Cursed by Knee Pain? – Exercises to Limit the Pain
Did you know that each year there are 19 million trips made to the doctor’s office for knee problems alone? Or that a young female athlete is about 8 times more likely to tear an ACL than a young male athlete? And golfing actually puts as much stress on the knee as tennis and jogging!
The knee is the largest joint in the body, and it’s amazing how stable it is when you realize that it’s basically two bones being held together by tendons and ligaments.
What is Hurting Inside my Knee? – Basic Anatomy
That’s a difficult question to answer and this is why.
Photo credit: robswatski
The knee is a hinge joint formed by the femur (the bone in your thigh) and the tibia (the shin bone). In between these two bones there’s a small pad called the meniscus. The meniscus is made up of cartilage (it’s softer and more pliable than bone) and its role is to provide a larger surface area for the joint as well as fill in gaps that are made during joint movement. It also acts to increase the stability of the joint, provide shock absorption, and make joint movement easier by improving lubrication for the bone surfaces. The bone ends have a lot of nerves in them so without a meniscus, movement would be very painful.
Now the bones are held in place by ligaments and supported by muscles and tendons that cross the joint. What’s the difference? Tendons connect muscles to bones (so when you contract your bicep your forearm moves) while ligaments connect bones to bones to hold them in place. The main ligaments around the knee are the anterior and posterior cruciate ligaments (ACL and PCL) and the medial and lateral collateral ligaments (MCL and LCL). The cruciate ligaments (ACL and PCL) are “inside” the knee and prevent the tibia (the shin bone) from moving around separately from the femur. For example, without them, every time you suddenly stopped your tibia would slide forward. The collateral ligaments (MCL and LCL) are on either side of your knee and they work to stabilize the knee as well. Without your MCL, your knee joint would “open up” every time it bent inward.
So you have the two bones, the meniscus, and now four ligaments to hold that all in place. Next, you have a capsule that surrounds the whole joint, twelve muscles that cross the joint to act upon it, and the iliotibial band (a thick fascia) that runs down the outside of your thigh and attaches just below the knee on the outside of the shin bone. All of these structures aid in movement and support. Lastly, the patella is the small bone known as the knee cap. The patella actually has a more technical role than it seems; it serves to add leverage for knee extension and is held in place by the quadriceps and patellar tendons (which is what the doctor hits with that funny hammer to make your leg kick out uncontrollably).
Whew that was a lot of information…and a lot of things that can be causing your pain.
What Could be Wrong?
So many things could be wrong! If you are experiencing pain in your knees, other than just having sore knees after exercise, you NEED to go see a doctor. Sadly, how to cure knee pain is to go to the doctor. With a knee injury exercises will only make the injury worse. I won’t go into the details of injuries but here are a couple things that could be wrong. If you feel unstable on your knee it could be one of the four main ligaments. If you feel popping, clicking, or catching (especially up stairs) it could be a meniscus. If bending your knee causes a painful burning sensation at the front of your knee it could be patellar tendonitis. And the list could go on…
With Knee Pain Exercises Aren’t The First Step
Let me guess, the thought, “It’s just a little hitch, I can run through it,” has been running through your brain. I know, I’ve been there too. But despite what you keep telling yourself and what seems easiest, I promise that “running through it” is not what you want to do. Yeah sure your body heals on its own, but it can’t if you don’t treat it right. Every time you try to run through it you are just exacerbating the problem and delaying the day you can be pain free.
But I Just Have General Pain
Even if you have general soreness, you don’t want to keep running on it without first trying to find the root of the problem. Your body is all connected (called the kinetic chain) meaning that something happening at one joint can cause pain down the line in another. The knees act to absorb a lot of shock, so the first place you want to look is your feet. How are your shoes? Do they provide the support you need? Go to a running store and have them help you find a shoe that provides the right amount of support for you. What type of surface are you exercising on? A slanted surface can cause excessive stress on a joint and so can different types of surfaces such as asphalt or sidewalks. Genetics also play a role in this as well. Look in the mirror; if your knees cause your legs to look bowed or knock-kneed this could be the problem. And lastly, if you have knee muscle pain your muscles around the knee could be weak, strengthening those might just be your ticket.
Physical Therapy for Knees
The first step in rehabilitating any injury is to limit or control swelling. You cannot be completely healed until all of the swelling is gone. Swelling also increases the pressure in the injured area causing pain and neuromuscular inhibition. Let me emphasize that pain will greatly inhibit the healing rate which is why it is your second goal in a knee physical therapy program. So in this case the “no pain, no gain” mantra is not applicable. Once you start knee physical therapy exercises, any exercises should be done in a PAIN FREE range of motion. The progress might be slow but if you rush yourself you will never heal properly. The next steps are to regain neuromuscular control (the body’s ability to unconsciously react to what position the joint is in); restore your full range of motion; increase your strength, endurance, and power; improve stability and balance; maintain your cardiorespiratory fitness; and incorporate functional progressions. Now, there is no textbook answer to knee physical therapy, and even though I have outlined the steps, there is not a distinct line between when one ends and the other begins.
Physical Therapy Exercises for Knees
Photo credit: iwona_kellie
These knee rehab exercises do not substitute the need of finding out the real problem behind your pain!
The way to begin knee therapy exercises is with very basic and simple exercises as you progressively build up to more complex movements. In physical therapy knee exercises vary but they are all very similar and accomplish the same goal. These exercises are just beginning exercises to help you strengthen your knee and should be performed repetitively 2-3 times per day and should be pain free.
1. Heel Slides: This is just like the name says. Start by sitting on the floor with your legs extended in front of you and slide the heel of your injured leg towards your hip; try to flex your knee as much as possible. Then slowly extend your leg and return to your starting position; try to straighten your knee as much as possible.
2. Straight Leg Raise: Sit on the floor with your legs extended in front of you. If you have left knee pain then slightly turn out your left foot (like a ballet position) so that your entire leg is rotated outwards. Now raise that leg about 6 inches off of the surface and then slowly lower it back down. You should be isolating the quad muscle that is right above your knee cap on the inner surface of your thigh.
3. Chair Walk: Sit in a rolling office chair and completely extend your leg to reach out in front of you. Use your heel to pull yourself and the chair forward and then repeat with the other leg. Do not let your knee bend past 90 degrees.
4. Stationary Bicycle: This is a great way to strengthen and increase your range of motion. Begin without resistance and make sure that your knees are directly above you ankles. They should also be slightly bent at the bottom of the resolution. If you can make a full resolution without pain then increase your speed and work up to increasing your resistance. If you cannot make a full and pain free resolution then pedal forward as far as you are able, stop, and then pedal backward as far as you able and then repeat.
5. Isometric Hamstring Contraction: Sit on a chair with your leg extended out in front of you and your heel on the ground. Keep your knee slightly bent and contract your hamstring by pushing your heel into the ground. No part of your leg should move. Hold the contraction for about 10 seconds then release and repeat.
6. Isometric Quad Contraction: Lay on your back with your legs extended and contract your quads by attempting you pull your knee cap towards your head. No part of your leg should move. Hold the contraction for about 10 seconds then release and repeat.
7. Hamstring Curl: This exercise will require an exercise band or a weight machine. If you are using an exercise band, lie on your stomach and hook the band behind your knee as well as something stationary, such as the leg of a table. Flex your knee against the resistance and then return to your starting position. If you are using a machine apply very light weight and perform a hamstring curl.
8. Quad Extension: This exercise will also require an exercise band or a weight machine. For an exercise band hook one end to a chair leg and the other end over your foot. While sitting in the same chair, extend you knee against the resistance. Return to the starting position and then repeat.
9. Terminal Extension: This exercise is done standing up and you just straighten your knee from a slightly bent position to full extension. Once that becomes easy, add a resistance band behind your knee so you add resistance when you straighten into full extension.
10. Step –Ups: Stand in front of a step and step up! It’s that simple. Keep a good pace and alternate which leg steps up first.
11. Wall Slide: Lean your back against a wall and slide down until your knees are bent (but not past 90 degrees) and then straighten back up again. Your legs should be parallel, feet shoulder-width apart, and your knees should stay over your ankles. To increase the intensity, perform this exercise with an exercise ball between your back and the wall! Because performing this with an exercise ball is a more complex movement, it is something you should build up to.
Now once you progress from there you can start incorporating complex movements rather than just strengthening and stretching. You should build slowly; some ideas are balance on one leg while throwing a ball back and forth or perform the wall slide with the exercise ball while throwing a ball back and forth. Just remember, if at the end of the day if you have more swelling or pain than what was there before, you have pushed yourself too hard and you need to back off. Lastly, follow up any exercises by icing for 20 minutes.
Now good luck and happy rehab!