Knee Pain

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.

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.

Kneed Relief?

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Our activities can put some strain on our knees. At the end of a long hike, or maybe it was a bike ride, or maybe after working in the garden our knees can feel achy and sore. Grab a foam roller and try these 3 exercises to help bring some relief to your knees.

Do your knees need more love? There are 3 routines on the Koa Fit Online Platform for knee health and strength. Check them out here.

Joint Health Month – Week Four

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We are finishing our lat week of Joint Health Month focused on the knees. ⁠
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A lot of the time, our exercises only focus in the knee in it’s most neutral position. In the first video, try this rotation and mobility exercise to find the full range of your knee. Explore how it moves so you can train smarter.⁠

Our knees need the hamstring. Weak hamstring = weak knees.⁠ ⁠ In the second video, try this version of a bridge to target the whole posterior chain system and start supporting those knees.⁠

Knee Month – Week Three

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This week we will focus on the function of the quad and hip flexors. We will start with a release of our hamstrings and create some space on the posterior part of the thigh so that we are able to fully engage the anterior part of the thigh.

Knee Month – Week One

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We are starting a month focused on knee health. A lot of the tweaks and discomfort felt across the top of the knee is due to increased tension put on the patellar tendon due to tight quadriceps. Use this first exercise to release some tension in the quads and free up some space for the patellar tendon.

Weakness in the lateral hip, specifically the glute medius, can also lead to pain on the sides of the knees. Use this exercise to strengthen the side of the hip and helps support the knees.

Sore Knees? Try These.

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Knee pain.  It has happened to most of us.  1/3 of Americans will experience knee pain at some point in their lives.  It is the 2nd most common cause of chronic pain and new reports show it is affecting more people each year.  So, if you are experiencing a “twinge” or maybe a “tweak” in your knees, it is time to take some action before bigger issues occur.

The greatest cause of knee pain is, by far, poor body mechanics and poor mechanics are  typically caused by a lack of mobility  which leads to a lack of strength.  For example, due to prolonged sitting, a lot of people experience a tightness in the front of their hips.  This tightness in the front of the hips leads to decreased strength in the back of the leg (glutes and hamstrings), which decreases the support in the back of the knee.  Without the support and strength in the back of the knee (posterior), force traveling through the knee joint is pushed into the front of the knee (anterior) and causes pain across the front of the kneecap (commonly called “Runner’s Knee”).  This is not the only cause of knee soreness, but it is definitely one of the most common.

The knee joint is where the femur (thigh bone) and the tibia (shin bone) come together. All 4 muscles of the quadriceps come together to form the patellar tendon which starts at the top of the knee joint, adheres to the patella as it crosses the anterior (front) of the joint until in attaches at the tibia below.  The patellar tendon lies within a grooved-out notch the allows you to bend and straighten your knee without irritation.  A lot of knee pain is caused when the alignment of the patellar tendon and this specially made notch go out of whack.

The inside of your knees is referred to as the medial side and the outside of your knees is known as the lateral side.  Imbalances between these two sides can cause the patellar tendon the shift towards the stronger side.  For instance, if you have had an injury to your knee in the past, you may remember your therapist trying to get the inner-most muscle of the quadriceps to fire.  This needs to be strong, so that your patella does not start to track to the lateral side of the knee joint and cause you more pain.  If this imbalance continues, a person can start to feel tightness in the IT band and other soft tissue on the lateral side of the knee while also experiencing sharp pain on the medial side of the joint.  The knee has to be balanced side-to-side (medial to lateral) to stay pain-free and happy.

Imbalances front-to-back (anterior to posterior) are the usual cause of pain in the first example of our Runner’s Knee.  However, we also see in the example above, that imbalances medially to laterally can cause different, but equally annoying pain.  The routine below starts with releases of the most commonly tight areas of the hip and lower limb that may cause imbalances at the knee joint.  They are followed by exercises that strengthen the muscles that are commonly weak in people with knee pain.  This routine will not help everyone with knee soreness, but if you have been experiencing sore knees after activity or “tweaks” and “twinges”, this is a great place to start.  Even if you have not had knee pain, this routine will help your knees stay happy, healthy and pain-free.