Avoid using body parts that hurts will never solve the problem. According to data, 1 in 4 adults suffers from knee chronic knee pain. Some of the issues I see at the gym is many are not able to do full squat because of the knee pain and condemning squat or any knee functioning exercises that they will cause knee problem. As mentioned earlier, avoiding using body parts that are in pain will never solve the problem. It is not the exercise that is causing the pain but it is the condition your body is in that is limiting the movement. It's like trying to drive the car at 100mph where it can only goes up to 80mph.
Arthritis and ACL or meniscus tear doesn't just happen, there are reasons. Yes, you can have unpredicted injuries like in sports, however, often times injuries or chronic pain happens because of tight, weak, underdeveloped muscle, tendon and ligament that exceeds the capacity in which the joints can handle. Using the previous car example, it is not the fault of the car. It is the driver who is not understanding the limitation of the car. Good news about human body is we can improve our body to upgrade the capacity in which our body can work in.
Anatomy of The Knee
Most common issues that I come across with knee pain is tightness of gastrocnemius and hamstring. Why these muscles? Here is a knee anatomy 101. In muscles, there are origin and insertion. Simple term, where the muscle starts (origin) and where the muscle connects(insertion).
Gastrocnemius is part of calf muscles that can be found right behind the tibia or shin bone. Origin of gastrocnemius is back of thigh (femur) bone and insert in back of the heel bone. Therefore, the muscle does crossover the knee in the back.
Hamstring is the muscle in the back of the thigh originate from bottom portion of pubic bone and insert to top of shin bone in the back. So these two muscles crossover knee joints at the backside. When these two muscles gets tight, from long duration of sitting, inactivity, and injury, femur and tibia, or thigh and shin bone get pulled together. When these two bones get too close, they can rub against each other and can cause inflammation or famous condition called arthritis. It is not the arthritis that is causing the knee limitations, it is the knee limitations that is causing the arthritis.
Actions of these two muscles are also interesting. Gastrocnemius has primary movement responsibility of plantarflexion of your foot and flexion of the knees. Hamstring has primary movement of extension of the hip and flexion of the knees. Because of the action of these two muscles, our knees are capable of flexing or bending. This also means that as these muscles gets tight or weak, then the knee itself will be weaker and limited in range and may lead to problems in the long run.
There is one another muscle that I need to introduce. The muscle is quadriceps. When talking about knee movement, it is not just about flexing but also extending as well. Quadriceps has primary movement of extension of the knees and flexion of the hip. Therefore, it has opposite movement pattern compared with hamstring.
Quadriceps, as name indicates, have 4 different muscles and they all insert to top of shin bone via patella ligament overlapping the patella. This also explain some of the reason why people have knee issues related to patella.
To get proper and full mechanical advantage of the knees, lengthening and strengthening of these 3 muscle groups are vital and should be implemented in the exercise plan.
In this article, I will share 4 exercises that I use to condition the knees. What I mean by condition is to bring back mobility and proper functioning of the muscles responsible for the joint action to be restore and not bulking up the muscles. If you are already exercising, these exercises can compliment and improve your exercise performance and may use as joint preparation before your leg workout. Those who are not exercising regularly, these exercises can also help maintain your joint functioning and hoping to minimize chronic knee pain that you may be experiencing.
Full Range Calf Raise (20-30 reps)
First exercise is full range calf raise. It is simple calf raise using stair step or anything you can use to drop your heel down for the stretch. This exercise may feel like it has nothing to do with knees but it make huge difference in your knee mobility when done right. Most important part of this exercise is to keep the knees hyper extended as much as you can. Remember that the calf muscles overlaps the knee joints? We are utilizing this mechanics in calf raises both train and lengthen the muscles. Focus still is in calves but see if you can feel in the back of the knees as well.
Elephant Walk (15-25 reps each)
As mentioned earlier, when the hamstring and calf muscles are tight the knees joints will also be tight and hard to manipulate. Therefore, the first thing you want to work on is mobilizing both hamstring and calf at the knees. As shown on video, all you need to do is brace your hands on the floor and work on flexing and extending the knees. Rather than just stretching out, I found that actual movement will have more benefit where you can apply both stretching and strengthening at the same time. If you cannot reach the floor, you can regress by placing your hands on the stair steps of couch and work your way to the floor. Video shows I'm alternating legs but you can work on one side firs then move to the other leg.
Heel Elevated Step Up (15-30 reps each)
Partial knee movement exercise off of the platform will mimic the movement you will have when you are going down the stairs. This concept is also can be utilize as exercise to strengthening the knees.
Video is using slant board on top of the 45lb plate but you can start from the floor and work your way up. You also should start without weights a weights and add weights when you can fully perform the exercise. Never rush with progression. We are working on muscles, ligament and tendons. Ligament and tendon does take time to recover compared with muscles.
Heel Elevated Squat (20-30 reps)
Elevating your heels while squatting does two things. One is eliminate your calf tightness and allow the knees to move more freely. Two is focus will be on strengthening all of the muscles, tendons, and ligaments that supports knee functions. If you do not have slant board you can use plates or dumbbells to lift the heels. Maintain upright posture and push those knees forward. For some reason, people seems to have fear of pushing the knees forward but that is what we are training in this exercise.
If the exercise seem strenuous, you can hold on to wall, table, pillar or bar to assist you with the exercise. As you get stronger, you can add resistance by carrying dumbbell, kettlebell, barbell and so on.
Precaution
As mentioned earlier, we are not just training your muscles but also your ligament and tendon. Muscles can recover in few days, however, ligament and tendon takes longer. You can use these exercises 2-3 time per week, however, be aware of the soreness and don't try to progress too early.
When performing these exercises make sure there are no pain. No pain does not mean that you can tolerate. It means you can feel the smooth transition in the movement without any limitation. When you feel limit or pain you are not to go beyond that point. Perform the exercise in comfortable range. Gradually you will have your range improved. If you do not have full mobility through exercise, do what you can do comfortably and work your way to improve the movements.
Kota Shimada
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