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The Healthy Knees Workout
6/11/2019 11:56:18 AM
 
“Bend the Knee!” is a major theme of Game of Thrones, but the story is a fantasy. What is not fiction is that the simple act of bending your knees can be painful for an estimated 100 million Americans, pain that results in over 600,000 knee replacements being performed each year. Rather than waiting to see when you will need to go under the knife, how about taking a proactive approach to keeping your knees healthy?
 
Of course, if you are currently experiencing knee pain, stop reading this article and seek help. If you, for example, cannot bear weight on your knees, have swelling, or can’t fully extend or flex your knees, get checked out by a doctor. If you’re good to go, consider taking a break from your regular training to perform a “knee prehab” workout.
 
Although the exercises in these workouts use resistance, they are not designed to significantly increase your strength, muscle mass, or help you lose fat. They will, however, help prepare your knees to handle the stress of your regular workouts. How can they do this?
 
Consider that the knee is a hinge, connecting the femur (upper leg bone) to the tibia (lower leg bone). It permits flexion (bending) and extension (straightening) of the leg, with minimal rotation. Further, the knee serves as a link between the ankle and the hip. If there are issues with the foot, ankle, or hip, this can present itself as pain in the knee. In other words, often the cause of knee pain may be structural imbalances in muscles far away from the knee, such as those on the hip or ankle.
 
The basic theory of corrective exercise is to stretch muscles that are tight and strengthen those that are weak. In the case of the knee, if the adductors (inner thigh muscles) are tight on one leg or the glutes are weak on one hip, these imbalances can affect the alignment of the knee, such as by causing the knee to buckle as you move. Imagine buying new tires for a car but neglecting to get them aligned – the tires will wear out faster. Likewise, if your knees are not in proper alignment with the feet, this could increase the stress on the knee.
 
One reason we develop structural imbalances is by sitting for prolonged periods and leading a sedentary lifestyle. However, structural imbalances can also often occur by not working the muscles through a full range of motion during exercise, such as when partial squats are performed. One muscle that is often weak in those who lift weights is the vastus medialis oblique (VMO), a tear-dropped shaped quadriceps muscle that crosses the knee joint and thus helps maintain knee stability. One common injury seen in sports that involve a lot of jumping is patellar tendonitis, which presents itself as chronic swelling of the tendon that connects the kneecap to the tibia. Often this condition can be corrected by simply strengthening the VMO.
 
The following are two workouts that address many of the possible causes of knee pain by restoring structural balance. If you have a history of knee pain (and have been cleared to begin a lifting program), start with Workout 1 for 2-3 weeks followed by Workout 2 for 2-3 weeks. Perform each workout three times a week; if you can only train twice a week, perform each workout for 3-4 weeks. If you’re just looking for a ‘knee tune-up,” jump right into Workout 2 as the intensity is higher.
 
The workouts consist of strengthening exercises for the glutes, quads, hamstrings, adductors, and calves. Stretches for muscles that affect the knee should be included at the end of the workout, and we’ve provided a few samples. However, stretches should be changed every few weeks as they all provide different lines of pull.
 
Workout 1
A. Poliquin Step-up, 3 x 10-12, 2011, rest 15 seconds
B1. DB Front Step-up, 3 x 10-12, 2011, rest 15 seconds
B2. Leg Curl, Prone, Feet Neutral, 3 x 6-8, 3011, rest 30 seconds
C1. Band Side Shuffle, 3 x 10 steps each direction, rest 15 seconds
C2. Calf Raise, Seated, Feet Neutral, 3 x 15-20, 1111, rest 30 seconds
D. Stretches for the Glutes, Hip Flexors, Quads, Hamstrings, and Calves: hold 30-60 seconds each for 1-2 sets
 
Workout 2
A. Petersen Step-up, 3 x 8-10, 2011, rest 30 seconds
B1. DB Side Step-up, 3 x 8-10, 3 x 8-10, 2011, rest 30 seconds
B2. Leg Curl, Seated, Feet Neutral, 3 x 4-6, 1111, rest 60 seconds
C1. DB Squat, Heels Elevated, 3 x 8-10, 4011, rest 30 seconds
C2. Calf Raise, Standing, Feet Neutral, 3 x 8-10, 1111, rest 60 seconds
D. Stretches for the Glutes, Hip Flexors, Quads, Hamstrings, and Calves: hold 30-60 seconds each for 1-2 sets
 
Here are a few coaching points on these exercises:
 
Poliquin Step-up. The Poliquin Step-up is an isolation exercise for the VMO often recommended during the early stages of knee rehabilitation. It is performed on an inclined surface, such as an adjustable slant board set at about 26 degrees. Because part of the foot is supported on an incline, it is easier to maintain your balance than the Petersen Step-up. Position your left foot on the incline with the ball of your foot over the edge, such that the toes are flexed slightly. The heel of your right foot should be in line with the ball of the left foot. Lift the toes of your right foot (just the toes, not the entire foot), which will prevent you from pushing off with that leg -- you want to be focusing on the VMO of the other knee. Stand up, rocking back as you do so that your right foot comes in light with your left; return to the start. Repeat with your other leg. If your right VMO is weaker than your left, start each set with the right leg.
 
 
DB Front Step-up. The step-up can be thought of as a transitional exercise to help you work into full squats. You start using a platform set at a height that you can use while maintaining optimal knee alignment, which is with the knee in line with the long toe. You may have to start with as low as six inches, which is the starting height of many aerobic steps; as you progress you can gradually increase the height. Lift the toes of your trailing leg to prevent you from pushing off to assist the working leg.
 
 
 
Lying Leg Curl, Feet Neutral. Free weight exercises tend to be better than machine exercises, but leg curls are an exception as they effectively work the knee flexion function of the hamstrings. Ideally, you want the pad to touch your glutes at the top of the movement. If you cannot achieve a full range of motion on this exercise, the weight is too heavy. Also, if you walk with your feet excessively turned outward, perform the exercise with your feet slightly turned inward to correct this imbalance.
 
 
 
Band Side Shuffle. This popular exercise affects the gluteus medius, which is a glute muscle essential for maintaining pelvic stability and thus knee alignment. Bands come in different tensions, usually indicated by color (so yellow might be the easiest, followed by green, blue, then red). You can also adjust the tension by placing the band above the knees (easiest) to just below the knee, and then around the ankles (hardest). Slightly bend your knees, and don’t bring your feet completely together as you want to keep tension on the bands.
 
 
 
Seated Calf Raise Feet Neutral. There are two primary calf muscles, the soleus (below) and the gastrocnemius (above). With the knees bent, this exercise targets the soleus. Because the soleus contains primarily slow-twitch muscle fibers, this exercise is performed for higher repetitions than the exercises for the gastrocnemius, which contains primarily fast-twitch muscle fibers.
 
 
Petersen Step-up. The King of VMO Exercises! The Petersen Step-up is performed on a low step, such as an aerobic step. Begin with your left foot on the step, knee bent and heel raised. Position the heel of your right foot in line with the ball of your left foot. Lift the toes of your right foot. Stand up, rocking back as you do so that your right foot moves slightly forward. Repeat with your other leg. If your right VMO is weaker than your left, start each set with the right leg.
 
 
 
DB Side Step-up. This step-up variation targets the gluteus medius but is performed with dumbbells for resistance. Start with a six-inch step; again, the starting height of many aerobic steps; as you progress you can gradually increase the height. Find a sturdy box or platform high enough so that when you put one foot on it, your upper thigh is parallel to the floor; if you cannot maintain optimal knee alignment during this exercise, use a lower platform. Position yourself to the side of the platform so the entire surface of your right foot is on the top of the box and your left foot is on the floor, just a few inches away from the platform. Lift the toes of your trailing leg (to prevent your front pushing off with that leg) as you straighten your other leg.
 
 
 
Seated Leg Curl, Feet Neutral. Align your knees with the center of the pulley, and do not use a weight that is so heavy that you cannot perform it through a full range of motion. As with the prone leg curl, if you walk with your feet excessively turned outward, perform the exercise with your feet slightly turned inward to correct this imbalance.
 
 
DB Squat, Heels Elevated. This quad exercise is performed with your heels on a board (or wedge board) about 2-3 inches high. Often full squats can’t be performed because of limitations in ankle flexibility. The calf raises and the calf stretch shown will improve ankle flexibility, but elevating the heels will enable you to get around this issue for now so that you can work the muscles through a full range of motion. As with a regular squat, spread your feet shoulder-width apart and point your toes slightly outward. At first you may not be able to squat all the way down or use any resistance, but this should improve after a few training sessions; do not increase the resistance until you can perform the exercise through a full range of motion.
 
 
 
Standing Calf Raise, Feet Neutral. With this calf raise variation you keep your legs straight to focus the stress on the gastrocnemius. To perform the exercise through a full range of motion to increase flexibility, position your feet so you can drop your heels below the balls of your feet.
 
 
 
Stretches. These are static stretches that work the muscles while the body is at rest. They should be performed at the end of a workout when the muscles are warm and more responsive to stretching. You gradually lengthen a muscle to an elongated position (just before the point of discomfort), then hold that position for 30-60 seconds before releasing the tension slowly to return to the start. As with resistance-training exercises, you should frequently vary the stretches you perform.
 
Calf Stretch
 
 
 
Glute Stretch
 
 
Hamstring Stretch
 
 
 
 
Quad Stretch
 
 
 
Knee pain does not necessarily have to be inevitable if you follow structurally-balanced workouts that strengthen the muscles throughout a full range of motion. Give these healthy knee workouts a try so that you will never have to worry about “Bending the Knee!”
 
 
Drawings By: Sylvain Lemaire (www.physigraphe.com)
References
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