The knee is a tricky joint.
There are many people out there who suffer from knee pain but never had a specific "knee injury" before like a fall.
The tricky thing about knee pain is that many times, the cause of the knee pain is not the knee itself.
I explain the position of the knee as "no man's land".
It sits between the ankle and the hip joint.
This means the knee's stability and position isn't dictated by the knee itself, but by what is going on at the hip or the ankle.
The knee is a joint where the main function is stability, or the ability to resist movement.
Like the elbow, the knee is known as a hinge joint so its main movement comes in the form of flexion and extension, but not rotation.
Because of the position of the knee between the hip and the ankle, you cannot do much to target the knee itself.
Instead, you must focus on the proper position (posture), mobility (range-of-motion), and stability (strength) of the hips and ankles to improve the health of your knees.
Your body's joints alternate from top to bottom with mobility and stability needs.
As you can see in the picture above, the main needs of your ankles and hips are mobility or the ability to move through large ranges of motion, where your knees main need is stability or the ability to prevent motion (especially rotationally and laterally).
What happens with many knee pain cases is that the joints change roles.
Over the years, our hips start to stiffen.
Unless we are constantly working on our hip's ability to move, flex, extend and rotate, we naturally lose this motion.
Add in extended periods of sitting to your daily life and your hips only get stiffer.
This creates shortness at the muscles like your hip flexors that attaches front of your pelvis which actually pulls your pelvis forward into anterior tilt.
This shifts our resting center of gravity forward putting the majority of your weight forward, into your knees.
Now that your knees are stiff and painful from bearing your weight throughout, add the fact that your hips cannot move very well.
As we said earlier, your hips need mobility and your knees need stability.
Well, if you cannot move through your hips, you're going to compensate and move through another joint above or below your hips, which typically is your knees.
At the same time, your hips become weaker because their change in posture. When you change a joint's muscle's resting position, you lose strength.
Your hips hold your most important knee stabilizing muscles -- your glutes and hamstrings.
So now your knees are excessively moving because of your stiff hips and are losing their ability to resist that motion because the muscles that control them aren't as strong.
It's like adding fuel to the knee pain fire.
The same is true for you ankles.
When you lose the ability to move well through your ankles (especially through dorsiflexion), we again compensate with excessive motion at the knee causing pain and damage to the knee.
When you walk, squat, lunge, or climb up stairs, you need the ability to bring your knee forward to or over your toes.
This motion should happen at the ankle.
If it doesn't, you run out of ankle motion and place excessive stress and movement at your knee -- ouch!
As you can see there are many issues that can arise at the knee because of issues up and down the kinetic chain.
To make things simple ---> mobile/strong hips + mobile ankles = happy/stable knees
Today, we are going to get into 3 steps to strengthening those knees!
Step 1| Stop doing things that hurt
This needs to be #1 on your list!
It's a very simple question -- "does what you're doing hurt your knee?"
Yes or no.
If it's no, then carry on with your exercise or activity.
It it's a yes, then stop doing it immediately.
It is amazing how renewed our members feel when we simply remove the exercises or movements that have been causing them pain.
I think this is very hard for many people because they feel like they're not going to get the same results with their exercise routine without that one exercise or movement.
This couldn't be further from the truth. There are a variety of ways to mimic the same intensity, heart-rate, etc. with completely different exercises that do not cause pain.
Think of it like picking a scab. If you do not stop, it's never going to heal.
By backing off the things that bug your knees, you allow for a reduction in pain and inflammation.
At the same time, the other thing you do NOT want to do is ditch your workout routine all together.
Countless research has shown the benefits of exercise and recovery from injury and pain.
Yes, the right exercise program for you and your injury can actually speed up your healing process and decrease your pain.
Stopping all together will only increase pain and stiffness, especially around your knees.
Step 2| Improve ankle and hip mobility
Step 2 in your knee strengthening program is to improve the mobility or range-of-motion at your ankles and your hips.
Let's start with the ankles.
Here is your test.
Start on one knee with your front foot straight ahead and positioned 3 inches from the wall.
Without lifting your front foot's heel or letting your knee cave inward, bring knee forward towards the wall.
If you can touch the wall with the heel staying down, you have adequate ankle mobility. If your heel lifts or you cannot reach the wall, we have work to do. (This is going to be the case for most people by the way!)
Here is one of our favorite calf stretches to do everyday -- down-dog.
- Start in push-up position with hands directly under your shoulders
- Keeping legs straight, push your hips as high as possible while driving heels towards the floor
- You should feel calves stretch
- Hold for :30-1:00
Work ankle mobility
Now that you've loosened up your ankles by stretching out your calves, it is time to work more mobility into your ankle
Remember that ankle mobility test you did against the wall?
We use that same test as an exercise to improve the mobility of your ankles.
- Start on one knee with front foot a few inches from the wall
- Keeping the front foot straight and heel down, bring knee forward over the middle of your foot and try to touch the wall
- Bring knee as far forward as possible without letting heel lift off the floor
- If you can touch easily, slide foot back an inch or two
- You should feel slight stretch in the back of your ankle
- Hit 10 reps on reach side daily
Now it is time to open the hips and improve their range-of-motion.
Most hips loose the ability to extend and internally rotate, so we are going to focus on stretching the muscles that restrict those motions.
Stretch hip with the 90/90 Hip Flexor Stretch (improve hip's ability to extend)
- Start on one knee both legs at 90 degree angles
- Keeping abs braced, slightly push your hips forward and lean into stretch
- Keep the glute of the down knee tight
- You should feel stretch in the front on the down knee's thigh and hip flexor
- Hold and breath easy for 1-3 minutes/side daily
Stretch hips with the pigeon stretch (improve hip's ability to rotate)
- Start in push-up position with hands under shoulders
- Bring one knee and foot our front and lay shin on ground, keep back leg straight
- The front knee should be in in-line with the same side's shoulder
- Try to get shin parallel to shoulders
- You should feel stretch in the same hip of the leg out front
- Hold and breath easy for 1-3 minutes/side daily
Step 3| Strengthen hips and hamstrings
Now that we have increased range-of-motion in the right areas, it is time to add strength to those muscles to keep your new mobility and posture.
Add strength to the right areas is like hitting "save" on the computer -- it keeps everything you've worked on in place.
As we talked about earlier, your glutes and hamstrings are your most important knee stabilizers.
The stronger they are, the less likely you are to rotate or over stress your knees.
1| Glute bridge
The glute bridge is a great drill that can be done daily and makes for a great warm-up drill. It is done to "wake up" your glutes and get them ready to work to control your knee.
- Start on back with knees bent
- Keep heels directly under your knees
- Start by bracing ab and lifting hips as high as you can
- Do not leg low back arch
- Hold top position for :20-:30 and keep glutes squeezed
2| Mini-band lateral walks
The mini-band is great piece of equipment we use with just about all of our members. They provide light resistance and help activate some of the most important muscles that control your knees like your glute medius.
- Start in athletic position with mini-band around your ankles
- Keep toes straight and feet shoulder width apart
- Take a 2" step to your left with your left foot and pause
- Then take a 2" step with the right foot in the same direction and pause
- Always stay shoulder width with your feet
- You should feel the sides of your hips working
- Repeat in each direction
- Start with 2-3 sets of 10 steps/side
3| KB Deadlift
The KB deadlift is one of the best exercises to strengthen and shape your glutes and hamstrings. It is typically the most challenging exercise for our members to master so take your time! Beginners initially want to squat the movement by excessively bending their knees. The KB deadlift is a hinge movement where you want to move at the hips and allow your torso to fold forward. This movement not only teaches our members to safely deadlift in the gym but also how to safely pick objects off the floor outside of the gym.
- Start one KB directly between your feet
- Take a hip to shoulder width stance, toes pointed out slightly
- Soften knees and push hips back (do not let knees travel forward)
- Keep spine in neutral position with shoulders back
- Grab KB and drive through heels to stand up
- Finish tall with glutes squeezed
- Start with 3 sets of 8 to 10 reps
4| Cable 1-Leg SLDL
The cable SLDL (stiff-legged deadlift) may be the best lower-body exercise for improving knee strength. The movement challenges balance, single leg strength and targets the glutes and hamstrings. It has a great transfer to real-world movements like walking, climbing stairs, and jogging as it's done on one leg at a time.
- Start tall with cable in one hand
- Start by softening knee of down leg
- Slowly reach back leg long and allow chest to fall forward (same arm forward, same leg back)
- Keep chest tall and stomach braced
- In bottom position, there should be straight line from head to back heel
- Quickly return to starting position and squeeze glutes
- Start with 2-3 sets of 6-10 reps/side