When it comes to dealing with injuries, the knee is often one of the biggest problem areas of the body.
Whether you’re focused on long-distance runs, sports that require all types of cutting and lateral movements, or any other strenuous activity that’s hard on the legs, the well-being of your knees and the surrounding muscles is integral to your fitness goals. Take care of them, and your lower body will be taken care of.
Most people who suffer knee injuries tend to suffer them seemingly out of nowhere. Sometimes, issues seem to creep up inevitably over a long period of time. Either way, all athletes and fitness-committed devotees can help prevent knee problems from happening. In general, that comes from listening to your body and not doing too much at any given time, while also knowing which muscles to strengthen so that your knees and legs are kept in working order.
The first thing to understand about knee health is that the knee is a stable joint that functions and exists directly between two very mobile joints—the hip and the foot, says Pete McCall, an expert exercise physiologist at the American Council on Exercise.
“If either the foot or the hip loses mobility, then the knee has to start moving in a different plane of motion,” he says. “When runners have less than desirable form, that means they’re either losing mobility from the hip or mobility from the foot, and the knee’s created that mobility.”
McCall recommends a regimen of core stabilization exercises, including plenty of planks (side and front), bridges, glute raises, and other related exercises. McCall refers to these as “foundational exercises” that provide great warm-ups for difficult workouts—they get the muscles going and strengthen the hips, taking the pressure off your knees.
If you experience knee pain, the best thing you can do is see an orthopaedic specialist, and remember that if you’ve been diligent about exercise for a long time, a week off for rest and recovery might be the best thing you can do, whether or not you’ve come down with an injury.
Symptoms: Pain behind or around the kneecap, often when bending the knee. Pain is usually worse while walking downstairs or downhill.
Common causes: Runner’s knee is usually an overuse injury, something that often afflicts long-distance runners, although athletes like weightlifters can also experience symptoms. It can also be caused by a direct blow to the knee, flat feet, weak quads, or other factors.
McCall reports that developing this condition means “the person lacks hip stability in the frontal plane.” Doing plenty of front planks and side planks is imperative to building up that strength so stress doesn’t come down on the knee that it can’t handle. Another highly recommended exercise is the step-up to balance, in which the person steps up onto a box and brings his other leg up into a flexed position and holds it for a few seconds.
Rehab/prevention tips: If already injured, the R.I.C.E. method (Rest, Ice, Compression, Elevation) is strongly advised—just don’t overdo it on the ice. Generally, some go with 20 minutes of ice applied per hour while others alternate putting ice on and off every 15 minutes or so. Seeing a doctor should allow you to get a better gauge on what you need to do.
Another tip: Be careful not to overemphasize the knee extension machine, says Chris Watts, an athletic trainer who's cared for many professional athletes over the years at the Steadman Clinic in Colorado. He says the exercise places far too much stress on the knees and can increase the chance of developing runner’s knee.
“[Doing these] will help the hip be stronger to support the knee because a lot of times the knee collapses because the hip doesn’t provide that stability from the top down,” he says.
Illiotibial (IT) band syndrome
Symptoms: The illiotibial band is fibrous tissue that runs along the outside of the leg from the hip to the lateral (outer) side of the shin. IT band syndrome develops when the band is irritated, usually resulting in pain on the outside of the knee, or just above the knee on the outside of the leg. ITBS that is not handled properly can lead to meniscus tears, which can require surgery down the line.
Common causes: A sudden increase in level of activity—such as increasing mileage as a runner or jumping into sprint-heavy workouts without transitioning from jogging. Can also come from up/downhill and stairs running and from general overuse.
Rehab/prevention tips: The R.I.C.E. method is also effective in injury rehabilitation here. McCall says much of the exercises that can work to fix or prevent IT band syndrome are similar to those that work for runner’s knee. Stretches that engage the hip flexors, glutes, and outside of the leg are effective, especially after exercising. Using a foam roller to stretch out the IT band usually greatly helps the recovery process, although it might be uncomfortable.
Once again, McCall suggests starting off with side planks, then progressing up to side lunges and side stepups to increase lateral hip stability. “Before you run, with both feet on the ground, reach across your body with your hand—with your right hand reach for about 10 o’clock, then reach for 2 o’clock with your left hand," McCall says. "Do that about 10-12 times. It loosens up the hips so they can work a little more effectively when your foot hits the ground.”
Symptoms: The source of pain is at the bottom and front of the kneecap, and you may feel stiffness in the area after a workout. You might also feel pain when flexing the thigh muscles. There are four grades of injury, ranging from pain only after training to pain during everyday activities.
Common causes: As the name suggests, jumper’s knee is generally brought on through excessive jumping, usually from sports such as basketball and volleyball. It often stems from overuse and lack of keeping the necessary muscles strong enough to avoid injury.
Rehab/prevention tips: Once again, go ahead and use the R.I.C.E. method to help you treat this one. Even elite athletes tend to brush jumper’s knee aside so long as their symptoms remain along the lines of the first grade of injury (as in only feeling pain right after working out), but things can, of course, worsen and it may require surgery some day. Watts says the best thing to do is go about workouts using as proper technique as possible while avoiding exercises that put stress on the knee. Patella tendon straps can also be a good idea.
“They actually do help and work,” he says. “They will take some pressure off of the tendon because it alters the mechanics, but it’s not actually solving the problem, per se. It’s just alleviating some of the symptoms so that you can build the quad and hamstring musculature up enough so that it can take some of the pressure off the patella tendon.”
Ligament sprains and tears
Symptoms: Injuries to ligaments like the medial cruciate ligament and anterior cruciate ligament are probably the most pronounced injuries on this list. While other conditions often develop over time, sprains and tears are generally sudden—they typically result from a sharp, jarring motion like a hit or an awkward landing, and can cause serious pain and damage. They are usually accompanied with a loud, distinctive "pop" or "snap" coming from the knee, followed by swelling, joint looseness and pain when putting weight on the injured leg.
There are three grades of a knee sprain: Grade 1 (over-stretching the ligament, but no tearing); Grade 2 (slight or partial tearing); and Grade 3 (a full rupture).
Common causes: They often result from sports that involve quick lateral motions like soccer, basketball, football, and lacrosse. The constant shifting of direction and weight from one knee to the other at varying angles stresses these key stabilizing ligaments, and collisions or fast pivots all present a risk.
Rehab/prevention tips: Putting braces on knees that have never had ligament damage before has not proven to be effective, although it has and is often done for football linemen due to the huge amounts of hard contact they face every play, Watts says. Braces can help people who have already had MCL or ACL tears, since they’re usually more susceptible to that injury again.
Recovery exercises are best done in a sort of physical therapy setting since it’s especially unwise to do too much too soon. Ligament tears can also be accompanied by damage to associated smaller ligaments (like the patellar ligaments or patellar tendons) as well as the meniscus. If you suspect you've damaged your knee ligaments, then make sure to speak with an orthopaedic specialist as soon as possible, and to consult with a physical therapist who will gauge a proper course of recovery.