Exercises for Stronger Knees
Updated: May 12
In Mammoth, it seems like a new knee or hip is a rite of passage when passing into the golden years. Validating years skiing on the mountain.
In 2010, about 7 million people were living with a total hip or knee replacement (Journal of Bone and Joint Surgery, 2015). The trends in 2015, also indicated a rise in incidence and a shift to younger age. You may know several people who have had a knee replacement in their late forties to early fifties, which is generally uncommon.
The rehabilitation, although painful at first, is relatively straight forward. Some people even return to skiing after 4–6 months. While for most, skiing is out of the picture. A knee replacement is a good option when you are no longer able to function (for example, walk for longer than 10 min or get up from a chair).
What if we could extend the life of our knees before we reached this point of no return?
Aside from trauma (sport's injury, a fall, or accident), knee pain is from inflammation and abnormal wear on the joint over time, leading to arthritis. Meniscus tears, cartilage damage and ligament strains can all cause pain in the knee and lead to degeneration.
When examining people with knee pain in the clinic, the most common movement error I see is called knee valgus. Valgus is when your knee moves towards midline while bending, such as squatting, stepping down or landing from a jump. This is often due to a motor control error or a muscle imbalance of the hip or foot.
Our bodies primarily operate on autopilot; we don’t need to think about how we move. But sometimes our bodies figure out shortcuts to achieve a goal. These shortcuts may become hard-wired into our movement patterns overtime. After using these shortcuts over years, it can lead to abnormal wear on the joint.
In the short term, you can develop outside knee pain from IT Band Syndrome or anterior knee pain from your knee cap tracking poorly. If your knee moves inward over a lifetime of movement, this can stress the inside of your knee. It may lead to MCL strains when landing forcefully, meniscus tears, cartilage damage and degeneration of the medial part of your knee by the time your reach 60.
If we can prevent abnormal wear on the joints, we minimize pain and degeneration of the joint. We will perform better by using our muscles in a balanced way, reduce our risk for injury, and extend the life of our knees.
Steps for healthy knees:
Step One: assess yourself.
Stand on one leg and bend your knee, coming into a mini single leg squat position. Either look down at your leg or in a mirror to determine if your knee is midline of your foot and hip.
The image on the left is “knee valgus” and the image on the right is good alignment of the lower limb.
Step Two: determine if it is a motor control issue and/or a strength issue.
Do another single leg squat, but keep your knee over your toes. Your knee can go past your foot, keep it tracking straight.
Can you do this movement? Is it difficult or feel weird? Do you need to stand on the outside of your foot? Did your hip swing out to the side? Or is it impossible?
If you can do this movement, but it feels weird, then it’s a motor control issue. If you can do the movement, but is hard, it’s a strength issue. If the movement is not available, no matter how hard you try, it is mechanical. Mechanical is when a restriction in the foot, hip or knee prevents optimal movement of the joint. Often, it’s a combination of all three.
Motor Control Issue
Motor control is your brain's control over the movement of your limbs. It’s when your autopilot went haywire (found a shortcut) and you need to recalibrate it. You can correct this movement through practice. Lots of repetition without any load (weight or heavy resistance).
Practice a single leg squat for a couple of weeks. When you squat down, keep your foot, knee hip and shoulders aligned vertically. It is easier to do this in front of a mirror.
If this is too hard, practice a squat with both feet on the ground. Squat down as low as you can, keeping your knees tracking over your feet. You can allow your knees to move past your feet, keep your torso upright and weight stays centered on your feet.
I recommend completing 3 sets of 12-20 mini squats per day.
Pay attention to how you move. When you are going up the stairs, notice if your knee is caving inwards and correct it. When you are doing a high step or step down on a hike, look at your knee. Practice makes perfect.
Many people are surprised to learn that knee tracking is controlled by the hip. To prevent the internal rotation and adduction of the knee (and valgus), you need to first strengthen the external rotators of your hip.
Exercises such as clamshells, fire hydrants and kick out/backs are commonly prescribed to strengthen the hip. These exercises are also useful if you are already experiencing knee pain. Complete 2–3 exercises daily with resistance from a resistance band for a couple of weeks. The next step is to strengthen the glutes through functional exercises.
You can begin by practicing squats, lunges (forwards and sideways) and step ups without weight and in front of a mirror. Try two sets of 6 at first, slow and with good form.
Watch your technique, do your knees move inwards, hip move outwards or body lean to the side? Foot, knee, hip, and shoulder alignment needs to be vertical.
Perform the movements slow and with good form. As it becomes easier, increase the tempo, or add light weights (10lbs). In a couple more weeks, it’ll be time to head to the gym.
When you are at the gym, continue to practice these exercises with weight and variation. These exercises are "functional". They use the whole body in ways that you move every day. Every time you ski down a mountain, you are squatting and pressing with your feet. When you backpack, you are doing step-ups and downs. When you pick up an object from the ground, you deadlift or squat.
Weight machines are nice to build strength because they are safe and easy to use. Although you build muscle strength, your movement patterns are unaffected. Adding these functional exercises to your gym program will help address underlying habitual movement patterns.
Have knee pain already?
If you already have knee pain, warm up your knees before these exercises on a stationary bike or a normal bike. Work on improving your flexibility, balance and try to do non-painful exercise, such as clamshells, fire hydrants and kick out/backs, until your knee starts feeling better.
Not all knee pain is treated the same.
The movement tendency valgus, described above, is just one of many reasons why knee pain develops. This article takes the easiest approach to treating knee pain using exercises of the hip. While this may help a lot of knee pain get better, it is often only part of the picture.
The knee is susceptible to weakness and stiffness not only at the hip, but also the foot. The way we carry ourselves, aka our posture, while running or walking may also lead to knee pain. If you have knee pain and notice no change with the above program, you will need further evaluation. I highly recommend seeking out skilled PT evaluation or treatment from a local provider.