Doing leg exercises with knee pain is one of the most common complaints people have when exercising. The knee joint is sandwiched between two joints that do a lot of moving around, and all the while, it’s supposed to stay stable; it’s a lot of hard work that we give our knees.
Fear not, though, because, with some knowledge, we can learn how the knee works, why it might be experiencing pain, and how to correct it or work around it.
I am not a doctor or a physical therapist. I am simply a man on a journey in the world of fitness who has come to learn a thing or two about the body.
My suggestions below are not meant to take the place of medical advice. Consult your doctor before starting a new workout regimen.
Let’s take a quick step back to anatomy class to understand the joint we’re dealing with and how it works.
Your knee is what is called a “stable joint.” Stable joints only move in one plane of motion and usually serve as connectors between two mobile joints. Your knee is the connecting joint between the ankle and hip which are both mobile joints (they can move all over the place); your elbows are another class of stable joints sandwiched between your wrist and shoulder.
The knee has no muscles. I hear this all the time… “I pulled a muscle in my knee!” No, you didn’t because they don’t exist. It’s a forgivable mistake, but we have to clear it up immediately so that you can start understanding what is happening here. The only things specific to the knee that can get injured are connective tissue (ligaments and tendons), the knee cap, and cartilage.
So, how does the knee work then if it has no muscles? The muscles above and below the knee control the knee’s movement and stability. Above the knee, you have your quadriceps and hamstring muscles; below the knee, you have your calf and tibial muscles (there are more, but these are the main ones).
The final thing you should note about the knee and how it works is that it likes to move in a straight line. Think of your kneecap like a train. When a train is driving on straight tracks, all is well. But if one of those tracks is just a degree off-center, the train will grind its wheels on the track and eventually break down. During movement, if your leg muscles are not working correctly, the knee can move all over the place. Every time it moves offline, you are putting yourself at risk of injuring it. Now, you cannot totally avoid this, and the knee does have some tolerance for movement outside of a straight line. In general, though, we want the knee moving straight.
Typically, when you are experiencing pain in the knee, the culprit is often one or more of the muscles above and below the knee. These muscles may not be working correctly to help the knee stay in line, which is what we will focus on in this article.
Exercise #1: the leg extension
A lot of people get worked up about this machine. Some think it is a death sentence for the knees, and others (like myself) believe it is a necessary tool; let’s discuss.
One of the most crucial muscle groups directly influencing the knees is the quadriceps. These are the muscles located on the top side of your leg. It is not just one muscle; quite a few muscles are on the top side of your leg, but we will speak about them all under the general term of “quadriceps muscles.”
The quadriceps are meant to extend your leg. If your knee is bent and you straighten it out, you are using your quadriceps muscles.
This leg extension is arguably one of the most important things your body does. We use leg extensions to walk, run, step up, get up from a seated position, jump, and more. During leg extension, if the quadriceps muscles are weak, you may overload them and compromise their knee joint support. Do this repeatedly, and you could end up with an injured knee!
I like the leg extension because it forces your leg into a straight line and targets your quadricep muscles exclusively. The problem that people get into with the machine is using too much weight before being ready for it. This machine allows you to use a lot of momentum, which is bad news for what we’re trying to do.
When you are doing the leg extension, I like for people to do high reps and light weights. This is because you won’t need to use any momentum to get the weight up, allowing you to focus on good form, and doing a lot of reps gives your muscles a ton of “practice” at moving properly.
I recommend doing three sets of 30 repetitions at least.
Exercise #2: Patrick Steps
A Patrick step is an exercise that will help you work on your control of the knee joint during movement. After working on the leg extension machine, I like the idea of putting the muscles to practice proper movement.
Many people experience knee pain when the knee starts to move over the toes. Since this pattern has been seen repeatedly, people often wrongly state that the knees should never move over the toes. This is a bandaid solution. Your knees have to move over your toes. Can you imagine trying to go upstairs or jump for something and keeping your knees behind your feet? Good luck if you do try!
The problem is not that your knees are going over your toes; it is that your knees need more support when they are going over your toes.
The Patrick step’s purpose is to fix that.
To do a Patrick step, I need you to stand close to something you can hold on to. Over the long term, you want to aim to do this exercise without any balance assistance. Stand straight up and reach forward with one of your heels by bending the knee of your opposite leg. You should notice that the knee that is bent is reaching forward far past your knee, and you should feel the quadricep muscles working hard to stand you back up. Repeat this movement for three sets of 20 per leg.
Exercise #3: wall sits
Exercise number three is a classic for leg development: the wall sit!
The wall sit is what is called an isometric exercise. This training style is a well-known but often neglected type of exercise that is highly effective at strengthening your legs.
When people have knee pain doing something like a squat, they typically experience that knee pain at the bottom of the squat when their knees reach a 90-degree bend. One of the best ways to get around that is to get stronger in that exact position. “But how??” you might ask.
Answer: the wall sit!
To perform a wall sit:
- Find a sturdy wall to support you.
- Lean against the wall and walk your feet forward a bit so that your weight is falling backward.
- Sit down on the wall until your knees are bent to 90 degrees, and hold that position!
You will probably notice your legs shaking immediately; that is fine! That means you are doing the exercise right. The wall sit is an interesting exercise because you are not moving and there is no weight. It is purely a mental game of how long you can take the burn!!
Start at three sets of 45 seconds and work your way up to a minute and a half!
Bonus: check above and below!
Moving away from the knees, we need to talk about the mobile joints surrounding the knees: the hips and calves.
These two joints can be just as much the culprit of knee pain as weak leg muscles.
If you have poor mobility in your hips or ankles, improving your mobility in those joints will either help clear up or clear up your pain entirely.
The reason for this is simple if those joints are not moving well, you will not move well either. If you are not moving well, then the chances of your doing something weird to your knee when you are squatting or lunging are very high.
What I am talking about here are compensations. Compensation is when the body has to move in a way that is not intended to get the desired result (squat or lunge in this case). Often, these compensations are pain-free for a long time, but as you do them more often, they eventually will wear your body down.
So, if you feel like your legs are strong, check your hips and ankles!
For an in-depth guide on improving your hip mobility, check out my blog post on hip mobility here!
Too long, didn’t read
Knee pain is a prevalent source of pain. However, despite the knee being the thing that hurts, it is often not the problem.
The knee is a joint controlled by the muscles above and below it. If any of those muscles are not doing their jobs properly, it eventually shows up as knee pain.
The muscle you want to focus on first if you suspect leg weakness will be your quadricep muscles (top side of your leg). These muscles are responsible for extending your leg, which is the movement that most people experience pain with.
To help strengthen these muscles without aggravating the knee, I recommend isolated quadriceps exercises like leg extensions, Patrick steps, and wall sits.
Beyond strengthening your legs in an isolated way, you will also want to check how much mobility you have in your ankles and hips. If your hip or ankle mobility is poor, You can bet that becoming more mobile in those joints will help alleviate knee pain. This is because immobile hips or ankles will cause you to move in ways that are not good for the body to get around your lack of mobility.
Unless you have had a specific traumatic event happen to the knee, like an impact injury, you most likely need to focus on strengthening your legs and becoming more mobile to clear up your knee pain!
Jordan Tank, Personal Trainer, Columbus, Ohio
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