by Mitchell Yass, DPT
This strategy is just as effective…and much safer…
Do you wince when you walk, kneel, squat or climb stairs? If so, you are definitely not alone. Nearly 20% of all cases of chronic pain are associated with the knee, and it’s severe enough to limit the sufferer’s mobility and affect quality of life.
Knee surgery, including knee replacement, is a widely used option, but it’s rarely the best choice…and should never be the first choice. Knee pain is often caused by weak and/or imbalanced muscles, which surgery or other invasive treatments do not address.
A much better option: For most people with knee pain, exercise is at least as effective as surgery—with none of the risks, according to research. What you need to know…
MUSCLE PAIN
When you see a doctor because of nagging knee pain, you’ll probably be advised to have an X-ray or MRI to look for arthritis, torn cartilage or other structural problems that can cause joint pain. But the tests, more often than not, point doctors in the wrong direction.
Eye-opening research: A study of nearly 1,000 patients with arthritis-related knee pain found that 63% had a damaged meniscus (cartilage that cushions and stabilizes the knee). But the same study also found that 60% of patients without pain had the same type of damage.
Most patients—and many doctors—fail to realize that there’s a poor correlation between structural problems and knee pain. That’s why I often advise clients not to have imaging tests—or consider surgery—until they’ve first tried my program of targeted exercise. In my experience, about 90% of knee patients have a muscle imbalance or weakness that causes all or most of their symptoms.
Here is a 30- to 60-minute workout that helps specific types of knee pain. Do the exercises on the side that is painful until the pain subsides—once the pain is gone, do the exercises on both sides. Stop if the exercise hurts.
A resistance band, ankle weight or machine in the gym can be used for resistance, which is key for strengthening muscles.* Start at a level where you feel you are working hard but not in pain, and gradually increase resistance.
The exercises can be performed by anyone, including those who have had knee surgery, but check first with your doctor. The quad stretch should be done daily. For each of the other exercises below, do three sets of 10 repetitions (resting 45 to 60 seconds between sets) and repeat the workouts three times a week (with a day between workouts).
WEAK HAMSTRINGS
The thigh muscles (quadriceps) tend to be a lot stronger than the opposing muscles (the hamstrings) on the backs of the legs. Why? It’s because virtually all of our daily movements—including walking and climbing stairs—are “forward.”
The problem: Weak hamstrings (they are mainly responsible for knee bending) cannot effectively counteract the force of much stronger quadriceps, causing a muscle imbalance. Result: The quadriceps shorten and pull up on the kneecap, causing excessive pressure and pain. The majority of people with knee pain will improve when they strengthen the hamstrings and stretch the quads.
EXERCISE #1: Hamstring curls. While sitting in a chair, tie the ends of a resistance band to a doorknob and slip it around the ankle…or try the seated leg curl machine at the gym.
What to do: Begin with the exercising leg pointing straight out, then bend the knee until it reaches 90 degrees. Return to the starting position.
EXERCISE #2: Hip extensions. This exercise works the gluteus maximus muscles in the buttocks.
What to do: While standing, place a resistance band behind one knee. Then attach the ends to a fixed point—such as a doorknob. While standing (you can rest your hand on top of a chair or table for extra support), bring the knee about 10 degrees behind the hip, then return to the starting position.
EXERCISE #3: Quad stretches. Tight quadriceps pull the kneecap toward the top of the joint and prevent it from moving smoothly. Tight quads can cause both knee and back pain.
What to do: Stand near a wall (or a dresser, bookcase or other solid support), and use one hand for balance. Reach back with your other hand, and grip the ankle.
Pull the heel upward toward the buttock. The knee should be a few inches behind the hip. Keep pulling until you feel a stretch in the front of the thigh. Hold the stretch for 20 to 30 seconds, and do the stretch twice. Pull gently! If it hurts, you’ve pulled too far (or too quickly).
QUAD STRAIN
Another common cause of knee pain is quad strain. What are the telltale signs? You might notice a “pulling” sensation at the top of the knee or in the thigh when you walk or climb stairs. A weak quadricep can cause the kneecap to shift out of place. Try this…
EXERCISE #1: Knee extensions. They strengthen the quadriceps and help the kneecap stay in a “neutral” position.
What to do: In a seated position, strap on an ankle weight or tie a resistance band around the front of the ankle and attach the other end to the chair leg. Keep the other foot on the floor. Begin with the knee bent to a 90–degree angle, then straighten it. Return to the starting position.
Important: Make sure that the thigh of the leg being exercised stays on the seat. Raising it will make the exercise less effective.
EXERCISE #2: Dorsiflexion. It works the tibialis anterior, a muscle in the front of the shin. Strengthening the muscle can help keep the calf muscle lengthened and allow the knee joint to function properly to prevent knee pain.
What to do: Sit on the floor with one leg extended. Slip an exercise band over the top of the foot and tie the ends to a sturdy table leg. Start with the ankle angled about 30 degrees forward, then pull the foot toward the upper body until it is 10 degrees past perpendicular. Return to the starting position.
*To increase muscle strength, add resistance (with heavier weights or a stronger exercise band) when the exercises become easy.