Fitness

Exercises for Knee Pain

Knee pain is common in physically active males and females. According to a new clinical guideline in the Journal of Sports Physical Therapy examining patellofemoral pain, approximately 25% of individuals will suffer from idiopathic (no specific onset) knee pain. In younger populations, knee pain is prevalent between the ages of 12 and 19 years old, with females more susceptible than males (Callaghan & Selfe, 2007; Willy et al., 2019).

Several common types of injuries are associated with the knee. Injuries can occur either from a traumatic injury resulting in fractures, dislocations or torn ligaments, or a gradual onset. Most active individuals experience knee pain with a gradual onset, resulting in pain on or around the patella (knee cap). These individuals also present with specific movement impairments. These impairments, from a biomechanical perspective, include muscular weakness in the hips and surrounding knee musculature. These result in a knee valgus position (knee uncontrollably moves inward towards the other) in commons tasks such as squats, step-ups, running, jogging, cutting, and jumping.

While each individual needs to consult a licensed medical professional before implementing any targeted programming, those who are limited by anterior knee pain (pain on the front of the knee) may benefit from the following corrective exercise program example. The program follows NASM’s OPT model and focuses on improving mobility, stability, and strength in the musculature above and below the knee joint.

Warm-Up

ExercisePhotoDuration
Self-Myofascial Release: Calves
Self-Myofascial Release: Calves
Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: Adductors
Self-Myofascial Release: Adductors
Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: IT Band/TFL
Self-Myofascial Release: IT Band/TFL
Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: Hamstrings
Self-Myofascial Release: Hamstrings

Perform on each leg, hold on tender area for 30-90 secs
Static Stretch: Calves
Static Stretch: Calves
Perform 2x each leg, holding for 30 secs each side
Static Stretch: Adductors
Static Stretch: Adductors

Perform 2x each leg, holding for 30 secs each side
Static Stretch: Hamstrings (Biceps Femoris)
Static Stretch: Hamstrings (Biceps Femoris)
Perform 2x each leg, holding for 30 secs each side

Resistive Training

ExercisePhotoSets/Reps/TempoNotes
Wall SlidesWall SlidesPerform 2 sets of 15 repetitions for each leg at a slow tempoPosition yourself with your back flush against a wall; knee in a locked position and pressing your heel into the wall. Slowly raise your leg, maintaining heel pressure into the wall and then lower
Ball BridgeBall BridgePerform 2 sets of 15 repetitions at a slow tempoPosition the ball between your shoulder blades; feet shoulder width apart and toes straight forward. In a slow and controlled movement, bring your hip up towards the ceiling, making sure the ball does not move. Once your body is parallel to the ground, hold this position for 2 secs and then lower your hips back down
Lateral (Side) Tube Walk
Lateral (Side) Tube Walk
Perform 2 sets of 15 repetitions at a slow tempo in each directionPlace a resistance band around your ankles. Start with your toes straight forward and feet shoulder width apart and in an athletic position. While maintaining an upright posture, take a step to the right. Next, bring your opposite foot towards the other. Continue this side-stepping position for 15 steps. Repeat going to the left.
Step-Up to Balance
Step-Up to Balance
Perform 2 sets of 15 repetitions at a slow tempo for each legUsing a box or a step, take a step forward onto the box and drive your opposite leg forward into a 90/90 position. Hold this position for 2 secs while actively contracting your quadriceps muscles and gluteus maximus muscle on your balance leg. Slowly step completely off the box. Repeat for 15 repetitions before moving to the other leg. Note: this exercise can be completed with or without weight.
Single Leg SquatSingle Leg SquatPerform 2 sets of 15 repetitions at a slow tempo for each legWith your toes pointed straight forward, your non-balance leg maintaining a position right next to the other and balancing on one leg, slowly squat down, keeping your knee in line with your 2nd and 3rd toes, and preventing the knee from moving forward over the toes. Squat down as low as you can without losing control and form, but no more than 90 degrees of knee flexion. Hold this position for 2 secs and then stand back up. Repeat this exercise for 15 repetitions before moving to the other leg.
Single Leg Hop to Stabilization
Single Leg Hop to Stabilization
Single Leg Hop to Stabilization
Perform 2 sets of 15 repetitions for each legWith your toes pointed forward, balance on 1 leg, jump forward and land on the same leg as you used to jump. As you land, you should try to land “soft” by bending your knee. Maintain proper balance for 2 secs when you land, keeping your knee in line with your 2nd and 3rd toes and behind the front of your toes. Note: If you are having trouble with this exercise, start with a very small jump forward and then progress in distance when you can maintain proper form. 

Cool-Down

ExercisePhotoDuration
Self-Myofascial Release: Calves
Self-Myofascial Release: Calves
Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: Adductors
Self-Myofascial Release: Adductors
Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: IT Band/TFL
Self-Myofascial Release: IT Band/TFL

Perform on each leg, hold on tender area for 30-90 secs
Self-Myofascial Release: Hamstrings
Self-Myofascial Release: Hamstrings

Perform on each leg, hold on tender area for 30-90 secs
Static Stretch: Calves
Static Stretch: Calves

Perform 2x each leg, holding for 30 secs each side
Static Stretch: Adductors
Static Stretch: Adductors

Perform 2x each leg, holding for 30 secs each side
Static Stretch: Hamstrings (Biceps Femoris)
Static Stretch: Hamstrings (Biceps Femoris)
Perform 2x each leg, holding for 30 secs each side

Conclusion

Knee pain is a common occurrence in an active population. While it may seem counterintuitive to exercise when you are experiencing pain, literature supports the practice of targeted hip and knee exercises, specifically the muscles of the posterolateral hip (Willy et al., 2019).

This sample program should be implemented at least three times a week for 4 weeks. Seek the consultation of a licensed medical provider prior to beginning any exercise program.

References

Callaghan, M. J., & Selfe, J. (2007). Has the incidence or prevalence of patellofemoral pain in the general population in the United Kingdom been properly evaluated? Physical Therapy in Sport, 8(1), 37-43. doi:https://doi.org/10.1016/j.ptsp.2006.07.001

Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., . . . McDonough, C. M. (2019). Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1-CPG95. doi:10.2519/jospt.2019.0302

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The Author

Adam Annaccone

Adam Annaccone

Dr. Adam Annaccone is the Program Manager for Sports Science at Children’s Health Andrews Institute in Plano, TX responsible for developing services, programs, and protocols utilizing the latest technology for the departments of orthopedics, rehabilitation, and performance. In this role, Dr. Annaccone collaborates with a team of professionals, including Orthopedic Surgeons, Physical Therapists, Athletic Trainers, Performance Coaches, Neuropsychologists, and Administrators, to enhance clinical practice and outcomes.

For over 15 years, Adam has worked as a Board Certified and Licensed Athletic Trainer, a Corrective Exercise Specialist and Performance Enhancement Specialist with a range of organizations from amateur to professional. He is an Independent Contractor for several NBA players and other professional athletes, providing movement assessments and targeted neuromuscular manual therapy and corrective/performance exercise programs and serves as a consulting practitioner for the Dallas Mavericks. Additionally, Adam is Adjunct Faculty for George Mason University in the Exercise, Fitness and Health Promotion Department and the University of St. Augustine for Health Sciences. He is also a consultant for the newly formed Sports Therapy Academic Program at Ono Academic College in Tel Aviv, Israel.

Prior to moving to Texas, Dr. Annaccone spent three seasons with the NBA Phoenix Suns organization on their highly regarded sports medicine staff, serving as Performance & Recovery Specialist/ Assistant Athletic Trainer. As a distinguished presenter, Adam has provided over 60 presentations, both nationally and internationally. In 2013, he was recognized by the National Athletic Trainers’ Association (NATA) with the NATA Young Professionals’ Committee National Distinction Award. Adam has been an active member of the profession of athletic training, serving on various local, regional and national athletic training committees; most recently serving as the District Representative for Texas and Arkansas for the NATA Government Affairs Committee. He received his Doctoral degree from Indiana University of PA in 2017, a Master’s degree from Clarion University in 2006 and completed his Bachelor of Science degree in Athletic Training at Duquesne University in Pittsburgh, PA.

1 Comment

  1. Cian O Brien
    November 18, 2019 at 4:45 pm — Reply

    I’m not too sure how helpful this program could be, to borrow a saying from Adam Meakins “corrective exercise is just rest in disguise” and this is what this looks like to me.

    As an authority on the subject I expected a lot better.

    The title also isn’t very helpful, and a little misleading, I’d expect it from an influencer looking for clicks but not an authority on training. This is why I clicked through, I thought “Wow – this is gonna be a comprehensive list with a deep dive into many different contexts”.

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