A major knee injury is no fun, but neither are some of the more minor aches and pains that we encounter in our knees from time to time. If you’re working out consistently, and knee pain is occurring during, or before, training on a more regular basis, it’s time to pay attention to the warning signs before things get worse. Below are some things to think about to both strengthen and protect your knee joints.

STRENGTHEN THE RIGHT MUSCLES

While we hear a lot about ligaments (ACLs, MCLs for instance) being damaged or torn in the knee, the fact of the matter is that the knee joint derives much of its functional stability from the surrounding muscles. In particular, the quadriceps work on both the knee joint itself and on the patella (kneecap) as it slides in the groove at the end of the femur.

Of the four individual muscles that compose the quadriceps, three of them attach on the lateral side, or outside, of the kneecap and when contracted actually pull the kneecap laterally as it moves the lower leg to extension. Only one muscle, the vastus medialis (the teardrop shaped muscle just above the patella and slightly medial), pulls the patella medially. When these muscles are in balance, the patella is stable and tracts smoothly in the center of its groove. However, if there is an imbalance in strength between the three muscles that pull the patella laterally and the vastus medialis, the patella can be pulled laterally too much, resulting in friction and knee pain as well as sub-optimal knee mechanics.

While exercises like squats and leg presses work the entire quadriceps, extra training attention may be needed to strengthen the vastus medialis. In short, one of the best ways to isolate this muscle is by doing the last 15 to 20 degrees of leg extensions. That’s when the vastus medialis is most activated and can be strengthened accordingly. This is a small movement that can pay big dividends!

WATCH THAT MIDDLE TOE

This is simple, yet very important point that many times gets overlooked or compromised. The knee is at its most stable when it operates as a hinge, in one plane of movement. For example, if you were to do a standing body weight squat and watch the travel of your knees as they move forward, the center of your knee joint should travel out directly over the middle toe of your foot. Yet if you watch people carefully while they are squatting or leg pressing or even doing lunges in the gym, you will often see the knee traveling inside the middle toe , especially when struggling to complete the last rep or two. This deviation places undo stressed on the knee compartment, the knee cartilage and the ligaments as well. Often weaker stabilizing muscles (adductors and or abductors) are to blame, which can be strengthened by using exercise bands. Foot rotation, in and out can also be a factor, but remembering to keep the knee moving directly out over, and in alignment with, your middle toe will reduce stress to the joint and help you avoid knee pain, both now and later.

CONTROL MOVEMENTS AND FORM

This point follows from the above in that controlled movements and proper form are essential to keeping your knee joint healthy and reducing the risk of injury. Stay in your proper exercise form and groove! Keep your knees traveling out over your middle toes, and also make sure there is no deviation in your hips and lower back which can change stress points on the knee. One of the most critical points in controlling the movement and staying “in the groove” is to descend slowly and then accelerate at the bottom of the movement to go back up. Too many people descend too quickly allowing momentum to build so at the bottom, when they begin the positive part of the movement, they’re not only lifting the weight itself, but the wait multiplied by the momentum of too a rapid dissent. For example, if I were to gently place a 5 pound weight in your hand versus dropping it in your hand from a foot above, there would be noticeable difference in force, right? If you descend more slowly you’ll just be battling the weight itself and not the additional momentum which can excessively stress both tendons and ligaments, increasing the risk of subsequent knee pain, and or leading to eventual injury. Take it slow on the way down and accelerate on the way up! 

WEAR SUPPORT

There has been a lot written on the topic of using knee wraps and braces over the past few decades. Some “experts” consider them a crutch to be avoided at all costs, and others see them as a helpful, protective adjunct when used properly. I fall in the latter camp of thought. That doesn’t mean we should be reliant on knee wraps or braces at all times, for all sets, and in all exercises. But, if we’re training heavy and using power movements like squats and leg presses, knee wraps can help protect the knee, reduce stress on tendons, and support proper form. These wraps should only be put on directly before the set and taken off directly afterward, for each heavy set. You will notice a difference.

SUPPLEMENT ACCORDINGLY  

Without getting too deep in the tall weeds of nutrition and supplementation, let’s assume that everyone is eating a high protein, well balanced diet and supplementing with vitamins and minerals accordingly. Proper nutrition is critical to recuperation and reducing the damage of the cumulative microtrauma that occurs with consistent training. That said, there are a few nutrients that merit specific mention when it comes to dealing with either chronic or acute knee pain. The first is vitamin C. Vitamin C is one of the major components of connective tissue healing and also has anti-inflammatory properties. Two to three grams of vitamin C taken over the course of the day, is commonly used in athletes who are training consistently to help tendons and ligaments repair. Collagen peptides can also aid joint repair from the cumulative trauma of training as can the combination of chondroitin sulfate and glucosamine as can be found in Labrada Nutrition’s Elasti-joint formula (in addition to other joint support ingredients).

WARM UP

I left this one for last because if I had mentioned it first, you probably would have quit reading. Boring, right? Everyone knows they should warm up…but most people don’t!  I’m not just talking about doing a quick warmup set, I’m talking about spending 10 to 15 minutes before you begin resistance training, on a recumbent bike or treadmill, for example, to help get the joints moving and increase your core temperature. Increasing your core temperature (as indicated by breaking a sweat) warms tissues, increases circulation and increases tissue elasticity. This can reduce the risk of muscle strains (micro-tears). Ever notice that when you’re feeling a bit stiff or sore and you begin working out, you feel better by the third or fourth set? Exactly! It’s best to warm up with light resistance, to break a light sweat and get the body prepared for heavier stresses in order to reduce joint wear and tear.