The past two weeks, we’ve talked about how the ankle and hip can cause pain in the knee, but that pain can also come from changes to the knee joint itself. When the pain originates from the knee, there are many different causes (insert one last plea to visit a physiotherapist instead of diagnosing your pain yourself), but some of the most common include:

• Meniscus tears, which can occur with twisting at the knee – whether that means cutting or pivoting improperly during sport, or simply standing up awkwardly (especially as the surrounding structures weaken with age)
• Ligament injuries, which can occur from direct blows to the knee joint or poor landing mechanics
• Bony changes, particularly arthritis, where improper joint mechanics over an extended time period cause additional wear and tear on the joint

If this is the source of your knee pain, now is the time to rely on ice, manual therapies (physio and/or massage therapy), rest, and gradual re-introduction to exercise. Listen to the guidance of your health professional, even if it’s not the news you want to hear!

As you start to resume your regular activity, you can apply the strategies from the past two posts (helping to stabilize above and below the knee) and pay attention to the signals your body is giving you. Never train through pain. Some other things to keep in mind as you get back in the weight room:

Positioning

Make sure your joints are aligned properly when performing any exercise. Your knees should track in line with where your toes are pointing. Remember earlier when we mentioned that poor alignment over time adds wear and tear? The most common pattern to contribute to arthritis in the knee is internal rotation of the femur, coupled with external rotation of the tibia. In other words, lack of strength in the hips (allowing the thigh to rotate inwards), coupled with tension in the calves and caving arches (allowing the bones of the shin to rotate outward). Give yourself a quick check in the mirror – when you stand, walk, climb the stairs – where do your knees point?

Be wary of isolating the knee joint

In your daily activities, it would be very rare for your knee alone to have to carry a load. Typically, load is displaced between all the joints of your lower body as you walk, run, climb, carry, or lift objects. Building strength and stability in the gym setting should reflect this as well – which means that leg extensions and leg press (in which hip extension is limited or null, thus placing all the work on the quadriceps and the knee) are better replaced with steps ups, squats, lunges, and deadlifts. Not feeling ready to jump back into a back squat? There are tons of ways to modify the movement, to work your strength back up gradually while still allowing all of your joints to work together. If you’re not sure how to modify, ask a health professional!

Don’t be afraid to let the knees travel forward

The old scare tactic of “not letting your knees pass your toes” has driven many people with knee pain to attempt to squat down while keeping their knees frozen in place over their ankles. Their aim is to lessen the shear forces at the knee, but the result is simply increasing their risk of injury to the low back. As Myer et al. demonstrated in their study of functional deficits in the squat pattern, “Overly restricted tibial translation during the squat increases anterior lean of the torso, which accompanies increases in hip torque and lumbar shear forces.” So long as heels remain planted on the ground and the movement still begins with the hips sitting back, there is no evidence to suggest that the additional knee flexion will contribute to injury risks. If anything, being able to control and build strength through full range of motion will only benefit your recovery from pain.

The knees need to be able to absorb and transfer force

In order to prepare for a time in real life that you may stumble and need your knees to absorb this load, you should include landing technique in your training – ranging from low-impact variations like snapdowns, to landings off a short box, to more progressed variations in which you transfer force out of your landing and explode into a jump. Here’s our client Andrea demonstrating a snapdown:

Include lateral and rotational movements

Your knee needs stability in every plane of movement – not just forwards and backwards. Include some sideways movements in your training (such as side shuffles or lateral lunges), and practice pivoting properly, so that you have that muscle memory in place for when you need it.

That wraps up our series on knee pain – we hope you’ve found some new exercises to help build up your strength and prevent injury! If you have more questions – please reach out and let us know.