Top knee strengthening exercises from a PT perspective

According to research, 25% of individuals over the age of 55 experience knee pain at least once a year. Knee osteoarthritis affects roughly 80% of older adults, and their treatment costs add up to a whopping $185.5 billion annually in the United States.

Due to these staggering numbers associated with knee pain, it is clear why it is essential to understand how you can prevent and manage existing knee pain. By reading this article, you will walk away with corrective exercises and stretches that can help lay the foundation for your own knee maintenance program to create a more resilient knee joint.

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STRENGTH

Some may think that the cartilage of the joints acts as shock absorbers, reducing forces on the joints. In reality, it is the role of the muscles surrounding the joints that truly dissipate forces away from joint surfaces. Weak muscles increase stress going through the joint surfaces, ultimately leading to more wear and tear over time. The muscles that play a significant direct and indirect role in knee function are the quads, hamstrings, and glutes/deep external rotators

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The quadriceps muscle group is among the most important muscles that impact the knee joint. The quads are composed of four independent muscles, three of which cross the knee joint and one that crosses the knee and hip. Together the quad muscles are responsible for extending the knee and flexing the hip. The antagonistic muscles to the quads, which lie on the posterior side of the knee and also play a significant role in knee health and function, are the hamstrings.

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The hamstrings consist of three distinct muscles which cross the hip and knee joint and work synergistically to perform knee flexion and hip extension. Lastly are the glutes and deep external rotators. Although the gluts and deep external rotator muscles seem unrelated to the knee, they play an important role in knee biomechanics. These nine muscles have the ability to extend, abduct and rotate the hip joint. Together these three muscle groups work to provide strength, stability, and shock absorption for the knee joint.

The quads and hamstrings primarily provide stability to the knee in the sagittal plane, whereas the hip muscles provide most of the knee's stability in the transverse and frontal planes. Functional movements such as running, walking, squatting, and jumping all impose triplanar forces onto the knee joint, so all three muscle groups need adequate strength. By having muscle strength and thus functional stability, the resultant forces placed on the knee joint decrease, thus reducing the chances of joint deterioration.

Here is a list of five exercises that often form the foundation of a therapeutic knee strengthening program. You will be ready to safely progress to more dynamic and challenging exercises and activities by mastering these exercises. Feel free to follow the link below to watch the full video on the exercises for in depth descriptions. Or click each individual exercise and it will take you to that part of the video.

• Quad set to straight leg raise
• Lie on your back keep one leg straight and one knee bent.
• Squeeze thigh and straighten out leg
• Raise leg roughly 6-10 inches and repeat
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• Squat
• Stand with feet hip width apart in a comfortable position
• Pretend like you are bringing your bottom down to sit into a chair until hips are just above your knees
• Squeeze your gluts and stand back up tall
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• Wall squat
• Stand with your back against a wall
• Slide your hips down the wall and hold
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• Single leg balance with reach
• Stand on one leg and slightly bend your knee
• Reach with opposite arm down toward the floor while keeping your back straight
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• Bridge
• Lie on your back on the ground and have both knees bent
• Push your hips up into the air and briefly pause
• Slowly loer hips back down to the table

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Watch our video here: https://youtu.be/X91ex98OoJ8https://youtu.be/X91ex98OoJ8

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STRETCHING

In addition to strengthening the knee joint, it is equally important to ensure that the joint has proper mobility. Limitations in joint motion can cause alterations in the biomechanics of the joint, leading to adverse stress on the knee joint and surrounding tissue. All stretches should be done with good tension for a minimum of 30 seconds. Stretching is best performed after a 6-10 minute mild aerobic exercise to increase blood flow and heat to the muscles and increase elasticity. Below you will find four stretches that can be done to help maintain the range of motion of the knee joint.

• Gastrocnemius (Calf stretch 1)
• Standing facing a wall. With one-foot forward and one foot behind the other, lean towards the wall with hands at shoulder height. Keep your back straight. Have your knee locked so it’s fully extended. Your heel should be on the floor when leaning forward. Think of leaning forward at the ankle joint. You will feel this high in the calf. Hold for 30 seconds.
• Soleus (Calf stretch 2)
• In the same position as the gastrocnemius stretch, bend the knee instead of having it locked. Again, think of bending at the ankle joint with the hell flat on the floor. You will feel this lower in the calf and Achilles. Hold for 30 seconds.

Quad Stretch

• Stand with a table or chair behind you. Place your foot onto the table or chair. Make sure your leg is straight in line with your body. Lean back to try to have your heel touching your buttock. Make sure you’re standing upright. To get the stretch in the thigh, squat on the leg you are balancing on. Or you may stand with a hand on the wall for balance, while grabbing the ankle with the other hand. Again, make sure the leg is straight. Hold for 30 seconds.

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Hamstring Stretch

• Lie on your back. Place both hands behind the knee. Pull your leg towards your chest. This stretch will isolate the hamstring. Keep opposite leg flat on the floor. Hold for 30 seconds

Maintaining proper strength and mobility of your knee will set you up for keeping a resilient and pain-free knee joint. Although an independent maintenance program is vital, at times, you may need further help to address your knee pain. If so, please reach out to your physical therapist to get a formal evaluation.

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