Knee pain is on the rise

Knee pain is on the rise and the rate of total knee replacements is surging. According to a study published in 2012 frequent knee pain affects 25% of the population https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408027/. The aging baby boomer generation is now approaching senior citizen age and the number of people living with arthritis is expected to jump from 50 million to 67 million by the year 2030 according to the CDC, https://www.cdc.gov/.

Common causes of knee pain

Knee pain can come from many sources. The pain can come from within the joint itself or from the surrounding soft tissues. Knee pain can be the result of aging and gradual wear and tear or the result of a traumatic injury. Common causes of knee pain include: arthritis, torn meniscus, torn or worn cartilage, sprained ligaments such as an ACL tear/sprain, tendonitis, bursitis, and iliotibial (IT) band syndrome. While some causes of knee pain may require surgery, many can be managed with a simple exercise routine. One of the most important aspects of addressing your knee pain is to see your primary care physician to discuss possible causes and treatment options. Development of an exercise program when your knee pain is mild or just starting can be essential to help decrease or slow worsening symptoms.

My knees don’t hurt…do I still need to exercise?

Yes! Prevention is key when it comes to joint pain. Developing and sticking to a workout routine to promote optimal joint health and muscle strength is also important to prevent or slow joint damage that accompanies aging. Your knee is a hinge joint comprised of your femur (thigh bone) and tibia (one of the lower leg bones), and your patella (knee cap) which glides in a groove in your femur. This joint needs motion to drive old synovial fluid (a lubricating joint fluid that keeps motion smooth, think WD-40) out of the joint and allow new nutrients to enter the joint through a process called fluid dynamics. A loss or restriction of motion will lead to less fluid exchange meaning less nutrients to the joint and faster breakdown of joint structures. Movement = healthy joints. Low impact strengthening exercises, flexibility exercises, and range of motion exercises are all excellent ways to promote joint health to stay fit and keep active.

5 great exercises to maintain knee joint health

These exercises are not medical advice. Do not perform any exercise that causes pain. Always consult with your physician prior to beginning any exercise routine.

Quadriceps isometric:

• Lay on your back with one leg straight and the opposite bent with foot on the floor. You can also complete in a seated position with your leg straight out or laying on the floor if you can safely get up and down from the floor
• With your straight leg tighten the muscle in the front of your thigh to push your knee down to the floor
• Use a pillow or towel roll under your knee if discomfort occurs
• Hold 5 seconds
• Repeat 10 time
• Gradually increase from 10 to 30 times

Straight Leg Raise:

• Lay on the bed or the couch with one leg straight and the opposite knee bent with foot on the floor. You can also complete in a seated position with your leg straight out or laying on the floor if you can safely get up and down from the floor.
• Begin by completing the quadriceps set from the first exercise
• Raise the straight leg up about 6-12 inches from the ground (never higher than the bent knee) then slowly lower back to the ground.
• Completely relax the leg between each rep
• Each rep should take 3 seconds to perform.
• Repeat 10 times and gradually increase to 30 times as strength improves.

Bridges:

Clamshells:

• Lay on your side (bed or couch, floor only if you are able to get up and down safely)
• Keep hips stacked straight up to the ceiling and knees bent at a comfortable angle.
• Raise your top knee away from the bottom knee keeping your ankles together.
• DO NOT rock back on your hip.
• The motion will be small maybe 4-6 inches and you should feel the work on the outside of your top hip.
• If the motion is big and/or you don’t feel the work- you are probably rocking backwards.
• Start with 10 reps and gradually increase to 30 reps as strength improves.

Planks:

• Begin by being on the ground or the bed based on comfort/safety getting up and down from the ground.
• Tuck your toes under and place your elbows under your shoulders at 90 degrees.
• Tighten your abdominals and glutes while you lift off the ground (facing down) a couple inches in a straight line like a plank of wood (hips, back, shoulders should remain in a straight line).
• Hold for 5-15 seconds (do not hold your breath) and slowly return to the starting position.
• This is a challenging exercise. I recommend not starting until you feel comfortable with the 4 previous exercises.
• You can modify by leaving your knees on the ground (use a pillow for discomfort) or performing in standing against the wall maintaining the same muscle activation.
• Pick the most appropriate challenge for where you are and work to where you want to be over several weeks.

Focus on your quads

Let’s talk about your quads. These are the large powerful muscles in the front of your thighs. They are the muscles we rely on to get up and down from chairs, up and down the stairs, and on and off the toilet. Weakness in this muscle can lead to difficulty with all of these activities.

The power of your glutes

All too often we forget to use the most powerful muscles we have: your glutes. Activating your glutes brings in the posterior chain of muscles that are designed to control your trunk and assist in standing up from a chair, returning to stand from squatting or stooping, and climbing stairs. This muscle is meant to take pressure and workload off the quadricep and decrease anterior (front) knee pain. The problem is most people have weak glutes because our normal day to day lives do not automatically target that muscle and instead we rely on our quads. This has resulted in a shift to a very quad dominant day to day life. To bring more balance to our biomechanics it is important to strengthen the glutes to offset the over activation and reliance on our quads.

Work your core

Another common problem for the knees is lack of support from the hips and core. Your hips are in charge of keeping things level while you walk. Weakness of the outer hip muscles results in abnormal biomechanics that looks like waddling. When this happens increased pressure goes through the knee as the foot hits the ground resulting in pain. The knee is essentially stuck in the middle between the reaction force at the ground and ankle and the stabilizing forces at the hips and core. A good knee strengthening problem will also target the hips.

Final Thoughts

It is important to remember that strength gains take time, usually several weeks, before noticing results. For more thoughts on why exercise is important please read my blog post https://forceofmovement.com/how-to-feel-better-with-exercise/

Consistency is key to successful strengthening programs. These exercises are not medical advice and not meant to treat specific injuries. Consult your physician prior to initiating a workout routine and stop any exercise that results in pain.