"Oh my aching knees!” At some point in time, sooner or later, we are all bound to utter that statement. Whether you’re a long-time exerciser or a weekend warrior, a 25 year old college athlete, or a 75 year old mall-walker, knee pain is bound to creep into your life. It’s practically inevitable. Now, obviously, knee pain caused by blunt force trauma (car accidents, for example) and other acute injuries (like torn ACL tears, meniscus tears, and shattered patellas) are a result of extenuating circumstances. These situations will require surgery in most cases, with requisite physical therapy, and the potentiality of some level of chronic pain due to the knee structure being permanently altered in some way. However, outside of these specific situations, chronic knee pain does not have to be a part of your daily life if you can take steps in your strength training program to prevent it.
First, in order to know how certain exercises can help with alleviating knee pain, it helps to have a little understanding of the anatomy of the knee joint itself. While relatively delicate, the knee is a surprisingly resilient joint that is formed where the femur (thigh bone) and tibia (shin bone) meet, and is protected in the front by the patella (knee cap). Additionally, there are a number of soft-tissue structures that help keep the bones of the knee in place:
- The ACL (anterior cruciate ligament) keeps the tibia from sliding too far forward from the femur
- The PCL (posterior cruciate ligament) keeps the tibia from sliding too far backwards from the femur
- The LCL (lateral collateral ligament) keeps the outside of the knee joint stable
- The MCL (medial collateral ligament) keeps the inside of the knee joint stable
- The menisci (medial meniscus and lateral meniscus) help to absorb shock in the joint during running and jumping
- The patellar tendon helps keep the patella bone in place by not letting slide around
Additionally, there are a number of big muscle groups that all attach to the knee joint that are responsible for controlling knee movement, namely the quadriceps group and hamstring group. Understanding proper exercises to strengthen and balance these muscles is vital to keeping your knees pain free.
One of the biggest issues that cause knee problems in most people, again, outside of major injury, is the imbalance of strength between their quadriceps group and hamstring group. Much of our daily activity (ex. walking, running, climbing stairs, getting out of chairs) puts a large emphasis on the activation of the quadriceps group versus the hamstring group. As a result, over years and years of moving in these repetitive patterns, your body compensates naturally by growing stronger through the quadriceps in relation to the hamstrings. This muscular imbalance creates an uneven force on the knee joint, causing stress on certain ligaments more so than others, and also potentially leading to arthritis.
In order to help correct this common imbalance there are a couple of things to remember when you are in the gym. First, make sure that you are activating your hamstrings as best you can on all of your lower body movements such as your squat, deadlift, and leg press/hip sled. The best practical way to ensure this is to always be conscious of “pushing your heels through the floor.” This simple coaching cue will help to keep you from raising your heels off of the floor, and prevent you from using too much quadriceps activation as you are extending your legs through the movement. Additionally, these auxiliary exercises make great additions to your overall strength program: lateral step-ups, step-downs, drop lunges, and hip bridges.
When you really stop and think about it, our knees are sensational structures! Though relatively simple in construction, they take on incredible demands on a consistent basis every single day we are alive, let alone what they allow us to do in athletic situations on the field or court. However, whether through bad injury, or neglect in the weight room, they can also be a source of major pain and frustration. Hopefully, with a little knowledge of how they are built, and how to keep them strong, healthy, and balanced, you will never have to experience kneeproblems again, and you can enjoy a life filled with all the activities you love!
Joe Gernetzke CSCS