Updated: Feb 20
I remember the times I would go for a run outside and after a mere 5 minutes be in agony. With every stride my knees would scream out at me saying "Hi, can you not?!" I would power through my run trying to ignore the fact that my knees were very grumpy at me. Only to get home and have to immediately pop an anti inflammatory. The following day was even worse! Can someone get me a wheelchair, please? A piece of advice: If your knees are in pain when you run, squat, hike etc..There is a reason for that, and you should listen to your body's message. Don't exercise through the pain.
Lucky for you, I have solutions to your knee trouble so you can get back to doing the activities you love to do pain free. Below I will talk about some strength and mobility exercises you can start doing that will help you recover from chronic pain in your knee joints.
Knee pain is not very nice to us, is it? It plays mean tricks on us. On the one hand, if you enjoy exercising, it punishes you for remaining active. On the other hand, if you'd rather be binge watching Netflix all day, it gives you an excuse not to move your body even more because it hurts. If you're someone who wants to lose weight and you know the extra pounds are contributing to your knee pain, but the knee pain makes it harder to do the physical activity you need to do... well, you're in a Catch 22, aren't you?
With that said, let's talk about knee pain: what causes it, how to avoid making it worse, and exercises and stretches you can start to implement into your gym fitness regime to make you feel better and move more.
Why do I have chronic knee pain?
Chronic knee pain is generally associated with wear and tear, which could be linked to any or all of these factors:
· Lack of mobility in the ankle joints
· Poor exercise mechanics (running, weightlifting)
· Poor or unbalanced muscle strength
· Previous injuries
What movements hurt your knees?
As previously mentioned, we need to ensure you do not make your knee pain worse. How? Your first goal should be to eliminate anything that triggers knee pain. In other words, if it hurts, stop doing it.
Now of course this is easy in theory, and when we are talking about a specific exercise like squats, lunges, or running. But what if the pain occurs when doing everyday activities like walking or climbing stairs? Figure out when in the day and where in the knee joint it hurts.
· Morning: If your knee pain is worse in the morning but gets better with movement, it’s typically because of arthritis.
Solution: do knee extensions upon waking while sitting on the edge of the bed.
· Midday: You could be sitting too much or doing too many repetitive movements. More information is needed to make an accurate diagnosis.
· Evening: Most likely a combination of poor muscle strength and poor movement patterns, putting unnecessary stress on the knee joints.
Solution: try the exercises and stretches noted below
· Going up stairs: Could be in part due to improper technique
· After sitting for a while: Ergonomics—the way you're sitting.
Solution: Improve your sitting posture or get an adjustable standing desk if possible.
· After standing for a while: Footwear or hard standing surfaces.
Solution: Shoes without arch support make your ankles and knees more prone to rolling inward which it easier for someone’s ankles to roll inward. Make sure you have good quality shoes.
· Inside (medial): It could be a sign of structural damage to the meniscus or ligament, or it could be a problem with the kneecap’s position. Tightness in the Iliotibial band (IT), the thick connective tissue on the outside of the leg, can pull the kneecap outward, putting stress on the structures designed to protect the medial side.
*Should be diagnosed by a clinician
· Outside (lateral): Often a sign of Iliotibial band syndrome. This is very common with runners and cyclists. Their repetitive knee flexion and extension causes the IT band to rub against the lateral condyle of the femur which forms part of the knee joint.
· Over the kneecap: This is usually patellar tendinopathy, weak quadriceps, faulty movement mechanics, or a combination of things.
Solution: see below for exercises and stretches
· Behind the kneecap: One possibility is bursitis (inflammation of a fluid-filled sac within the knee joint). Another possibility is chondromalacia patella (arthritis on the back of the kneecap), whereby the smooth cartilage on the back of the bone wears away, and instead of gliding over the femur, it starts to rub and cause pain.
What are the best exercises to perform if you have bad knees?
Step 1: Soft-tissue work
I suggest you address three typically problematic areas that cause chronic knee pain: calves, quads, and the IT band. Grab your self a foam roller and roll it out!
Unlike most exercises, the more it hurts, the more you need to do it.
Step 2: Ankle mobility drills
Dorsiflexion range is a crucial aspect when it comes to ankle mobility, and consequently how your knees are impacted as well. Functionally, dorsiflexion is best achieved with the toes on the ground and the lower leg moving forward over the ankle and foot while running and walking. Without a good range of motion while in dorsiflexion, you can end up with knee problems.
You can get a loss of dorsiflexion movement by prolonged inactivity, or too much activity with bad mechanics. When the shin doesn’t move forward over the ankle, it shifts inward. This ankle eversion causes the arch to flatten and the knee to go into valgus, collapsing in toward the other knee.
Step 3: Hip-dominant exercises
It is imperative that you have strong hip muscles, including the glutes so the hip can stabilize itself properly. If the hip is not properly stabilized, the femur adducts and creates knee valgus—the same motion you see when you have a lack of dorsiflexion ROM. The exercises below are some of my favourite hip dominant exercises that will strengthen the glutes and hip stabilizers.
Depending on the exercises and weights used, the sets and reps will differ. Use your judgement. Focus on motor control. Weighted RDL's will probably need fewer reps compared to body weight glute bridges.
The longer you've had chronic knee pain, the more work you will need to put in the gym and the more patience you will need to have.
If all you need to do is fix a flawed movement pattern, you may find the knee pain vanishes quite quickly. If you need to build your muscle strength up, steady progress will be made. Grace yourself with patience.
No longer are the days in which I have to be carried down the Himalayan Mountain range because my knees are in excruciating pain and blown up to the size of a cantaloupe (true story), and I hope with these strategies you can achieve a pain free and mobile existence, too.
P.S If you'd rather leave it to the pro personal trainer (achem), send me an email at email@example.com to inquire about personal training sessions with me. If you live in Vancouver, I work in a gym near you and I'd love to work with you one on one.
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