Got Knee Pain?- 3 Key Factors
Knee pain is a common issue I see with people in and out of the gym at all levels and ages. But for something so common I don’t see enough quality advice on how to treat it, a lot of people believe that it is inevitable for your joints to suffer if you do a lot of activity or as you get older and accept it as something you have to deal with. Well, I didn’t like the thought of that so I pursued as much information as I could and learned about treating knee pain through personal experience and by reviewing recent literature. I’m confident with a period of training and focusing on the steps I will lay out, anyone can play sport, lift and do the things they love whilst mitigating knee pain.
So how do you address knee pain well I’ve put it into 3 factors
Your Mobility particularly at the hip and ankle which will also effect your biomechanics of your running, squatting moving etc
Your Strength and the balance of musculature
The amount and frequency of load you put through your knees
I will also say that alongside these factors adequate sleep, good nutrition and hydration play a big role in reducing inflammation throughout the body and therefore have benefits in overcoming pain. However for this article I will focusing on the factors that I’ve found have the most direct impact on knee pain. At different points in my life and training I focused on one of these factors but it wasn’t until I worked on all of them collectively did I start to really mediate the pain.
The first factor is mobility, particularly hip and ankle mobility. The knee joint is a hinge joint quite simply it’s designed to flex and extend only, the hip and ankle are called ball and socket joints and they are designed to move in all sorts of directions. If your ankles are stiff (possibly from the type of footwear you most commonly use) and your hips are stiff (possibly from being seated a lot) they can put pressure on the knee to perform side to side movement its not designed to do.
How do you know if your hips and ankles are stiff?
A simple ankle range of motion test is the knee to wall Dorsi flexion test, this is really simply you touch your knee against a wall then move your foot back as far as you can checking that your knee can touch the wall and keeping the heel in contact with the floor. Measure both sides you want to be between 2-4” from the wall and for both sides to be within a half inch of each other.
A good test for the hips is the faber test, this test involves you lying face up with your legs in a figure 4 position, let the knee drop out to the side be sure to not let the opposite hip rise. The goal is to get the knee to touch the floor, if it’s really high or you have one side higher that the other you could benefit from getting up out of your chair every once in a while and doing some mobility exercises.
One move I would recommend that works both the hip and the ankle is the combat stretch. You can also load this with a kettlebell or plate and if you are getting pinching in the front of the ankle you can use a band at the base of the foot to create a distraction stretch.
The second factor is strength and the balance of your musculature. A big focus should be placed on the posterior muscles, a lot of what we do is anterior focused both in sport and general life (running, jumping or sitting, driving, typing at a computer). Therefore working your back, gluteus and hamstrings can be great for your posture that will also help your positioning in other movements and exercises and also takes force away from the knee. I like to think of your hamstring muscles as your breaks and especially in sport it helps to have good breaks. Jumping really high or running really fast is not what hurts it is the landing and sudden stops, if your muscles can’t take it they will put tremendous force through the joints and tendons. Some exercises to work on your posterior chain are hamstring curls, deadlifts and back extensions.
The other muscle that can impact knee health is the vastus mediailis oblique (VMO) which is the tear drop shaped muscle that runs on the inside of the knee. This muscle guides the path of the patella (the knee cap) you want it to glide straight when flexing and extending the knee. If it is out of alignment the knee cap can press against the lower leg bones creating a grinding pain. The VMO is responsible for the first 15º of motion meaning it initiates the full extension of the knee and the first slight bend of the knee. So you can work on this by doing short range step ups, start side on with the foot flat, progress to heel elevated and then heel elevated and unsupported. Sled drags or walking backwards on a treadmill that is off also works the VMO and is often a safe way to load the knee over toe position.
3. Load Frequency
The final factor is the amount of load and the frequency that you put load through the knee. A lot of people will get pain in the front of the knee just bellow the knee cap from high impact or dynamic movement or they might get pain and stiffness the following day. This is sometimes called jumpers or runners knee, in academic literature it is referred to as patella femoral pain or patella tendonopathy. Your tendons are tissues that connect muscle to bone and they are used in spring loading, they stretch and compress to give you bounce of the ground when you are running and jumping or any explosive movement. If you want to know the impact tendons have try running in sand. It’s really difficult because on a hard surface your tendons have something to spring of off but in sand your tendon use diminishes because of the soft surface so you are using nearly all muscle and will tire very quickly. Tendons can handle huge amounts of force, (in fact studies are yet to find a true limit) but only if they are conditioned to handle that load. Just like muscles you have to strengthen them, tendons are very sensitive to volume they respond better to more shorter amounts of frequent loading. A safe place to start is with an isometric hold. Two exercises that work the patella tendon are single leg extension holds and Spanish squats, this was tested by Jill Cook one of the leading professors in investigating patella tendinopathy. She found that 5 sets of single leg extensions for 45 seconds not only strengthened the patella tendon but had an analgesic effect (meaning it reduces the pain) for roughly an 45 minutes after. Making it a great priming exercise to start your session with and may allow you to focus on other exercises without pain. Once you’ve made progress with isometric loading the next step is eccentrics. With the leg extension use two feet to bring the weight up then one leg to control it down. After that you can start basic spring loading things like a step up with a small bounce Paul Fabrits has a great video on all the different ways you can scale that movement which I’ll provide in a link bellow. The important thing to remember is building your tolerance gradually.
I often fell victim to falling into this cycle; I would take time of because my knees were hurting and completely rest they would feel better but my tendons would get weaker and then I would throw myself back into highly demanding exercise and get pain sooner than before. Remember tendons need load to strengthen them but too much volume can mean they breakdown. Whatever amount your doing that is causes pain scale back, this could be the amount of practice or time of workouts. Check to see if you experience pain 24hours after exercise and ask yourself is it better or worse than normal. Then add in the exercises I previously mentioned and if you get no pain scale up, if you get pain scale back.
A final mention is supplementation there has been some studies that have had some success using collagen and Gellatin alongside vitamin C when used in conjunction with an exercise routine to support joint and tendon health. For this I would suggest taking it 20 minutes prior to exercise.
That is all the advice a have so far and I didn’t say it would be easy. It takes consistency and effort to build durable joints but if you look after them there is no reason you won’t be able to do all the things you want to do for as long as you want pain free. If you found this useful please share it or send it to someone that may be in need of help. If you have any further questions please reach out me directly via Instagram @woodsyworkout where I post more exercise information and tips.