How to Prevent and Eliminate Knee PainSeptember 14th, 2009
Is your quality of life being limited by chronic knee pain? If not, wouldn’t you like to reduce the possibility of this limitation? In either case, the information below will help you build strong knees that are resistant to pain and injury.
I dealt with the frustrations of chronic knee pain for about 4 years and sought the help of several specialists without making much progress. This is unfortunately a familiar case for many people. I knew that I must have been doing something to cause the pain and realized that the only way to truly resolve the problem was to figure out what it was.
After finally getting closer to the root of the problem, I made significant improvements and am now able to climb stairs, walk long distances, exercise, and play tennis without knee pain. It’s very satisfying to say the least and I hope that the proceeding information will help you achieve similar results.
Don’t Underestimate the Importance of Prevention
Although the importance of prevention is much more obvious in regard to disease, it’s still a very important aspect of your physical health. My step-daughter has a friend who’s an excellent soccer player and was a likely candidate for a college scholarship. Unfortunately, she ended her soccer career during her junior year of high school by incurring her second ACL tear. As a ski racer and a tennis player, I’ve heard many stories like this, and I’m sure you have too. Although some injuries are too traumatic to be prevented, many of them can.
Even if you’re not an athlete, knee pain can compromise your ability to perform basic functions like walking and make it difficult to fully enjoy life. As such, you should embrace the importance of building healthy knees even if you’re not currently experiencing any pain, and this applies to the rest of your body as well.
What Causes Knee Pain?
The health and proper function of your knees depends on a number of factors including muscle strength, muscle flexibility, joint mobility, and gait pattern. If any one of these factors are compromised, you’ll be vulnerable to pain and injury.
If the supporting musculature of the knee joint is week, more of the stress incurred by the knee will be transferred to it’s ligaments. Likewise, if the major muscles that act on the knee are inflexible, it will increase the strain on the knee joint, the tendons attached to the muscles, and the muscles themselves. A lack of mobility in the hips and ankles will also increase the strain on the knee and exacerbate all of the problems listed above.
Due to a number of factors including previous injuries and a sedentary lifestyle, many people develop weaknesses and imbalances that lead to a faulty gait pattern. The knee is usually the joint which takes most of the resulting burden and becomes vulnerable to pain and injury as a result, especially during strenuous physical activity.
Orthotics are Not Always the Answer
Many people tend to overpronate when they walk which causes their ankle and knee to roll inward and leaves the knee in a compromised and vulnerable position. As such, knee pain is frequently blamed on foot problems and orthotics are often used as the solution. Although orthotics may help to reduce the pain, in many cases, they merely compensate for the problem rather than directly addressing the root cause of it.
I was convinced by a physical therapist that I had an anatomical foot deformity that was causing me to overpronate, and based on this, I wore orthotics for several years. Although the orthotics did help some and I don’t completely doubt the physical therapist, I eventually discovered a much more logical explanation for most cases of knee pain.
Your Butt is Meant for Much More than Just Sitting
The gluteus medius, one of the smaller butt muscles, resists the internal rotation of the thigh, or in other words, prevents your knee from rolling inward. Regardless of how good or bad your foot function is, a weak or inactive gluteus medius will likely lead to knee trouble. Since realizing this and addressing it, I’ve completely stopped wearing orthotics and my knee has improved greatly.
Many of us spend the majority of the day sitting. We sit in the car when we drive to work, we sit at a desk all day, we sit in the car to drive home, we sit down at the dinner table, and then we sit on the couch to watch television. The human body was not designed for this much sitting. Our primitive ancestors rested by getting into a deep squat which is a basic and natural position that many of us have lost the ability to get into.
When we sit, it causes the gluteal muscles of the butt to lengthen and the hip flexors to tighten. By sitting for many hours every day, as many of us do, it creates an imbalance that results in the weakening and deactivation of the gluteus medius muscle which allows the knee to roll inward more easily and leaves it susceptible to pain and injury. For some people, their gluteus medius becomes so weak and inactive that they can’t even consciously contract it. As such, the gluteus medius should be a focal point of any knee strengthening program.
Healthy Knees Depend on Ankle and Hip Mobility
The hips and ankles are designed for mobility and can accommodate a fairly large range of motion. The knees, however, have a smaller range of motion and are better suited for stability. When the mobility of the hips or ankles is restricted, the knees are forced to compensate and are put under more stress than they’re designed to handle. As such, ankle and hip mobility are of critical importance to healthy knee function.
The following videos demonstrate some excellent mobility exercises for the ankles and hips. If you don’t see the text pointers in the first video, turn on annotations by clicking on the furthest button to the right of YouTube toolbar.
As you’ll soon see, I demonstrated all of the exercises in bare feet. I think exercising in bare feet is an excellent way to maximize muscle recruitment, improve balance, and promote healthy foot function. All of the exercises included in this article can be done barefoot in the comfort of your own home, but if you’d prefer to do them somewhere else, I recommend wearing Vibram FiveFinger shoes.
The Importance of Flexibility and Muscle Tissue Quality
As I previously mentioned, tight muscles can contribute to knee pain and increase the risk of injury by creating additional and uneven stress on the knee joint. Furthermore, tightness in the major muscles acting on the hips and ankles can inhibit the mobility of these joints and make an additional contribution to knee trouble.
When most people think of flexibility or muscle tightness, they associate it with stretching. However, trigger point therapy, or self massage, is a very important factor as well. Muscle knots, also referred to as trigger points, are localized areas of tightness within a muscle where many of the fibers have become stuck together. They are caused by frequent use of the same muscle and compromise the muscle’s strength and flexibility. Fortunately, muscle knots can easily be eliminated through a variety of self massage techniques which loosen muscle tissue, release knots, and improve flexibility. For this reason, self massage is just as important, if not more so, than static stretching and should ideally be done prior to anything else.
Trigger points can also refer pain to nearby joints, and in some cases, may be the entire cause of your pain. For a better understanding of how to identify and address trigger points, I highly recommend The Trigger Point Therapy Workbook by Clair Davies. I often develop trigger points in my vastus medialis which is the inner part of the quadriceps, and thanks to this book, being able to manage them has been a significant help.
In relation to the knees, the most important muscles to massage on a regular basis are the claves, quadriceps, hamstrings, glutes, and hip flexors. The following video demonstrates how to massage these muscles using the foam roller. You should spend more time on each muscle than I do in the video. I went through each muscle quickly to keep the duration of the video short. Unless you’re naturally very flexible, you should also do static stretching for the same muscles. A good resource for learning a variety of different static stretches is Sport Stretch by Michael Alter.
Protect Your Knees with Stronger Muscles
As I previously mentioned, strong muscles will help to stabilize the knee and reduce the pressure on it’s ligaments and the joint itself. While it’s important to develop balanced strength throughout all of the muscles of the lower body, two muscle groups that are of particular importance are the glutes and quadriceps. The glutes are important because of their ability to control excess movement of the knee, and the quadriceps are important because of their influence on the alignment of the knee cap.
While isolation exercises can be useful for injury rehabilitation, it’s important to realize that they don’t train small stabilizer muscles or the more complex movement patterns that are a common part of every day life. As such, they don’t do a whole lot to improve the function and resilience of your knees. Compound exercises that require balance and incorporate multiple joints will do a much better job, and single leg exercises are the best.
Some of the easier exercises to start with, especially if your knees are in bad shape, are the step up and the glute bridge. As the condition of your knees improves, you can progress to exercises like the split squat, lunge, and single leg deadlift. This last exercise, the single leg deadlift, targets the important gluteus medius muscle very well and has been an especially important part of my improvements.
The following videos demonstrate the split squat and the single leg deadlift. For the split squat, keep your knee tracking directly over your foot, and for the single leg deadlift, keep your knee slightly bent to promote activation of the gluteus medius. For both exercises, be sure to maintain excellent upper body posture.
Don’t Underestimate the Importance of Nutrition
Regardless of how much effort you put into an exercise program to build healthy and robust knees, it won’t do much good without an adequate amount of high quality nutrition to support the development of healthy cartilage, bone, muscle, tendons, and ligaments. To insure that you’re acquiring the necessary nutrients, eat plenty of natural whole foods such as meat, fish, fruit, and vegetables. Fish and other seafood is especially beneficial because the high content of omega-3 fatty acids will help to prevent the inflammation that is so commonly associated with knee pain. Omega-3 fatty acids are also an important aspect of good health in general.
Proper hydration is also critical to knee health because it keeps the cartilage surfaces smooth and allows the ball of the joint to glide smoothly within the socket. Because of the increased joint friction that results, dehydration can promote inflammation, pain, and even arthritis. I think a good guideline is to drink approximately as many ounces of water each day as half of your body weight in pounds.
While there are a lot of popular supplements available for joint pain, particularly glucosamine and condroitin, I personally don’t think they’re necessary and they especially shouldn’t take the place of the more effective measures described in this article. However, if all else fails and you have the money to spare for such supplements, they may be worth a try and could potentially make a difference. One supplement I do recommend is Great Lakes Gelatin which is natural and derived from cattle hide and bone. If you have the time to prepare it, bone broth is an even better source of gelatin. Like glucosamine and condroitin, gelatin promotes the repair of cartilage and is also useful for repairing the lining of the intestines.
Beware of Overuse
There’s no doubt that the human body is built to move or that regular exercise helps to keep us healthy, but movement and exercise need to be a balanced with adequate rest and recovery time. Exercise, especially if strenuous, wears down the body and increases the need for recovery and repair. If adequate recovery time isn’t provided, the body will continue to break down and eventually become susceptible to pain and injury. This is especially the case with people who exercise excessively to lose weight, release stress, or compete in an endurance activity.
If you live a very active lifestyle and exercise frequently, make sure that you allow yourself enough recovery time, and be prepared to take a break if you notice any warning signs of pain.
For more information about how to put together an effective program to eliminate and prevent knee pain, I highly recommend Bulletproof Knees by Mike Robertson. This book presents many more exercises than I can include in a single article and provides guidance on how to adjust your exercise program as the health of your knee progresses. It also discusses plyometrics which is another important aspect of building healthy knees that I left out in the interest of limiting this article to a reasonable length.