As a personal trainer for the past 11 years, I have dealt with plenty of clients that have had knee problems. From runners to weight lifters, most people come to the table with some ache or pain in the knee.  

In order to diagnosis an issue, we need to look at two factors: knee stability and joint health.  A healthy joint can balance without pain, while a stable joint will not have any issue with medial or lateral instability.

A very common knee injury amongst many athletes is the anterior cruciate ligament (ACL) tear. To avoid this injury, there are many exercises one can perform daily within their own exercise regimen. Three such exercise that we like to promote for strength and stability are:

  • single legged elevated heel touches
  • stork or single leg hip hinges (balanced over only one leg),
  • knee extension and flexion exercise.

All exercises can be performed with little to no equipment, using only your body as the resistance.

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When working with a client with knee pain, it is important to ascertain which factor you are dealing with.  Looking at their workout routine might shed light on the issue, and yield a diagnosis of poor stability or strength.  The first two exercises we like to perform with our clients to check if the issue is stability (which we learn through our assessment process), are the heel touch and the one legged hip hinge, aka, “the stork.”

1. The heel touch is performed off of a box or step. The objective is to touch the ground with only the heel of your foot. To avoid overworking the issue or injury, we work both legs, so it will not matter which leg you begin with, because you will perform equal repetitions on both sides.  

The exercise can be performed at various heights depending on the ability of the person and the severity of the issues. For example – runners knee (a common issue amongst runners due to over exertion of the supporting structures of the knee) tends to be caused by a lateral mal-tracking of the knee joint commonly due to IT band tightness. The IT band is a muscle sheath that runs down the lateral aspect of your leg, and it is responsible for supporting both the anterior and posterior muscles of legs as well those of the hip. The band runs from the hip to the knee, which may create tendonitis due to mal-tracking.

The heel touch forces the smaller muscles of the hip to engage as the opposite leg is lowered to the floor, auto-correcting the knee by forcing the individual to stabilize their bodyweight over the leg on the box (or elevated step). Over time this exercise should become easier and easier to perform for the client if they are tracking properly at the knee, no matter the height of the elevation they are placed on.

2. The one legged hip hinge, or “stork,” allows for many variations and positively effects many common issues found in athletes. However, for the purpose of this discussion, we will look at only the positive effects on the knee.

Like the heel touch, the importance of this exercise is teaching the body how to stabilize your weight over a smaller base of support, (one foot and leg in contact with ground). When a person can perform this movement, there will be a straight line running from the ankle, up through the knee to the hip of the person’s stance-leg (ultimate goal). Any derivation from this straight line allows you to focus your attention on correcting the issue.

For example, if the knee falls inward (inverts) as the person begins to stabilize over their leg, this tells you that the lateral structures (muscles) aren’t strong enough to keep the leg straight. If the knee everts (pushes outward), the same weakness is occurring, only this time, to the inner part (medial aspect) of knee.

To correct this, have the person begin to focus on what the ultimate goal is in their mind. Giving them a model to follow, as well as using other tools to feed the mistake, will help to ensure that the body will respond.

Tools that can be used are weights to force the body to respond, stability pads, and most likely bands to help fire inactive muscles. Exercises one and two promote joint stability and ensure that the joint is healthy and ready to strength train.

Side view portrait of a young woman doing squats at fitness gym

Side view portrait of a young woman doing squats at fitness gym

3. In order to be able to perform exercises like a squat or deadlift, your joints have to be prepared. If you have an unstable or week joint, chances are squats and any variation of triple extension will be very ineffective. In order to properly strengthen the knee specifically, we need to make sure we are strengthening it directly.

There are plenty of ways to do that, however, for our purposes we will only discuss two single joint exercise at the knee: knee extension and knee flexion.  

Knee extension takes place when the anterior muscles, the quadriceps, contract and bring the shin (lower leg fibula and tibia and ankle) toward the knee, thus extending the leg or straightening it. When the quadriceps relax, the leg lowers itself back to a bent-knee position.

This exercise can be done sitting on a bench, hanging your leg off the edge of the table and performed for repetitions by simply contracting the quadriceps.

For knee flexion, you are simply trying to bring the heel of your foot toward your glutes. To perform this exercise you need to contract the posterior muscles of the leg, the hamstrings. When contracted, the hamstrings flex the knee joint allowing the lower leg to move towards the hips.

Both of these exercises can be performed on a table or bench with nothing more than a towel or Thera-band as resistance.  In fact, when athletes are pre-rehabilitating or rehabilitating a knee injury you will commonly see them in the athletic trainer’s room performing such exercises with an athletic trainer.

If you feel like you are further along than someone recovering from knee surgery, you can perform both of these exercises on machines in the gym which allow you to load the joint, known as the leg extension and leg curl machines.

To best understand what you may be experiencing at the knee, whether it be instability or lack of strength, you don’t need to understand all the structures of the leg…

You simply need to be able to determine and identify which common issue you are dealing with. Asking a series of simple questions will help identify the issue at hand these questions include:

  • Is there pain in the knee? 
  • Is the pain radiating from the inside (medial) or outside (lateral) of the leg?
  • Does the leg buckle in or out when preforming a body weight squat?  
  • Are you able to get in and out of a chair without assisting yourself, or holding on?

Identifying the issue will help you program properly on how to correct it. Strengthening the muscles cannot be truly enhanced until your joints are properly mobile and functioning. Once your knee can move without issue, you can strengthen the muscles that surround the knee without hesitation or worry.

Happy training!

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