Surprising new ways to build healthy knees

Improving balance, losing weight, and strengthening muscles help prevent injury and reduce pain.

One of the most common reasons people visit their doctor is because of knee pain or injury. Arthritis, ligament and meniscal tears, fractures, dislocations, and sprains can limit your mobility and take away your independence. “Difficulty walking, climbing stairs, squatting, and getting up and down from chairs are common complaints from people with knee pain,” says Michael Orpin, a doctor of physical therapy at Harvard-affiliated Massachusetts General Hospital.

Keeping the knees healthy helps prevent injuries and reduce pain. Work with a physical therapist to develop a strengthening plan, which will likely include the following.

Exercise above the knee

There are many muscles in the hip and thigh that play an important role in knee health. Some of the major muscle groups include the quadriceps in the front of the thigh, which extends your knee and holds your body weight on a bent knee; the hamstring muscles, which bend the knee; and the gluteal muscles located in the hips. “Weakness of the hip muscles can create excessive inward twisting of the leg during normal weight-bearing activities, such as going down stairs, and can lead to higher levels of stress across the knee joint,” says Orpin. He recommends exercises that work many muscle groups at once, such as moving from a sitting to a standing position repeatedly. That’s called a sit-to-stand. “If it’s painful to do this from a chair, try it from a higher surface like the edge of a bed,” says Orpin. He suggests doing three sets of 10 sit-to-stands. 

Exercise below the knee

The gastrocnemius muscle, the largest muscle in your calf, crosses over the back of the knee and plays an important role in assisting with knee control. This muscle, inaddition to the soleus muscle, helps propel the body during walking, stair climbing, and running. Weakness in this muscle group could contribute to more stress through the knee joint. Orpin recommends heel raises to strengthen the calf muscles. Hold on to a counter for balance. Slowly rise up on tiptoes, then lower heels to the floor. That’s one repetition. “Try three sets of 15 repetitions,” he says.

A focus on balance

Part of maintaining balance requires your knees to work with other joints that enable you to stand−the hips and ankles. But the coordination takes practice.  A physical therapist will help you improve your balance by training your muscles to work together with simple exercises. For example, you may stand with one foot right in front of the other, as if you were standing on a tightrope, and eventually stand on one leg for up to 30 seconds.

Weight loss

The focus of each pound you carry is magnified by the time it reaches your knees. If you’re walking across a flat surface, the force on your knees is equal to one-and-a-helf times your body weight; going up a hill, the force is equal to two to three times your body weight.  Shedding extra weight reduces the force on your knees, which can help prevent arthritis and injury, and also reduce existing knee pain. “When patients lose weight, they describe feeling lighter on their feet, having more energy, with less knee pain and intensity of symptoms,” says Michael Orpin.

To aid weight loss Orpin suggests aerobic activity that won’t overload the knee, such as riding a stationary bike. “It’’s easy on the knee, and it promotes a good range of motion of the joint,” he says. Light to moderate walking is also beneficial if  it’s not painful. “If a pool is accessible, this is a great place to exercise. The water reduces weight on your joints and can make it easier to move. Try walking in the water forward, backward, and sideways to challenge different muscles,” says Orpin.

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