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Knee pain – therapeutic exercises

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Knee pain can be really troublesome – all joints in the body are important, but for some reason, it just seems like having a bum knee is worse than anything. As the popular yogi, Bikram Choudry said,

“You can mess with the Gods, but dont mess with the knees!”

There are so many different knee injuries and causes of knee pain. What is most often not realised however, is that the knee is largely influenced by the workings of the feet below and the hips above. Think about it – the knee is at the mercy of how you tread on your feet and sit on your pelvis. If you place undue stress on one or both of these areas, the knee inevitably must compensate for these stresses.

There are of course, also misfortunate traumas to the knee such as tackles in rugby and soccer, freak falls and car accidents.

This article aims to inform the reader of some of the more common knee injuries and suggests some exercises for reducing knee pain. Regardless of what your injury is, most causes of knee pain will be alleviated with a similar set of corrective exercises. This is because the knee, in terms of its biomechanical function, is relatively simple. The knee essentially has only two degrees of freedom namely, flexion and extension (there is some minor rotation movement at the knee as well). In other words, the knee pretty much just bends and straightens.

Exercises for helping knee pain are thus mostly flexion and extension movements about the knee, but also incorporate foot and hip exercises as a means to reinforce knee biomechanics.

3 Common knee pain injuries

  1. Anterior Cruciate Ligament [ACL] tear – sudden twists or excessive force on the knee joint, commonly caused by repeated jumping or coming to a rapid halt while running can stretch ligaments beyond their capacity.

knee pain

Cartilage tear (meniscus) – The knee joint is bolstered on both sides by additional strips of cartilage, called menisci or semilunar cartilages. One of the most common knee injuries is a torn or split meniscus. Severe impact or twisting, especially during weight bearing exercise, can tear this cartilage. Tears of the meniscus can also occur in older people due to wear and tear. Symptoms include swelling, pain and the inability to straighten the leg. The damaged cartilage can be surgically trimmed or even removed without causing any joint instability.

Patello-femoral pain syndrome – Patello-femoral pain syndrome is characterised by pain felt behind the kneecap. Squatting, walking up and down hills or stairs, or sitting still for extended periods of time can exacerbate the pain. The usual cause is abnormal movement of the kneecap as the knee is bent and straightened. This can lead to wear and tear of the cartilage on the back of the kneecap. Imbalances in muscle strength, tight muscles and structural abnormalities of the lower limb can contribute to the problem. The pain usually comes on gradually over time.

Exercises to help the knee

  1. Petersen Step-up – perhaps the most important strengthening exercise for the knee. The Petersen step-up strengthens the vastus medialis oblique muscle [VMO] which is underdeveloped in the vast majority of people.

Step-up with knee raise – Extend through the hip and knee of the front leg to stand up onto a box or bench. As you stand on the box with your left leg, flex your right knee and hip and help by squeezing your left glute muscle to bring the knee as high as you can. You can watch a good video and see pictures of this exercise here.

Stationary bike – cycling is a good way to increase strength and range of motion. Ensure you have the right positioning of the legs. At the bottom of the pedal stroke, the bend in the knee should be 15 degrees. Start with 10 minutes and slowly increase your time.

Hamstring curl – there is a number of ways to work your hamstrings but perhaps the best one for rehabilitating an injured knee would be the swiss ball hamstring curl. This exercise works the entire length of the muscle which spans across both the knee and hip joints. It also facilitates gluteal activity, very important for knee stabilisation.

Monster walk – this is excellent for developing strength in the gluteus medius, a very important knee stabilising muscle. Do this exercise in either direction over a length of 5-10m.

Wall sit with medicine ball squeeze – try to squat low enough so that your thighs are parallel to the floor. Ensure your knees do not extend past your toes. If they do, stand back up and place your feet further away from the wall. Keep your back flat against the wall and squeeze against the medicine ball with your inner thighs. Hold for 30-60 seconds, breathing steadily. (Caution – omit this exercise in the case of an ACL tear)

knee pain vmo exercise

Calf raise – you can do this in the gym using the seated or standing calf raise machine. Alternatively, you can do these off the edge of a step with or without the use of dumbbells.

knee pain calf stretch

One-legged squats – this can be a very challenging exercise so you have a few options with varying degrees of difficulty (pictures are in order of difficulty level). The aim here is to perform the squat such that the knee tracks in line with the foot and the hip as you squat down. In the case of a weak gluteus medius muscle, the knee will tend to move inwards towards the opposite leg as you squat down. This is often accompanied by pain. Squat only as low as you can without feeling pain. Try to increase this range.

knee pain exercise 1

knee pain exercise 2

knee pain exercise 3

The above exercises will benefit the majority of presenting knee complaints. In the case of an ACL tear however, a more detailed exercise program will be needed. This is because the ACL is of such structural significance to the knee joint that the prescribed exercises must be of the right difficulty for the patient. Each individual case requires close examination so that an adequately tailored rehab program can be devised.

The exercises shown in this article are particularly good for runners knee and meniscus irritation injuries. Check with your health practitioner first as to the suitability of these exercises for your complaint before attempting on your own.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

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