Monday, August 30, 2010

Knee Exercises

I have been asked a few times by people who believe they suffer from runner's knee what exercises I do for  my knee, so I decided to post on the subject.

I do three knee strengthening exercises regularly and throw in some others irregularly. Here are the most common three I do:

1) Static Wall Sit - feet appropriate distance from wall, I "sit" with my back against the wall so that my legs are bent about 90 degrees at the knees, and my knee joint does not extend forward beyond the ball of my feet.
Static Wall Sit

2) Quarter Squat - with two legs planted about hip width apart, or balanced on one leg with hips level and lower abdominal muscles engaged, I squat slightly by dipping my butt slowly and directly toward the floor (not leaning foward, but keeping back straight, and the hips stable). I dip/squat only as far as I can go while keeping my foot/feet planted flat and stable on the floor, hold this position for 10 seconds, then slowly straighten the leg. 

One-Legged Quarter Squat

3) Leg Extension - I use a super heavy resistant tube for this. I pick a kitchen chair, and put the handles of the tube over the back legs of the chair, and pull the center of the tube forward through the two front legs of the chair. Sitting on the chair normally, I find the center of the tube and twist it once and insert my foot as shown in the image below. Then, I perform a set of leg extension exercises by straightening my leg. This is good for the latter half of the leg extension motion, which is the most important for strengthening the medial quadriceps muscles. I do them slowly, and hold the extended position for a few seconds on each repetition.
Leg Extension (resistance tube)

Leg extensions can be performed by sitting flat on the floor with your leg out in front of you with a pillow under the knee. Press the back of your knee down into the pillow forcefully several times, holding the extended position, and then relaxing. Concentrate on using just the muscles of the leg to do the work.

Rather than concentrating all of this into one single workout, I would typically do the wall sit exercises three to four times throughout the day, holding the sitting position for one minute each time. If you can't do one minute, start with what you can do and work up over time.

Quarter squats and leg extensions I often do all during one single workout period.

For me, these are the three most beneficial exercises to do for the knee when I have Runner's Knee. issues. By "Runner's Knee" here, I mean true Runner's Knee, or patellofemoral pain syndrome, which occurs as pain around and behind the knee cap. If you are having pain along the outside of the knee joint you are likely not experiencing true runner's knee, but rather an Lateral Collateral Ligament (LCL) strain/tear or more likely iliotibial band syndrome (ITBS), and in addition to exercises like these, there are some other things you might consider, which I have summarized in posts on my other blog. If on the other hand, you are experiencing pain to the inside of the kneecap, you may be experiencing a cartilage or meniscus injury and/or a strain or tear of the medial collateral ligament (MCL). 

If you are not absolutely sure your condition is true "Runner's Knee," I would suggest you see a physician specializing in sports medicine and or orthopedics who is experienced with knee injuries for an assessment before you start doing these or any other exercises.




5 comments:

  1. Another thing to consider is that some recent research coming out has shown that many knee injuries from running (and other injuries), are actually caused by weak hips. So just because it hurts at your knee doesn't mean it's your knee that's causing the pain. Hip strengthening exercises can fix a lot of problems, especially if you sit at a desk all day.

    But of course, check with your doctor or physical therapist to determine what's wrong with you first. Then take action.

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  2. Good point Fitz. I posted a short note on one of those papers awhile back on my other blog. Here I can't really attribute my knee problems of late to hip strength deficits, because I have been doing regular hip and core strengthening exercises since January.

    I believe my primary issue here was that I increased my mileage a little too fast in preparation for a half marathon while becoming lazy with my form during the second half of long runs, once I was fatigued.

    I began the hip strengthening exercises to support changes in my form that I made to alleviate some ITBS issues, and it worked beautifully. Hip strength and core/hip stability are critical for preventing the inward flex and rotation of the knee that contributes to ITBS, overpronation, and a host of other related injuries and overuse syndromes.

    In fact, they along are adequate for patellofemoral pain for many people, but once my knee was inflamed, and I strained my MCL, I had to add the knee exercises to ensure that as I come back to running again, the soft tissues of the joint are have not weakened.

    So, these are just the knee exercises I've added in. I do a range of other exercises targeting my core and hips, and primary among those are bridge pose and one-legged bridge pose, and planks. I may add a post which summarizes those at some point, but I've talked about them in some posts on my other more technical blog (http://www.be-fit-now.com)

    Cheers!

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  3. I should also point out that the form I describe for the hip squats also emphasizes hip stability, and is intended to target not simply muscles at the knee, but also those responsible for maintaining stability in the core and hip when bearing weight on a single leg. I think those aspects of the single-leg squat in particular are critical for developing the neuromuscular coordination in both hip and upper leg muscle groups, so a runner not only ends up with the strength, but also the proper control to maintain good form (some call this muscle memory).

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  4. A quick comment: surely the exercises you describe above are aimed at strengthening the quadriceps muscles (especially the medial quad) rather than the knee? As I understand it, the idea is that a stronger medial quadriceps prevents the kneecap from the mistracking that causes patellofemoral pain syndrome.

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  5. Andy, to be sure, the exercises strengthen the quadriceps, but a cool aspect of anatomy is that the quadriceps is group of muscles responsible for extending the knee. Although they are located along the femur, they are actually knee musculature. Cool stuff. They attach to the patella (knee cap) at several places, and if all of the quadriceps muscles don't pull with the right tension, the thinking goes, the kneecap doesn't track properly and rubs/wears on the cartilage and bottom end of the femur.

    Another note is that any exercise that places stress on the ligaments and tendons that cross the knee joint will over time result in structural changes in these soft tissues, strengthening them. So, in a very real sense, when you do leg curls and extensions, you are strengthening the knee, including the muscles on the front and back of your leg that are responsible for it's flexion and extension.

    However, when I call these "knee strengthening" exercises, I am mostly just being lazy with jargon. I am less lazy with jargon on my more technical blog (http://www.be-fit-now.com), than on this one! Thanks for your comment, and opportunity for me to offer some further explanation.

    Cheers!

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