able to maintain good pelvis and knee stability. The elevated femur starts in a relatively adducted and internally rotated position and moves into abduction and external rotation. So we're also adding a frontal and transverse plane component to the normally sagittal plane step up/down. All the same guidelines apply to cross-over lateral step ups as the normal step ups/downs that we highlighted above.

Yoak Step Ups

If you want to challenge your balance, you need to add demands to the task that decrease your stability. Perturbations are an effective way to add instability to your exercise. Perturbations are awesome because they provide constant variability. Research has shown the variability of practice can lead to greater skill acquisition and retention. A perfect example of this is golf - it gets easier to hit the same shot after practicing with the same club over and over at the range. However, it becomes more difficult on the course when you change clubs, shot angles, and distances. I really like using the yoak with a step up exercise to add another dimension to the balance demands. Hikers can definitely appreciate this exercise and should add it to their training!

Quick tips for doing this exercise :

• The faster you move through the step up and step down, the greater the perturbation

• If this exercise gets easy, make it harder and speed things up!

• This exercise is meant to challenge your balance! You can only learn by adjusting your performance when it is challenged! As you can see, I even lose my balance!

Getting Stronger? Now On To Step Downs

Step downs are a staple in our lower extremity rehab progressions and for good reason. You can isolate/bias one leg without any "cheating" using the other leg like on squats, deadlifts, or the lunge variations we have discussed. Furthermore, depending on which direction you step, you can preferentially bias either the glutes or the quads, or workaround people's mobility constraints like a lack of ankle dorsiflexion.

It all comes down to simple biomechanics and lever arms - if you know your biomechanics you know movement! If you want to:

➡️ Target the knee: Go with anterior step downs

➡️ Target the hip: Go with lateral or posterior step downs

Closing Thoughts

The step up and step down variations of exercise are both excellent movements that should be incorporated into any strength-specific or rehab program! The single-leg control, strength benefits, and translation to daily activities make these such awesome exercises. Be sure to focus on the control and form with these techniques as we harped on above, as with any movement that you incorporate into your routine. As you see fit, progress yourself and get creative!