Treating Knee Pain

Knees can hurt for many reasons like overuse, underuse, overweight, falling on them, many reasons. It is easy to tweak your knee when your body turns but your foot does not. And, don't discount the repetitive knocks our knees get just in living a normal life. Any and all of these can cause massive wear and tear on our knees.

One more thing that can cause knee pain, uneven muscle strength between your quadriceps-the muscle group on the front of your thigh-and your hamstrings-the muscle group on the back of your thigh.

So, your knees hurt. What can you do about it? If your knee pain is severe, see a doctor to find out the extent of any wear and tear to the knee, whether any knee repair is necessary. More than likely, if you are a candidate for surgery, the doctor will have you do exercises to prepare for surgery anyway, so keep reading.

If your knee pain is just an irritating, nagging type of knee pain, you may be able to resolve your pain or at least improve your mobility through exercise. The purpose behind these exercises is primarily to improve the strength and balance between the two muscle groups: quadriceps and hamstrings.

Isometric knee exercises

Isometric exercises are static, or still, exercises. You do not use motion or weights, just static muscle work holding the muscle in tension for a period of time. The two isometric exercises that I describe here are called quad(ricep) sets and ham(string) sets can be used for stability or as a warm-up for other exercises.

I like to use quad sets and ham sets just for stability. One of my knees suffered an ACL (anterior cruciate ligament) tear several years ago and I was able to avoid surgery, largely due to these exercises. By the way, if you are a weekend jock and intend to keep being a jock, you probably should go ahead with ACL repair if you get a significant tear. You can only make it worse by playing hurt.

For either of these exercises you can lie flat but you get more benefit if you are sitting up on a relatively firm surface, propping up your upper body on your extended arms.

Quad sets

1. Seated on a firm surface like an exercise mat or your bed, extend your legs out in front of you, keeping them close together.


2. Flex your ankle so you are pulling your toes up toward your knee


3. Tighten the tops of your thighs. Imagine you have a ball under the back of your knee and you are trying to squash it. If you have some discomfort doing this, roll up a washcloth, place it under your knee, and squash it for real. It helps with the visualization and gives you a sense of security.


4. Hold as tight as you can for six seconds. Maintain normal breathing. Muscles need oxygen so breathing is important.


5. Perform ten repetitions.

Ham sets

1. Seated on a firm surface like an exercise mat or your bed, extend your legs out in front of you, ankles about shoulder width apart.


2. Bend your knees until they are at least 6-to-10 inches off the exercise surface.


3. Flex your ankles, pulling your toes up toward your knees.


4. Dig your heels into the exercise surface as if you were trying to drag the surface with your heels up to your buttocks. Don't allow your heels to move. Just pull against the surface until you feel your hamstrings tighten and then hold.


5. Hold this position for six seconds. Maintain normal breathing.


6. Perform ten repetitions.

Isotonic exercises

Isotonic is the opposite of isometric. You perform isotonic exercises in motion, moving through a full or partial range using weights or some other form of resistance. Sometime the exercise is a combination of isometric and isotonic, like doing biceps curls with a dumbbell and then holding the flex static for a count of 30 on the last curl.

You can add ankle weights to any of these exercises but I recommend practicing without weights for a time or two, to educate your body to the motion before you add any weight. I would also start with very little weight and build up.

Drakes

'Drakes' are so named for the late Ducky Drake, a coach and trainer at UCLA who came up with these exercises for his players.

1. Seated on a firm surface like with your legs out in front of you, bend your left leg so that your foot is next to your right knee. This is for stability.


2. Set your right quad for a count of 2, tightening the quadriceps like in the Quad Set exercise.


3. Without losing the tightness of the set, keeping your ankle flexed and leg straight, raise your leg until your heel is 4 to 6 inches off the surface.


4. Set the quad even tighter for a count of 2. Movement relaxes your muscle tension so you are regaining any tension that was lost


5. Do not loosen the tension in the quad and lower the leg to the surface.


6. Tighten the quad for a count of 2 for the same reason as step 4.


7. Relax for a count of 2. Ensure you relax the leg completely.


8. Perform three sets of 10 with at least a two-minute break between each set. In other words, rest your right leg while you do the Drakes with your left leg.

One set of 10 will make a difference in your life but if you want real strength and stability, you will do three sets. If you are doing these therapeutically, you will do them a couple of times a day.

Hamstring curls

If you do these using a hamstring curl machine at the gym, pay special attention to steps 2 and 3.

1. Lying on your stomach on a firm surface with your legs extended.


2. Flex your ankle so your toe is pulled up as far as it can go.


3. Bend your right leg bringing your heel up toward your buttocks. Do not allow the heel to go past the line of the knee. You really don't want to force the knee capsule too far. It is the same reason you don't allow your butt to go lower than your knees when you are doing squats. When you bend your knee past 90°, the exercise does not benefit the muscles and could create undue stress and unnecessary stretching in the knee capsule.


4. Straighten your leg again.


5. Rest and repeat for 3 sets of 10 repetitions.


6. Repeat on the other side. Actually, with these, it is easiest to do 10 on one side and then 10 on the other until you have done the 3 sets.

Short-arc Quads

For this exercise, you need a firm padded roll under your knee that bends the knee at about 45°. I filled a 3-pound coffee can with sand and taped the top on. Then I wrapped it in a folded towel. That made it just about the right thickness and firmness for short-arc quads.

Short-arc quads are called that because you don't move the lower leg through its complete arc. You do a short arc. If you work out at a gym, this is something you can do on the quad machine as well, just go through the last 45° of arc on the machine.

1. Seated on a firm surface like an exercise mat or your bed, bend your left leg so that your foot is next to your right knee. This is for stability.


2. Place the roll under your right knee.


3. Flex your right ankle so that the toe is pulled up toward your knee.


4. Straighten your right leg. Actually, a better way to do this exercise is to tighten your quadriceps, almost like you were trying to squash the roll, until the leg straightens from the shear effort of your push. It's a mental thing that gets better results than just lifting your lower leg.


5. Do ten repetitions and switch sides.


6. Do three sets of ten on each leg.

Abductors and Adductors

Abduction moves your limb out to the side, away from the midpoint of your body. So, the abductors of your leg allow you to move your leg out and away from your body laterally, to the side.

Adduction is a movement that moves your limb to and across the midline of your body. So, the adductors of your leg allow you to cross your legs.

If you were doing anything like those awful tire exercises at football camp, you would need very stable abductors counterbalanced by strong adductors.

FYI: most clinicians use the terms A-B-duction and A-D-duction. This is so that they are clear which muscles they are talking about. Yep, they sound out the first two letters when talking about your A-B-ductors or A-D-ductors.

Abductor to-the-front exercise

The abductors for your leg, are all in the hip and thigh region, obviously, since the lower leg only moves back and forward. Interestingly, only one major abductor muscle is in the thigh while several more are in the pelvic cavity and one is on the hip.

These exercises, therefore, are also good for strengthening and stabilizing the hip region. Your hip, like your shoulder, is a ball-and-socket joint meaning it has circular plane of motion while the knee itself is a simple hinge joint meaning it has only the one plane of motion. To strengthen and stabilize the knee, you must also have stability in your hip.

1. Lying on your left side, bend your left knee up in front of you so that your left foot is under your right knee. Brace yourself with your right hand and arm in front of you.


2. Straighten your right leg and set the quad, flexing your ankle so that the toe is pulled up as far as possible like in the Quad Set exercise.


3. Keeping your quad firmly set and the outside of your foot parallel to the ceiling, use the muscles of your hip and thigh to move your foot forward at a slant. Your foot should start at just above the exercise mat or bed and end up at about 12-to-18 inches off the bed.


4. Return the foot to the neutral position and relax the set.


5. Repeat 10 times.


6. Roll over and repeat using the left leg.


7. Perform 2 sets of 10 each leg.

Note: Ensure you relax between each rep. You still get some benefit if you don't but you will not get the full benefit.

Abductor to-the-back exercise

The reciprocal of the front abductor exercise is the abductor back exercise. This is a more difficult exercise if only because we don't make this motion often enough to have good mobility in this direction. Pay attention to the instructions, especially the extra information that points out where you can go wrong.

1. Lying on your left side, bend your left knee up in front of you so that your left foot is under your right knee. Brace yourself with your right hand and arm in front of you.


2. Straighten your right leg and set the quad, flexing your ankle so that the toe is pulled up as far as possible like in the Quad Set exercise.


3. Keeping the leg straight, your quad set, and the side of your foot parallel to the ceiling, use the muscles of your hip and thigh to move your foot back behind you at a slant. Your foot should start at just above the exercise mat or bed and end up and end up at about 12-to-18 inches off the bed. Try to avoid any motion of your upper trunk. This gets easier as your condition improves.


4. Return the foot to the neutral position and relax the set.


5. Repeat 10 times.


6. Roll over and repeat using the left leg.


7. Perform 2 sets of 10 each leg.

Adductor exercises

1. Lying on your right side, bend your left knee and flare your leg out so that your left foot is tucked behind your right knee. Brace yourself with your left hand and arm in front of you. Note: I have also seen this with the left leg bent up in front of the right knee. You should experiment.


2. Straighten your right leg and set the quad, flexing your ankle so that the toe is pulled up as far as possible like in the Quad Set exercise.


3. Lift you right leg off the exercise surface about six inches, keeping your inner ankle pointed at the ceiling.


4. Repeat 10 times.


5. Roll over and repeat for the left leg.

Toe press ups

Toe press-ups are a stability exercise. You can do them sitting or standing. I personally prefer sitting until I know that the knee capsule is strong enough to handle any missteps.

In case you doubt the efficacy of toe presses for knee stability, grab your knee just above the kneecap so that your thumb is on the inside of your thigh and your fingers on the outside. Do the exercise. Can you feel the muscle action that is required to perform a toe press? Amazing, isn't it?

Standing toe press ups

1. Place the balls of your feet on the edge of a rise or step. Ensure you have good support in case you slip. A stairway with two handrails is good, a much shorter rise of 1-to-2 inches is better.


2. Straighten your legs and set your quads like in the Quad Set exercise.


3. Using ankle action and a lot of calf muscle, rise up onto the balls of your feet.


4. Maintaining control, lower your feet again allowing the heels to fall below the level of the step or riser.


5. Repeat steps 4 and 5 for 20 repetitions.

Sitting toe press up using a leg press exercise machine

1. Place the balls of your feet on the bottom edge of the leg press foot plate. Do yourself a favor and set the weights to the lightest resistance. See how you feel the next day before increasing the weights.


2. Straighten your legs and set your quads like in the Quad Set exercise.


3. Using ankle action and a lot of calf muscle, press the plate away from your body.


4. Maintaining control, flex your ankles allowing the press to pass the heels.


5. Repeat steps 4 and 5 for 20 repetitions.

Sitting toe press up using a stretchy strap or tube

1. Sitting comfortably on any surface, place the ball of one foot in the center of the stretchy strap (elastic bands) or tube (Theratube).


2. Straighten your leg and set your quad like in the Quad Set exercise.


3. Using ankle action and a lot of calf muscle, point the toe away from your body.


4. Maintaining control, flex your ankle allowing the toe to flex past your heel.


5. Repeat steps 4 and 5 for 20 repetitions on each leg.

I have seen people do both legs with the stretchy device but it can force the ankles to roll in and actually create instability and pain so best you do one leg at a time with the stretchy stuff.

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