Exercises for Knee Pain Prevention

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At some point, most adults will experience some form of knee pain. Depending on what that pain feels like and where you feel it can give us clues into what to do to prevent it from getting worse or coming back. Below is a quick guide. Think of it as a starting point. It is not meant to diagnose or treat and ailment, but as an offering to help keep the knees as healthy as possible for as long as possible.

Movements of the Knee

Before we jump into specific areas of pain, let’s talk about the biomechanics of the knee. The knee is commonly known as a hinge joint. Most people are familiar with the knee’s ability to flex (bending the knee so our heel gets closer to our butts) and extend (straightening the knee like kicking a soccer ball). But, the knee also rotates in 2 directions which are called tibial internal rotation (IR) and tibial external rotation (ER). This rotation is the primary movement of the knee. If we are lacking in either of these rotations (most people lack IR), it inhibits are ability to flex and extend in full range without putting stress on the knee joint.

This means, no matter what type of knee pain you experience, you should always start with rotation exercises. Below are a few ways to learn how to rotate, assess how much you have, and then help to increase the range and strength of the rotational movement.

Once you have established healthy rotation, scroll below to address where you have pain.

Pain in the Front of the Knee

Pain in the front of the knee, either above or below the patella (knee cap), is one of the most common forms of knee irritation. It can come on as quick as a little “tweak” or linger for a few days or months, maybe after a big hike. This is usually a sign of a strength imbalance in the legs where the quads (front of the thighs) are stronger than the hamstrings (back of the thighs). This can happen for a variety of reasons, but the exercises below are a good place to start when this type of pain sets in. Remember, always start with at least some of the rotational exercises above before moving on to anything below.

Pain in the Back of the Knee

Though it may feel counterintuitive, pain in the back of the knee is also associated with weakness in the hamstrings, specifically eccentric (muscle gets longer under tension) strength. When the hamstring can’t stabilize and support the back of the knee, the ligaments, tendon, and other connective tissue in the joint have to do the work. This leads to inflammation from being overworked and shows up as a symptom of pain in the back of the knee. Below are a few exercises you can do to help support the knee.

Pain on the Inside or Outside of the Knee

If you have pain in the inside or outside of the knee, then you have a rotational issue in your knee. Pain on the inside and outside can have a variety of reasons it is showing up, but at the heart of it, is that you don’t have enough rotation in the knee to support how much flexion and extension you are needing/demanding from your knee joint. Spend a lot of time on the very first exercises at the top. Once you have gone through those, you can start the movements below.

Up and Down the Chain

The knee is commonly called the “victim” of our movement. Meaning, our feet and ankles and our hips have a lot to do with the force our knees experience.

If we are lacking dorsiflexion (the forward movement of our shin to the top of our foot), we will more than likely externally rotate at the knee and turn our foot outward to help us move through our gait. This causes an unwanted rotational pressure through the knee. If we are weak laterally (outside of our hips), we tend to collapse at the hip, putting a shear force through the knee joint and putting pressure on the inside and/or outside of the knee. Below are a coupe of exercises you could add to your knee program, to help ensure the entire chain of joints and movements is working properly.

These exercises should be used as a tool kit. At no point, should you experience any pain or discomfort with any of the movements. The mechanics behind your knee pain can be different from another person’s even if the same symptoms are present. A full movement assessment is a good way to get the full-body picture of what may be causing you discomfort. If you would like to set up an appointment to get a full assessment and a personalized exercise program, please reach out to me at Brenna@KoaFitUSA.com.

Recipe – PB and Banana Protein Muffins

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These muffins pack a punch with almond flour, protein powder, and only using honey as a sweetener. They are gluten free and delicious. They are the perfect mid-morning snack, mid-hike fuel, or as a replacement for dessert.

Ingredients:

  • 3 small-medium bananas (about 1 cup mashed)
  • 3 eggs
  • 1 tablespoon honey, optional
  • 1 teaspoon vanilla
  • 1 3/4 cup almond flour
  • 1 teaspoon baking soda
  • 1/2 teaspoon baking powder
  • pinch of salt
  • 1/2 teaspoon cinnamon
  • 2 scoops protein powder (1/2 cup packed) I use Gnarly’s Vanilla Whey protein available at Koa Fit.
  • 1/3 cup natural almond butter or natural nut butter of choice (runny kind works best)

Directions:

  1. Preheat oven to 350 degrees Fahrenheit. Grease muffin tin with oil or insert muffin liners into 12-cup muffin pan. Set aside.
  2. In a large mixing bowl, mash bananas until there are no large chunks left. Then add eggs, honey, and vanilla, and whisk until well combined.
  3. Stir in the almond flour, baking soda, baking powder, salt, cinnamon, and protein powder.
  4. Add the almond butter and lightly fold it into the batter.
  5. Divide the batter into the 12 muffin cups, filling 3/4 of the way. Bake for 15-20 minutes, or until golden brown and a toothpick inserted comes out clean. Remove the muffins from the oven and let cool for 20 minutes. 
  6. Enjoy!

Nutrient Information:

  • Serving Size 1 Muffin
  • Calories 196
  • Fat 8.1g
  • Carbohydrates 12.1g
  • Protein 8.4g

Exercises for High Hamstring, IT Band, and Hip Pain

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A lot of runners, hikers, cyclists, and walkers will experience high hamstring, IT Band, or other hip pain in their lives. With 60% of runners experiencing high hamstring pain, and 50% of cyclists and 20% of runners experiencing IT Band pain, hip pain is one of the most common injuries/complaints among this active group. The good news is that with a little bit of prevention/intervention work, a lot of those aches and pains can be avoided.

The hip is a ball and socket joint which gives it its ability to move in a large variety of ways. The six motions of the hip are: external rotation, internal rotation, abduction (leg moving away from center), adduction (leg moving towards center), flexion, and extension. Tension and limited range of motion in the hip (and the whole body) can only be caused by 2 things – mechanical tension (structure limitation) or neural tension. Most of our day-to-day mobility restrictions are cause by the latter.

When expanding space in the hip capsule, rotation should be addressed over any linear limitations. Without the establishment of good rotation, both internal and external, other ranges such as flexion and extension will never improve. Good range AND control of both of these rotations should be the primary goal of anyone experience hip tension.

Below are a few exercises to help. When doing these exercises, there should be no pain. You should feel stretch in the long tissue (the part your are lengthening), but you should never feel restriction or pinching in the closed angle (where the body is shortening or folding). There should also not be pain in other joints like the spine and/or knees.

While both rotations should be explored, if you are primarily experiencing hamstring pain, you would want to focus on your hip internal rotation and control. If you are experiencing more IT Band symptoms, you should focus more on the external rotation movements.

First, explore your hip range with this exercise:

Next, let’s work on hip external rotation and hip extension first.

Now let’s work on hip internal rotation.

And then put it all together with hip CARs. This exercise can be done daily on its own as a warm up for a run.

Have questions? Reach out at Brenna@KoaFitUSA.com.

Exercises for Plantar Fasciitis and Achilles Pain

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While not the same, Achilles Pain and Plantar Fasciitis can come from the same mechanism – insufficient dorsiflexion. Dorsiflexion is the ability of your ankle to flex in a way that gets the top of your foot closer to your shin. How much you need depends on the movements you want to do. For example, at least 10 degrees is needed for walking on a flat surface and at least 15 degrees is needed to run on a flat surface. If you want to add hills or uneven surfaces to the game, you are going to need more.

Getting more dorsiflexion isn’t as easy as stretching your calves. In fact, stretching past your range of dorsiflexion is what probably caused the pain in your heel or achilles in the first place. When you dorsiflex, a bone called the talus rolls anteriorly, but then needs to glide posteriorly. Sometimes, we feel this lack of glide when we flex our ankles and feel a resistance or “hard stop” at the front crease of the ankle. This lack of glide overstretches the tissue on the backside of the ankle, and over time, can create inflammation at the heel or the achilles depending on where we are weaker, what’s happening with the rest of our gait, and other factors.

To gain back dorsiflexion, we need to establish heel rock. This is our ability to invert and evert at the calcaneus (heel bone). Watch the video below to practice this move.

After we understand inversion and eversion (and probably discover we lack eversion), we combine this motion with the entire movement range of the ankle.

After we establish this range of motion, we move on to working directly on our dorsiflexion. This next exercise can be hard the knees if done on the floor (as shown). You can modify it by placing the foot that you are working on up on a chair or table.

Once we increase the range of our dorsiflexion, we will want to gain control of it with this next exercise.

Finally, we want to work the eccentric (loaded and lengthening) of dorsiflexion to ensure we have the strength we need when we are out on our runs, hikes, and walks.

It is important to remember that if you currently have pain, you may need to include an anti-inflammatory method in your recovery. You can talk to your doctor about what is best for you. These things need to work in combination to reduce the inflammation and prevent the injury from coming back. Anti-inflammatory options alone (such as ibuprofen and cortisol shots) will not fix the mechanics of the problem that got you in pain in the first place. Meaning, as the anti-inflammatories wear off, you could be back at square one if you have not done the work to fix the issue (not to mention you are leaving a lot of strength and power on the table by not expressing your full range of motion).

Your best option? Prevention. Start these exercises now so you don’t have to experience pain in the future.

Want more? Koa Fit’s Online Library has 35+ routines not just for ankles, but for hips, shoulders, low back, and more. Try it out today boy clicking here.

2 Exercises for your Low Back

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To keep our low backs happy and safe, it is important for us to learn how to stabilize them when we lift, push, and load them. Just as important though, is to learn how to move the lumbar spine in bending and extending, twisting and side-bending. Our lives are not lived in neutral spine, and in order to keep our spines prepared for our active lives, we need to train outside neutral as well.

These 2 exercises will help you discover how much you move (or don’t move) in your lumber spine, which motions are easier and which are harder, all while strengthening those deep core muscles that we need to keep the spine safe.

3 Exercises for Your Ankles

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Do you keep rolling your ankles? Maybe you feel like they are stiff and don’t move well? Is there a little tweak in them after a big hike? Do you always feel the need to stretch your calves? Try these 3 moves (daily if possible) to help bring some mobility and control to your ankles and tension relief to your calves and feet.

Case Study – Dislocated Shoulder

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Session 1

A client of mine came in recently who had dislocated his shoulder. The dislocation happened 9 days prior and he had already been to the ER to have it “popped” back into place. The shoulder was still very sore, did not take load well, and was extremely guarded (shoulder elevated towards the ear, elbow flexed, and arm hugged into the body).

Letting pain be our guide, we used shoulder CARs (controlled articular rotations) to explore the full range of the shoulder in all movements (external rotation, internal rotation, abduction, adduction, flexion and extension). This gave us a baseline of his current movement capacity, allowed him to explore his pain-free range, and displayed where the “weakest links” resided.

After the CARs, we moved onto some capsular work for the shoulder. Again, letting pain be are guide, we explored the range of motion in shoulder external rotation. We used PAILs (progressive angular isometric loading) to establish if the reason for the lack of motion was neurological tension (guarding) or mechanical (something injured). This allowed my client to gain range in a safe way without further injuring his shoulder.

Once we created more range in the shoulder (most of his loss was due to guarding), we gently moved the shoulder through the full, pain-free range of shoulder external rotation and internal rotation to “upload” to the nervous system the availability of this new range.

This may not seem like much, but it is a safe and easy way for this client to learn where he can move his shoulder safely. It connects our mind and body (via the nervous system) so we are less likely to guard and compensate. This expedites the healing process and gives us a roadmap of what we can train during this time so there is no “waiting” between rehab and fitness. We have identified where there is a lack of range, where there is a lack of control or strength, and we can use those perimeters to adjust the workouts so he can keep getting strong while protecting his shoulder from further injury.

Session 2

When we met again, and we went over his shoulder CARs, his range had much improved. We could see there was still limited motion in his internal rotation and his flexion, so we addressed that lack of range of motion first by adding a PAILs (progressive angular isometric loading) for shoulder internal rotation.

After creating that space, we repeated our shoulder CARs movement and then moved on to some strengthening for the shoulder capsule.

We started with shoulder external rotation since he had been working on that at home for the last week. We also started with eccentric loads (loading as the muscles elongates rather than shortens) in both shoulder external rotation and internal rotation because it has the ability to train the tissue as if it wasn’t injured. Eccentric exercises can override the reflex to guard the joint and lets the nervous system know that it is okay to move and load that area. This is the path back to full range strength.

This is the beginning of the strength phase. Again, loading in the eccentrics allows us to strengthen the shoulder, in full-range, while avoiding any unnecessary re-injury or pain. He will be sore from this exercise, but in a normal, muscle-sore capacity.

Stay tuned for more updates as we continue to progress.

Want to know more of have questions? Reach out Brenna@koafitusa.com

Morning CARs Routine

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Your daily routine to maintain joint strength and mobility to keep your body moving well. CARs stands for Controlled Articular Rotations. When doing this routine, you want to be pain-free – especially no pinching on the closed-angle side fo the rotation (short side). To get the most out of your CARs, make any part of your body that is not doing the motion rigid and stiff.

Neck CARs

Spinal CARs

Scapular CARs

Shoulder CARs

Elbow CARs

Wrist CARs

Hip CARs

Knee CARs

Ankle CARs

Toe Work

Feet and Ankles

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Feet, our connection to the world around us. These 29 muscles, 33 joints, and 26 bones propel us through our lives. How they work and connect affects how everything up the chain works, from our ankles and hips, to our low backs and shoulders. Over the next few weeks, I am going to focus on our feet and how to keep them happy. Check back each week for new videos.

The best place to start, is to see if you have control of your feet. Try this video below. If you can’t get it at first, keep trying. It will come quicker than you think.

Now that we can move our toes, let’s try to gain some more range of motion. Try this big toe extension stretch with both a straight and bent knee. Hang out in both positions, but spend a little more time in the one that feels the most useful.

Moving up to the ankles with this next video. Limited range in our ankles usually means we have limited “rock”. Meaning our heel has a hard time rocking side-to-side. Try this next exercise to check on this side-to-side movement while also working on gaining more control of the movement.

Now that we have some side-to-side movement, we can work on increasing the range of our dorsiflexion (shin bone towards the top of the foot). This PAILs/RAILs exercise allows us to gain more range of motion while actively engaging that new range. This means, we are strengthening while we are gaining more flexibility.

To round out all our work, we will finish with ankle CARs. This helps upload all our new range and maintain it beyond our session.