Knowing Your Knees: Care and Prevention of Knee Pain
Photo by Kyle Kranz
You are as old as your knees. This truth applies to runners and athletes, as well as the average Joe. Knee pain can originate from a variety of ailments, from knee osteoarthritis (OA) to specific injuries, to trouble with your feet or hips affecting alignment and weight distribution.
Knee troubles can also happen suddenly, or appear and progress gradually over time.
But, as the old saying goes, an ounce of prevention is worth a pound of cure. When it comes to the knees, nothing could be as true as this wise old adage. This article will help you better understand the ways you can care for, strengthen and even prevent further damage to your knees.
Key Points We'll Cover
- Expert advice
- Exercises and treatments
- Overview of knee injuries
- Preventative and strengthening methodologies to avoid injury
Breakdown of Common Knee-Related Injuries and Osteoarthritis
Let’s start by taking a look at common factors which lead to knee pain. Please note that this list is not meant as a diagnostic resource; if you are experiencing knee pain, consult your physician if the pain does not lessen within a week.
Iliotibial Band Syndrome (ITBS)
Iliotibial Band Syndrome occurs when the namesake band of fibrous tissue which runs from hip to shin on the lateral or outer side is irritated. This most often results in pain near the outside of the knee or just above and to the outside of your knee cap. When not handled properly, ITBS may lead to meniscus tears and surgery. ITBS can often form due to sudden increases in activity, jumping straight into a heavy workout without a proper warmup, running up and down hills or stairs, and general overuse.
Jumper’s Knee can result in pain at the bottom front of your kneecap and can cause stiffness in that area when you work out. Another symptom is pain when flexing.
Doctors and physical therapists grade the pain as represented by four levels, from pain after training to pain with everyday activities. Jumper’s Knee often comes from excessive jumping, especially in regards to volleyball or basketball. Overuse and lack of muscle strength can also lead to pain.
Ligament Sprains and Tears
Sprains and tears are often considered one of the more pronounced types of knee injuries (outside of a developed condition like osteoarthritis). Damage and injuries to ligaments, such as the anterior cruciate or the medial cruciate, are sudden and result from sharp, jarring motions.
Ligament injuries cause significant pain and can lead to damage that will need physical therapy to overcome. These sprains and tears are often accompanied by sharp, distinctive snaps or pops from the knee. You will also experience joint looseness, pain with weight on the leg, and swelling. Doctors and physical therapists use a 3-Grade system to determine the severity of a Ligament sprain or tear: Grade 1 indicates an over-stretched but not torn ligament, grade 2 indicates slight or partial tearing, and grade 3 is this most severe with a full rupture.
Ligament injuries typically happen during sports that involve quick shifting motions. Sports such as basketball, football, lacrosse, and soccer are common offenders, especially with collisions and fast pivots.
Knee osteoarthritis can result from being overweight, old injuries, diet, or unlucky genetics. People who suffer from knee OA often experience various levels of pain and a less active life. Any of the injuries listed in this article can lead to OA, especially when not treated properly.
The onset of OA is gradual and can lead to stiffness and swelling in addition to the various levels of pain. It tends to start with symptoms which come and go before worsening over the next few years. Two things happen to cause OA: a breakdown of cartilage in the joints and/or abnormal bony growths (osteophytes or bone spurs).
According to the CDC, almost half of Americans will be affected by osteoarthritis during their lives; for people over 50, OA is the leading cause of disability. (source: Centers for Disease Control and Prevention, "Osteoarthritis Basics," http://www.cdc.gov, as paraphrased in https://www.arthritis-health.com/types/osteoarthritis/what-knee-osteoarthritis, accessed March 14, 2018)
Runner’s Knee leads to pain behind or around the knee, particularly when bending. Walking down an incline or stairs can lead to worse pain. Runner’s Knee is typically an injury from overuse and often affects long-distance runners (though other athletes can also experience this injury). Other causes aside from overuse are a direct hit to the knee, flat feet, and weak quadriceps. Try not to rule out Runner’s Knee simply because you don’t align with any of these; several factors can flare this particular injury.
The Dos and Don’ts of Treating Pain
Now that you have a better understanding of your knee and what may be causing your pain, let’s look at possible solutions. Remember, it’s always best to consult your doctor if the knee pain lasts longer than a few days. Trying to ignore the pain can lead to worse injuries.
If You Are Experiencing Knee Pain: Do Not
- Ignore Your Pain
We cannot stress this enough. Ignoring your pain or attempting to exercise past it can make a minor injury worse and lead to permanent damage and OA.
- Jar Your Joints
High-Impact equals further injury. Avoid “jarring” type exercises like the jumping, kickboxing, and running.
- Over Rest
To keep your muscles healthy while your knee heals, find an exercise program that is safe and keeps up with staying in shape. If you’re having trouble determining a safe exercise that works for you, consult a physical therapist and have them assign a few.
- Risk Falling
Falls are more likely with your knees out of commission and can increase damage to your knees. While you heal, keep your home well-lit and be sure to use handrails on stairs. If you need to use a ladder or footstool, then make sure that it is stable or you have someone present to steady it.
- Resist a Walking Aid
Crutches or canes can take the pressure off of your wounded knee, while braces or splints can keep the joint stable. You can also use the motorized scooters available in most stores to avoid overexerting your knees.
If You Are Experiencing Knee Pain: Do
Building up the muscles that can take pressure off of your knees and increase flexibility will aid in a faster recovery. Cardio is a good choice, like swimming or water aerobics. Many people enjoy Tai Chi, which can ease stiffness and improve balance. If you are working with a physician or physical therapist, run your exercise routine by them to ensure it fits in your recovery.
In regards to OA, exercising regularly and losing any extra pounds are both heavily recommended. This can help reduce the load on your knees and help improve your OA instead of simply treating the symptoms.
- Consider Acupuncture
This one isn’t as well backed. The American Academy of Orthopedic Surgeons (AAOS) does not recognize Acupuncture as a plausible solution or treatment due to a lack of studies supporting its effects. The American College of Rheumatology (ACR) and the Osteoarthritis Research Society International (OARSI) take a softer stance.
Certain patients do report a benefit to pain management. Some experts such as Dr. Amanda Nelson (a rheumatologist at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill) recommend giving it a try if treatment options are scarce or little improvement is seen (source). If you are interested in trying acupuncture, get a recommendation from your doctor and be sure the practitioner is accredited.
- Seek Physical Therapy and/or Expert Advice
The recommended second step for anyone suffering knee pain (after the RICE method detailed below). Before seeking any form of treatment or picking a series of exercises from a web article, consult a physician to discover the extent of your injury. If recommended, seek a physical therapist to help with your recovery. Working with a lack of information or an improper self-diagnosis can lead to further and longer-lasting damage, if not permanent, and a higher risk of OA in the future. Research is encouraged, but don’t discredit seeking the advice of licensed professionals.
- Spa Therapy
Balneotherapy has been growing in popularity as an OA treatment since 2014 when it was first included in OARSI’s guidelines. Balneotherapy involves spa treatments such as heated mineral water soaks, mud baths, and water massages.
Most studies which showed marked improvement in pain and stiffness involved treatment regimens for an hour or more at a time over several weeks; soaking in your tub for a bit may help with immediate symptoms but will doubtfully lead to much improvement over time,
- Take Advantage of Temperatures
For the first 2-3 days after an injury, use a cold pack to ease swelling and numb pain. Wrap the ice pack in a towel to protect your skin and then rest it on the injured area for 15-20 minutes. Then use something warm like a bath, heating pad, or warmed towel for the next 15-20 minutes. Ice can help reduce swelling, slowing blood flow while heat can help relax muscles and increase blood flow which can be beneficial for recovery.
- Upgrade Your Shoes
This suggestion works along the lines of taking extra pressure off of your knees. Cushioned insoles can help reduce the stress on your knee from daily activities. The same can be said for ensuring your shoes fit properly and offer good support for your posture and body shape. For finding the proper insole or getting advice on a good fit, consult your doctor or physical therapist. Some stores also have special machines that measure the stress on your feet and recommend insoles, but they only have a certain amount of information to work from.
- Use RICE
Rest, Ice, Compression, and Elevation. This method for treating knee pain is recommended for minor injuries and OA flares. RICE is fairly straightforward: give your knee a break, use ice for swelling and numbing properties, wear a compression bandage, and elevate your knee. Remember to use the ice for only 15-20 minutes at a time and wrap it in a towel to protect your skin.
A List of Exercises to Strengthen Your Knees and Avoid Injury
When interviewed by Men’s Fitness, expert exercise physiologist Pete McCall from the American Council on Exercise recommended a regimen of core stabilization exercises such as bridges, glute raises, and planks.
Still others recommend targeting areas that support the knee: gluteal muscles, hamstrings, lower back muscles, and gluteal muscles. As always, you’ll want to warm up and stretch before focusing on any muscle building exercises; also plan a cool down.
Good warm-ups include low-impact activities like walking or riding a stationary bike for 5-10 minutes.
The exercises below are recommendations and certainly won't fit everyone's needs. If you have existing knee issues, a physical therapist will be able to advise of exercises you can and can't do.
Bridges target abdominal muscles, glutes, hamstrings, and the lower back.
- Start lying on your back with your arms by your sides and your palms up. Both of your knees should be bent, with your feet flat on the floor.
- Use your abdominal and gluteal muscles to slowly lift your hips off the ground until your hips, knees, and shoulders form a straight line. You want to keep your abdominal muscles in and your glutes hard to hold the position and not overextend your back.
- After a couple of seconds, return to your starting position.
- Perform 2 sets x 10 reps
The power for this exercise should come from your hips, not your heels.
Glute-Ham Raises, or GHRs, require proper equipment. Odds are your gym has a GHR machine.
- Your starting position will be facedown and practically parallel with the floor. Your thighs will rest on the half-moon pad of the apparatus, your knees just behind. The backs of your ankles will set on the two smaller pads. P
- Push your knees into the pad and contract your hamstrings to raise your torso. You want to keep your back as straight as possible and your feet in the north-south position without turning your heels inward.
- Once you are perpendicular to the floor, slowly revert to your starting position.
- Perform 3 set x 6-10 reps
Half Squats target your glutes, hamstrings, and quadriceps. Half squats grow more effective if you gradually add hand weights, starting with 5lbs and progressing to 10 over time.
- Start by standing with your feet shoulder-width apart. If you are using weights, hold your arms in front of you; otherwise, you can hold your arms out, rest them in front of your thighs, or grip something for balance.
- Keep your chest lifted and your back straight as you slowly lower your hips like you are sitting down.
- Plant your weight on your heels and hold for 5 seconds before pushing through your heels to stand again.
- Perform 3 sets x 10 reps
Heel Cord Stretch
This one is great for your helping stretch your calves and improve mobility in your ankles. You may be wondering, why do I need to improve my ankle mobility if I'm trying to improve my knee strength? Everything is one long chain both hip and ankle mobility play a huge role in knee alignment and function.
- You start standing and facing a wall, with your good leg forward and slightly bent at the knee. The leg you are conditioning should be straight and behind you, heel flat and toes slightly pointed in.
- With both of your heels flat, shift your hips toward the wall. You want to hold the stretch for 30 seconds and then relax for another thirty. Be careful not to arch your back.
- Perform 2 sets of 4 reps with this stretch..
Hip Abductions and Adductions
Abductions affect the abductors and gluteal muscles. If you have weak hip abductors and adductors your knee won't track correctly. This places a tremendous amount of stress and strain on your knee cap and ligaments.
- Lie on your side with your bottom leg bent. Extend your top leg and gradually lift it to a 45-degree angle. Keep the leg straight, but do not lock your knee.
- Keep your leg up for 5 seconds before slowly lowering it and relaxing for a moment before repeating.
- Start while lying on your side.
- Bring your right leg so your foot is flat on the ground (this will be our top leg initially).
- Cross your top leg over your bottom keep your knee bent and your top leg's foot on the ground before lifting the bottom leg off of the floor 6-8 inches.
- Hold the position for 5 seconds, lower, relax, repeat.
- Build up to 3 sets of 20 reps for each leg. You don’t have to hit this goal right away— start small and work to improve over time.
Body Weight Leg Extensions
Leg Extensions, like half squats, can be made more effective through the addition of weight. Almost all gyms have a leg extension machine. Initially, you can perform this exercise with just your body weight.
- Start by sitting on a chair, bench, or leg extension machine with your back straight and your feet flat on the floor.
- Contract your thighs and gradually straighten and raise one leg as high as possible without forcing the movement. Hold for five seconds, relax, and bring your foot back to the floor.
- Repeat this motion for 3 sets of 10 each leg.
Leg Presses with a Resistance Band
Leg presses affect your quadriceps and hamstrings. For these, you’ll need an elastic band with a comfortable amount of resistance.
- Set the center of the band against the arch of your food and hold each end. Lie on the floor with your elbows bent.
- Contract your thigh muscles and bring your knee towards your chest.
- Flex your foot and straighten your leg so that it pushes against the elastic band. Hold for two seconds before relaxing and lowering your leg to the floor. Switch legs and repeat.
- With Leg Presses, aim for 3 sets of 10 reps.
Modified Hurdlers Stretch
Tight hamstrings are a common culprit when it comes to knee pain (study). Research has been done linking short hamstrings to Patello-femoral pain (runner's knee). If you played sports growing up, tight, short hamstrings are the norm not the exception.
If tight or weak hammies are the main culprit behind your knee pain look into kettlebell swings and (light) kettlebell deadlifts. These dynamic exercises can really help to unlock your hamstrings while building a rock solid posterior.
- Sit with one leg extended, though do not lock your knee. Place the bottom of your other foot against the inside of your stretched leg against or slightly above the knee.
- Square your shoulders and hips and straighten your back. Maintaining this posture, slowly lower your entire torso towards your straight leg.
- You can reach an arm forward to grasp your toes if it helps. If you can't touch your toes, feel free to use a pull up band. Hold the position for a few deep breaths, then straighten.
- Perform this stretch 2-3 times per leg.
Targeted at your quadriceps, these stretches can be done standing or lying down.
- For lying down, rest on your side, using an elbow to prop up your head. Lay stretched out, with both legs extended.
- Reach your hand down and gently pull your top leg so that it bends at the knee with your foot reaching towards your buttocks. You don’t need to reach all the way; stop if you feel any pain.
If you are standing, simply catch your ankle in your hand and gently lift your foot towards your buttocks. Your upper leg should remain straight and stretched.
- You want to hold the position for 30-60 seconds before lowering your ankle back down. Repeat the action with your other leg.
- Repeat this movement 2-3 times for each leg.
Single Calf Raise
The Single Calf Raise targets your calves and ankles to help with knee alignment. It can also improve your coordination and balance.
- Start by finding a support; you can use a chair, a wall, or a rail to steady yourself. Once you have your support, stand on one leg.
- Extend your left ankle and raise up onto your toes. Lower and then repeat.
- Perform 3 sets of 8-12 reps per side.
Straight Leg Lift
You’ll feel this in your quadriceps and hip flexors.
- Start by lying on the floor with your right leg extended straight and your left knee bent. Your left foot should be flat on the floor.
- Straighten, but don’t lock, your right knee by contracting your thigh muscles. Slowly raise your right leg until your knees are parallel and then lower it back down. Repeat 8-12 times before switching legs.
- Perform 3 sets of 8-12 reps per leg
These can also be performed while propped on your elbows— keep them aligned to your shoulders— or prone to target your hamstrings and gluteal muscles. When prone, rest your head on your arms before tightening your gluteus and hamstring and raising the leg towards the ceiling.
Supine Hamstring Stretch
This stretch targets its namesake, meaning you’ll feel it at the back of your thigh and behind your knee.
- Start by lying on your back with both knees bent and both feet flat against the floor. Lift one leg off of the floor, clasp your hands behind your thigh (below your knee, not at the knee joint), and straighten your leg.
- Pull your leg towards your chest and head until you feel the stretch. Hold the position for 30-60 seconds before slowly lowering your leg and repeating the motion with your other leg.
- Perform 3 reps per leg.
If you have trouble grasping your thigh, you can loop a towel around your leg and use it to pull.
Wall sits target several areas: abdominal muscles, hamstrings, gluteal muscles, and quadriceps. They make for a good alternative to lunges and squats.
- Stand with your lower back against the wall. Keep your feet shoulder-width apart and a comfortable distance from the wall.
- Bend your knees and lower your body until your thighs are parallel to the floor. Make sure your knees stay above your feet without shifting in front of them and your abs are firm to keep your back safe.
- Once your thighs are parallel with the floor, hold for 30 seconds before standing up. As your strength improves, increase your time.
- Perform 3 reps
You can use an exercise ball against your lower back to make motion easier and more comfortable.
The above list is just a sampling of the various exercises you can take advantage of in order to strengthen your knees and prevent or reduce pain. While information is readily available online to help you learn how to strengthen your knees, it is also prudent to seek the advice of professionals such as physicians, physical therapists, rehabilitative coaches and personal trainers.