Conventionally, treatment for knee pain has been focused around the knee itself. But, in fact, most knee problems are not standalone conditions. In this article, our physiotherapists in Singapore will share with you how we can help your knee pain by addressing the root problems and also some exercises to avoid knee pain.
Like any other joints of the body, the knee gets painful when there is abnormal load on it. When the knee has an ideal alignment, the force going through the knee does not cause injury. Being the center joint of the leg, abnormal force from the hip or the ankle will always have an impact on the knee. Whenever there is a combination of forces from multiple directions, such as compression plus gliding, or compression plus twisting, the knee tends to get injured or degenerated over time.
The single leg balance is one of the good ways to look at the forces going through the knee. Try balancing on one of your legs, which part of your foot feels the most pressure? Is it more towards the forefoot, the midfoot, the arch area or the heel?
If you feel that most of your weight is on the forefoot, your hip is most likely swayed forward, and your knee is usually pushed backwards to counter it and this generates stress in a compressive and gliding manner to the knee. If you feel that most of your weight is on the inner part of your foot or the arch area, you may notice that your knee is turning inwards, and the foot arch tends to be flattened. This generates excessive stress on the knee joint in a compressive and twisting manner, leading to overloading of the knee ligaments, cartilage and muscle tendons.
Ideally, the outer part of your feet and heels should bear the majority of your body weight. For this to happen, the hip joint and the ankle joint needs to be in the right alignment. Here are some useful strengthening and stretching exercises to avoid knee pain and prevent knee injuries.
The clamshells exercises is one of the most basic exercises for gluteal muscle activation. This exercise, though widely used, is done incorrectly most of the time. The main muscle that is activated is the gluteus medius and maximus muscle. These muscles are responsible for external rotation of the thigh bone. The cue given is to squeeze the buttocks gently together, and feel for opening in between the groin region. However, most of the time, the emphasis is placed on the opening of the knees, which uses the muscles of the lateral thigh instead.
Stand against the wall with two steps forward. Firstly, reduce the gap between the lower back and the wall by activating the abdominal and gluteal muscles gently. Slowly lower yourself down, do not allow your knees to go past your ankles. Ensure that your toes are not gripping the floor and your knees are slightly open (this reduces the engagement of the calves and inner thigh muscles respectively). In this position, if you feel strain in your knees and immense pressure around the knee joint, you are doing this wrongly. If done correctly, you should feel the activation and fatigue of your quadriceps, abdominal and gluteal muscles.
Tibialis Posterior strengthening
Sit on a chair and attempt to increase the foot arch by curling up the foot. You should not be using your toes in this exercise, therefore your toes should be relaxed and not gripping against the floor. Once you have attained this, maintain the arch and go from a sitting to a standing position. You will need to activate your gluteal and core muscles to effectively perform this exercise.
Hip Adductor stretch
Find a stable elevated firm surface. Put one of your legs up with the hip in an externally rotated position, while the other leg lunges forward. To increase the stretch, ensure that the knees are away from each other and slowly lower your body down by bending the forward knee.
Hip flexor stretch
Start in a kneeling lunge position. If your knee hurts when kneeling, use a folded towel or pillow for comfort. Ensure that your forward leg is sufficiently ahead of your body so that when you lunge forward your knee is not going over your ankle. Gently feel the stretch along the front thigh of your back leg. Do not arch your back when lunging forward. Now, hold on to the ankle of your back leg and bend your knee to increase the stretch.
Knee pain is usually not a standalone condition. Being the center joint of the leg, abnormal force from the hip or the ankle will always have an impact on the knee. Common knee problems include osteoarthritis, tendon or cartilage injuries, ligament and meniscus tears. The key to reduce knee pain is to identify the excessive stress placed on the knee on a daily basis. Generally, exercises should not be painful when performed, otherwise knee injuries may occur. If you are still experiencing knee pain after performing the above exercises, it is best to seek medical advice from a physiotherapist.