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.