Knee pain can wreak havoc your fitness routine. Working as a Physical Therapist for over 20 years I’ve seen an array of injuries. There was the Dad who demonstrated a “Teenage Mutant Ninja Warrior move” to his 4-year old son, a marine who injured his knee on a skydiving mission, and the totally fit yoga practitioner who could no longer tolerate tree pose. While injuries are as unique as the individuals and activities that cause them, I have seen a few patterns over the years that I’d like to share with you. You can look to see if you can solve your own bio-mechanical puzzle. For the knee pain that bothers you during your workout and doesn’t seem to be getting better or worse, considers these gems:
1. It’s not always the Knee
8 out of 10 times, individuals with knee pain have weak hips. This is especially true for runners who tend to work out in the “sagittal plane” (front to back), and neglect the muscles controlling side to side motion. When the muscles in the hip become weak in any sport that requires jumping, hopping, running, lunging or pivoting, the knee will have poor alignment. This is turn causes the knee cap to track out of the bony groove that secures it. When the poor tracking of the knee cap occurs, the pain underneath the knee cap increases. Crepitus or that crunchy painful sound is often heard. This is also known as lateral tracking of the patella. This condition can be exaggerated by poor alignment in the knee or a weak quadriceps muscle. Both hip strengthening and medial quadriceps strengthening are helpful in this case (see the exercises below). Paying attention to your alignment while running, lunging, squatting and jumping is also key. Your knee should remain over your 2nd toe during movement, once it deviates towards the inside of mid line you can be sure trouble will follow. When this deviation is repeated over and over as in a run or repeated squat, you’ve got faulty bio-mechanics and the problem will not go away until this most important issue is remedied.
Muscles to Strengthen: Gluteus Medius, Vastus Medialis (Inner Quad)
Tip: Watch your Alignment and practice keeping your knee over your 2nd toe when lunging or squatting.
2. Poor Alignment
Alignment in you back and hips can have a huge impact on pain felt in the knee. One of the most common problems is asymmetrical tightness in the hips, or in other words one hip being tighter than the other. This is rarely found alone and typically the tight hip is coupled with a tight “side body”, or torso on one side. While trying the exercises below, pay attention to your tight side. Identify the tight side. Is it right or left? Once you’ve identified the tight side spend a little extra time on the stretch, and consider that the opposing muscle is most likely weak. In this case if the hip flexor is tight, it is likely that your gluteus maximus is weak. As originally mentioned this is a broad overview of the most common dysfunction we see. There can be other patterns, but this is by far the most frequent we observe in the clinic.
Muscles to Stretch: Hip Flexors (Psoas and Rectus Femorus), Quadratus Lumborum
Muscles to Strengthen: Gluteus Maximus
Tip: Stand frequently during the day, and stretch your hip flexors. Going from a sitting day job, straight out for a run can be tough on your knees. Again, watch your alignment and look to see if your keeping your knee aligned over your 2nd toe. Tight hip flexors can impact your ability to maintain good knee alignment.
3. Keep your knee strong and supported
Once we’ve got the alignment and hips in order, we are ready to properly strengthen your knee. Think of strong muscles like a nice “hug” to your joints. It gives the knee cap support and allows the joint itself to almost float as you are exercising. If your knee pain is in the tendon just below your knee cap you may have a tight Rectus Femoris muscle and a good long stretch may be in order. See the thera-ball squats below as well as the hip flexor, and IT band stretches. Keep in mind that strong hips are a prerequisite to these exercises, so these tend to be the “icing on the cake” so to speak.
Muscles to Strengthen: Quadriceps and Glutes
Stretching: Rectus Femoris and IT- band.
Tip: Train for your sport. What-ever your favorite form of exercise may be, you must cross-train. Strengthening and stretching to continue to keep your body both strong and supple is a must. Balance is once again a key component to success in both your form and workout routine.
If knee pain has got you down and out, try these exercises to work through the kinks. Trust me, they have proven to be helpful to many different athletes. Ninja warriors and tri-athletes have been able to move more and hurt less by implementing this program. If your knee pain persists, you may need to see a professional. I highly recommend physical therapy. Additional causes of knee pain can include meniscus pain, plica disruption, or ligamentous injuries. All of these issues start out with poor biomechanics. Consulting with a physical therapist will most likely result in identifying the source of the problem and forming better habits. A physical therapist help you navigate the most conservative option to get you moving again. Taking action to fine tune your system can go a very long way towards a road to recovery.
You can join our workout program, designed by a physical therapist with variety and balance in mind. Check it out here.
Yours in Health and Bliss,
Amy Beth Hopkins has her Master’s Degree in Physical Therapy from Loma Linda University in Southern California. She has Owned and Operated Your Personal Best Physical Therapy in Austin Texas for 16 years. She is also founder of Health and Bliss for Life, an online resource for Anti-Aging Medicine, Fitness and Soul-filled Living.
1. Lateral Walks: place your feet shoulder width apart and bend your knees @45 degrees with toes pointed out. Maintain this semi- squat position and walk 10 steps to the left, then 10 steps to the right. Repeat 2x each direction
2. Squats with Medicine Ball: Place feet shoulder width apart and place the medicine ball in between your knees. Squeeze the ball with your knees to hold it in place. Squat, being careful to keep your knees in line with your toes (as if you are sitting in a chair). Repeat 3 sets of 10.
3. Hip Flexor Stretching:Get into a half-kneeling position, with your back leg being the one you are about to stretch. A. Hold a stick, dowel, or foam roller in front of you and actively push it down into the ground. This is a small, but important, step as it engages your core and forces the stretch to happen where we want it to.Keep your body upright and posteriorly rotate your pelvis (think: squeeze your glutes as hard as you can). Almost everyone I have worked with can actually feel a stretch at this point, without even taking it further.Then, keeping your pelvis rotated, glutes squeezed, and body upright, lean forward at the hips, holding at the end for no more then 2 seconds.
4. Quadratus lumborum and IT band stretching: Standing with your side 1.5 feet from a sturdy wall or object, cross the leg closest to the wall over the other leg. Then lean your arm against the wall and allow your hip to fall in toward the wall until you feel a stretch on the side of your leaning leg. Hold this stretch statically for 30 seconds.
6. Glut Med Strengthening / Hip Hike: Stand on one leg. Stand on the edge of a step. Keeping the other leg straight, raise the hip on that side so the whole leg comes up. Then slowly lower it back down.You don’t necessarily have to be on the edge of a step; you could also do this by bending the knee (ie, standing on one leg and lifting the opposite side hip up)
7. Glut, Quad Strengthening / Lunge: Lunges with weight. With your back straight, slowly lower your body until your front knee is at a right angle. Keep your knee in line with your middle toe and feet facing forwards.