William J. Smith

Athletes, bankers, construction workers, elderly individuals, the list can go on and on when it comes to people who complain of knee pain. Knee pain can begin in many forms; chronic, acute, and idiopathic (symptoms but no direct cause) to classify the main categories. Whatever the form of knee pain you have, educating yourself can be a first step to relieving pain. Let this article be your guide on how to Stretch, Strength, and Move your knee back to health.

STRETCHING :1st Component

In order to understand if the muscles around your knee are restricted or tight we first must test them. Please reference the following tests for your baseline score (straight leg raise, prone ankle to hip, and Thomas test).

Straight Leg Raise:     http://www.nismat.org/orthocor/acl_postop/index.html   
    * see example below

Prone Ankle to Hip:    http://www.kneeguru.co.uk/html/dictionary/goniometer.html   

Thomas Test:              Knee hangs off table. If knee drifts out, a tight IT-Band is present.

Ex: Straight Leg Raise (SLR) Lie on your back with your knee brace locked. Bend your other knee so that you can put your foot flat on the bed. Contract your quad tightly before you raise your leg (see quad set). Slowly raise your braced knee until the ankle is approximately 12 inches off the bed. Slowly lower the leg back to the starting position. NOTE: This patient is in a later stage of rehab and is lifting his ankle more than 12 inches.

Based on our findings during testing, we will need to stretch the restricted muscles.
Please Reference www.njpostrehab.com for a download on hip stretches that will address these restricted tissue areas.


STRENGTHEN: 2nd Component

Stability
Enhancing the stability in the knee joint will be our primary concern. I stress that no pain outside of muscle pain should be felt during these movements. With that said let's progress.

Quadricep Set (4 big muscles in front of upper leg)
Description: Sit on floor with legs straight in front. Make fists together and squeeze between both upper legs. Hold for 10 seconds. Repeat 5-10 times.

Bridge with Towel or Small Ball between Knees
Description: You will lay down on your back. Feet will be positioned 12-16 inches from your hips as your knees are bent to around 90 degrees. Place ball between knees, squeeze, then lift your hips. Hold for 5 seconds. Repeat 8-12 times.

Wall Sits with Towel or Small Ball between Knees
Description: Sit against a firm surface with a flat back against wall. Position the ball or towel between knees and squeeze. Once squeezing drop your hips down into a sitting position keeping your back flat against wall.

Single Leg Stability Squat
Description: Face a wall. Stand on one leg with opposite knee lifted up and back off floor. Proceed to bend at the hip and knee with side that has your foot on the ground. You will feel this in the front of your leg and upper hip. Hold for 20 seconds. Repeat 5 times/leg.

Note: You should feel no front knee pain. If this happens bring opposite knee in front of body.


MOVE: 3rd Component

Lateral Stair Walks
Description: Walking in a forward direction up and down steps places a large amount of stress upon the knee. Hence when we add variety the body will quickly adapt and recruit new muscle groups, primarily inside and outside of the hips.

Double Leg Squat Up/Single Leg Squat Down
Description: Stand up with Two legs and come down with One leg. Prior to beginning the descent with One leg place the heel of the foot off the ground onto to floor to assist with the downward movement. The single leg descent will activate stabilizer muscles in the hip and eccentrically (muscle lengthens) load the quadriceps.

Single Leg/Single Hand Touch to Ground
Description: Stand with only One Leg on the ground. If needed stand close to a wall for a potential support object. Initiate a slight squat with the supporting leg by flexing the knee and hip. As the knee and hip are bent, touch the same side hand to the ground in front of the supporting leg.

Remember, use a pain scale for all movements. Never feel pain above a 2 or 3 out of 10. 10 being excruciating. Gauge your improvement by making a quick note everyday following the completion of the exercises. They should get easier to complete while your ability to move more confidently improves.