Nagging Knee Pain and How We Can Help

Knee osteoarthritis is the leading cause of knee pain in adults. 90% of all knee replacement surgeries are due to late-stage osteoarthritis. By 80-89 years old, 10% of people have undergone a knee replacement surgery.

Knee osteoarthritis can have many causes, some of which are: natural wear and tear from aging, previous injuries, obesity, and weakness in lower extremity musculature. Due to these causes, the articular cartilage in your knee can wear away. The articular cartilage is like a cushion that prevents bone on bone contact during movement. When this cartilage is worn away it leaves no barrier to prevent the bone-on-bone contact in the knee, and severe pain is the result 

So, you may ask, “what are some of the things I can do to potentially avoid knee surgery due to knee osteoarthritis?” Certain risk factors are preventable:

Being Overweight

Although a touchy subject, maintaining a healthy weight is an important way to prevent knee pain and ultimately a knee replacement. The force that you place on your joints can be up to 6 times your weight. So even losing even 15 pounds could help reduce a significant load on your knees’ daily activities. If losing weight has been difficult, consulting a dietician about a diet plan is a good start to losing weight. Although exercise is extremely important for health reasons including reducing knee pain and for weight loss, daily caloric intake is the most important factor in terms of losing weight. 

Weak Muscles

When talking about knee pain, it is important to mention the importance of having strong lower extremity musculature. The two most important muscles to keep strong in relation to knee pain are your quads (the muscles on the front of your thigh) and your hamstrings (the muscles on the back of your thigh). When performing weight bearing activities, the stronger the lower extremity muscles are, the more shock they are able to absorb and the more they can stabilize the joint. This will help prevent excessive load being transferred directly to the knee joints. Stretching is also very important to having well-balanced knee musculature. Having strong and well balanced muscles can help prevent awkward compensatory walking patterns and poor mechanics during other daily activities that will place more stress on the knee. 

Importance of Being Proactive with PT

So, you may be thinking, all this is great info, but what specifically can I do? Now, I will go into specific exercises and stretches that can help prevent knee pain. The information for exercises I will be providing is more geared towards individuals whose pain isn’t extreme and are still relatively mobile, able to walk, able to bend knees slightly during weight bearing, and able to perform some activities of daily living.

Exercise #1: Dumbbell Squat

A great exercise to start out with that will help with lower extremity strength and control is a bilateral dumbbell squat. The weight you should use depends on how strong your lower extremity musculature is currently. If you are unsure if you are able to do the squat with weight, attempt squats without weight first, and if you are not relatively fatigued by your 6th rep, then you can slowly increase weight to comfort. Repeat this for 8 total reps. If you feel unsure about your ability to balance during a squat this exercise might not be appropriate. 

How to do the Bilateral Dumbbell Squat:

1. Stand with your feet shoulder-width apart and toes are pointed directly forward.
2. Hold a weight in each hand with your arms at your sides and palms facing inward.
3. Engage abdominal muscles
4. Slowly bend your knees about eight inches.
5. Don’t let your knees go over your toes during squat. A proper squat should feel like you are in the process of going from standing to sitting in a chair.
6. Hold mini squat position for 3 seconds.
7. Slowly rise to an upright position. Do 8-12 repetitions. Repeat this exercise for 2 sets. Perform this sequence of 8-12 reps for 2 sets, 3 times a day.

Exercise #2: Hamstring Stretch

The quad and hamstrings can often become tight due to a variety of factors. Stretching is very important to maintain proper muscle length and avoid imbalance in knee musculature. 

How to do the Hamstring Stretch:

1. Lay flat on back.
2. Wrap a towel around your foot and hold with both hands as shown in the photo.
3. Keep knee straight and engage quads (muscles on the front of the thigh).
4. Lift leg while keeping knee straight. 
5. Lift leg until stretch is felt on the back of the thigh and hold in that position for 30 seconds. 
6. Bring leg slowly back down. 
7. Repeat on the other leg. During this exercise the stretch should be held for 30 seconds and repeated 3 times on each leg. Perform this 3 times per day.

Exercise #3: Combined Quad/Hip Flexor Stretch

The quadriceps muscles help stabilize the knee and is imperative in proper knee function. This exercise combines a stretch of the quads with the hip flexors to ensure flexibility across both joints.

How to do the Quad/Hip Flexor Stretch:

1. Lay flat on back on a flat table/bed with leg hanging off the edge of the table. 
2. Use a long belt or towel and wrap it around your ankle/foot as shown in the picture below.
3. Pull back slowly until stretch is felt in the front of your thigh and hold this position for 30 seconds.
4. Bring leg slowly back to starting position.
5. Repeat on the other leg. During this exercise the stretch should be held for 30 seconds and repeated 3 times on each leg. Perform this 3 times per day.

Exercise #4: Straight Leg Raises

These are a great exercise to help build quad and hip flexor strength. This also is an easier exercise to perform for the quads than dumbbell mini squats. Do this for 8-12 total reps. Adding ankle weights might be necessary to fatigue at the appropriate amount of reps for certain individuals.

How to do the Straight Leg Raise:

1. Lay on your back and bend your left knee so your foot is flat on the table/bed.
2. Tighten abdominal musculature.
3. Tighten your right quad, keep your knee straight, and lift your straight leg to the height of your opposite knee.
4. Hold for 2 seconds at the top and slowly lower to the starting position.
5. Repeat with opposite leg. Do 8-12 repetitions. Repeat this exercise for 2 sets. Perform this sequence of 8-12 reps for 2 sets, 3 times a day.

Exercise #5: Heel Slides

This last exercise is for individuals who have lost range of motion when bending or straightening the knee. This exercise can also be used for individuals who are worried they may start to lose range of motion in the knee. 

How to Do Heel Slides:

1. Lie on your back with your legs extended and your feet slightly apart.
2. Slide your affected leg as close to your buttocks as you can.
3. Hold this position for 5 seconds.
4. Slide your heel back to the starting position.
5. Take 1 minute of rest between sets. Do 15 repetitions. Repeat this exercise for 2 sets. Repeat this sequence of 2 sets of 15 repetitions 3 times per day on the affected leg.

Some tips for Heel Slides:

• Slide your heel as close to your buttocks as you can.
• Only bend your knee to a place that is comfortable.
• You may feel slight pressure or a sensation in or around your knee, but it shouldn’t be painful.
• A towel can also be used to help pull leg back if moving heel towards buttocks is difficult. 

Often knee replacement surgery can be avoided by weight loss, exercise, strengthening, and stretching.

Knee osteoarthritis can be debilitating, but we are here to help! If you have specific questions about your knee pain, please contact us at Serenity Medical Centers at 512-646-2743,.