Knee pain? Try this exercise rehabilitation!

In daily diagnosis and treatment, I often encounter a type of patients who experience knee pain when walking or climbing stairs, and sometimes feel pain when exercising. Although rest can relieve the symptoms, this pain always recurs, which makes people feel very distressed. These patients usually undergo imaging examinations, and the results show partial ligament tears, cartilage wear, and joint aging. Doctors will advise them to walk less and rest more, and if that doesn't work, they will have to undergo joint replacement surgery. However, patients always ask: "Is there any way to avoid surgery? I still need to walk and climb stairs in the future."

The answer is yes! In most cases, exercise rehabilitation can not only help patients relieve pain and avoid further injury, but can also improve function and reduce the probability of eventually needing surgery. There have been many high-level clinical studies and guidelines summarizing the effectiveness of exercise rehabilitation (Figure 1), and we have also begun to think more about the characteristics and activity mechanisms of the knee joint itself.

Figure 1

The knee joint can be divided into two parts: structural stability and mechanical stability:

——Structural stability: the density and alignment of the bones themselves, the cushioning effect of cartilage, the role of ligaments in limiting excessive movement, etc., are usually determined by genetics; (Figure 2)

—— Mechanical stability: refers to the muscles connected to or across the knee joint. There are many of these muscles, many of which even extend from the hip joint (Figure 3);

Figure 2 Figure 3

The structural stability of the knee joint allows our knee joint to complete activities within a limited range, avoiding irreversible serious damage beyond the limited range. However, overuse can cause structural damage. If our activities lack mechanical stability control, repeated additional stress will be exerted on the structure. When it exceeds the tolerance range, it will cause pain or gradual damage, thus forming a vicious cycle. (Figure 5)

Figure 4 Figure 5

Perhaps simple rest can prevent the tissue from being stressed, but it may also cause the tissue's ability to withstand stress to gradually decrease. Therefore, scientific activities and enhanced mechanical stability of the knee joint are the key to restoring normal function without pain. The body's own ability to adapt and adjust is actually very powerful. With the help of a physical therapist, gradually entering a virtuous cycle is the key to long-term stability.

We can call knee pain caused by poor mechanical stability "poorly controlled knee pain". This knee pain will naturally disappear if the control of the knee joint is improved. Rehabilitation usually includes two parts:

1. Adjust the way you exert force in your daily life activities, especially avoid buckling your knees when pushing off the ground, so as to reduce the burden on your knees and thus reduce the occurrence of pain (Figure 6);

Figure 6

2. Self-therapeutic practice methods mainly include three aspects:

- Stretching and relaxation can help reduce the occurrence of knee pain by relieving muscle tension, increasing joint flexibility, improving range of motion and relaxing the nervous system, including stretching/foam rolling;

Quadriceps stretch (Figure 7):

1. Stand upright, bend your knees, and draw your heels toward your buttocks until you feel a light stretch along the front of your thigh.
2. Hold this position for 15-30 seconds, then relax and repeat 2-4 times.
3. Switch to the other foot and do the same stretch.

Foam roller relaxation on the outer thigh:

1. Prepare to foam roll and sit on the floor.
2. Place the foam roller on the outer thigh muscles.
3. Find the painful spot and stay there for about 30 seconds.
4. Apply moderate pressure and roll the foam roller back and forth over the painful spot.
5. Continue rolling and relaxing, moving to the next pain point.

Figure 7 Figure 8

-Strength exercises can improve your ability to balance and strengthen the corresponding muscles, which can reduce the burden on the knee joint, improve the stability of the knee joint, and thus reduce the occurrence of pain; it can also help increase bone density, thereby improving bone strength and tolerance. This is very important for reducing the occurrence of fractures and bone and joint pain, especially for the elderly and people with osteoporosis.

Side bridge exercise (Figure 9):

1. Lie on your side with your body in a straight line.
2. Bend your upper arms and place your palms directly underneath your body.
3. Use your arms and side waist strength to lift your body into a side-lying bridge position.
4. Keep your body stable and avoid arching or slumping your back.
5. Hold for 15-30 seconds, then lower slowly.
6. Perform an equal number of repetitions on each side for a balanced workout.

Fig. 9

-Applied exercises help the brain learn to apply in practice, reduce the chances of joint instability and abnormal stress during exercise, improve the way and posture of exercise, thereby reducing the risk of knee joint injury and alleviating pain.

Single-leg squat-contralateral leg against the wall (Figure 10):

1. Stand upright and keep your body steady.
2. Lift one foot to keep your body balanced.
3. Squat down with your supporting leg while pushing your lifted foot out to the side against the wall.
4. As you squat, keep your knee in line with your second toe and avoid bending your knee too far past your toes.
5. Control the squat depth to ensure that the range of movement is stable and without shaking.
6. Slowly return to an upright position and repeat an equal number of times (it is recommended that you try 6-12 times at first, depending on your ability).
7. Perform the exercise evenly on each side to maintain balance.

Fig.10

Except for some muscle soreness and stretching that may occur during the first relaxation exercise, subsequent strength exercises should only cause muscle soreness without any joint discomfort or familiar pain. This shows that the force applied during training is correct. If you keep doing it, the pain will usually continue to disappear, and you will be full of energy in your daily activities. You may even get a pleasant byproduct like a "perky butt." As for those who are worried about whether their legs will become thicker, please don't worry. The intensity of these exercises is far from increasing muscle circumference, so you can practice them with confidence. Of course, the rehabilitation process takes time. Only by maintaining a positive attitude and persisting in practice during the rehabilitation process can you achieve the best rehabilitation results.

Note: When doing strength exercises and stretching and relaxation, you should make reasonable choices and arrangements based on your individual situation and professional guidance, avoid overtraining or improper exercise, and ensure the best rehabilitation effect; if you still feel discomfort such as instability/stuckness in the knee joint, or have obvious swelling reactions no matter how you adjust, it is recommended to see a doctor to clarify the problem before choosing the appropriate treatment and exercise plan. Because different people may need different treatment methods, it is recommended that you consult a doctor or professional physical therapist in case of uncertainty to develop a rehabilitation plan suitable for your individual situation.