In many cases, knee pain is a symptom of something going wrong in the hips and/or feet.Casarsa Guru/Getty Images
Over the course of my personal training career I’ve worked with well over one hundred adults, from once high-level athletes whose former physical prowess would have left me awestruck (or so they say, anyway…), to middle managers who choose the elevator over the stairs every single time. Working with such a diverse cross-section has not only broadened my coaching skills, it has also allowed me to formulate a few generalizations about the human condition, the main one being that after a certain age, almost everyone’s knees start to hurt.
Yes, time catches up to all of us, and when it does it’s often our knobby knees that first sound the alarm. It could be arthritis, bursitis, or tendinitis; could be a strained ligament or damaged cartilage. Whatever the cause, the result is a whole lot of frustration – you want to exercise, but those achy joints start singing a chorus of creaks and groans the moment you take a step.
Before you resign yourself to a life of sedentary grumbling, I have some good news to share: that very thing you long for (movement!) is, in fact, the solution to your woes. In many cases, knee pain is a symptom of something going wrong in the hips and/or feet. Weak and tight hamstrings can also be a factor. By thinking strategically and making use of exercise modifications, there’s a very good chance you can maintain a fitness routine, wonky knees and all.
Here’s how it’s done.
Reduce the range of motion
Squats are such an important exercise because they work all of the major lower body muscles – the glutes, the quads, the hamstrings, and the calves. But for my money, what really sets squats apart from the rest of the pack is how well they train the hips. Strengthen the hips, and everything downstream tends to benefit.
How do we squat, though, when our knees won’t let us? We make use of props to both reduce and better control our range of motion. The box squat is a classic example. Any gym worth joining will have plyometric boxes, which is just a fancy name for a big ol’ box typically made of either wood or foam. The height of these boxes can be adjusted depending on the side that’s on the floor; set the box to a height that will allow for productive, (relatively) pain-free squat and sit your butt on it.
I love box squats because they place a greater emphasis on your posterior chain (that is, the hamstrings, the glutes and the lower back), meaning there is less stress on the knees. And because the height of plyo boxes can be varied, as your squatting abilities increase so too can the depth. Don’t let the name of the exercise discourage you – box squats can also be performed with a bench, a chair or an ottoman.
Explore different movement patterns
For some people, squats of any kind are off the menu. A client I’ve been working with for a few months now is one of these people. He’s waiting to have both of his knees replaced, so we have had to make use of some creative methods for training his legs.
You know that old joke where the patient tells their doctor, “It hurts when I do this”? What sort of advice does this hilarious doctor reply with? “Well then, don’t do that!” For people like my client, exercising is a lot like this apocryphal scenario. We focus on strengthening the hips with side lying leg raises and strengthening the ankles with calf raises. We work on balance and stability by standing on one leg, softly locking-out the knee of the grounded leg to give the quads some attention.
As anyone with knee issues will tell you, some days are better than others. On days when the pain is minimal to non-existent, my client and I will try some more adventurous movements, such as the Romanian deadlift or the sumo deadlift – lower body exercises that involve the hips to a greater degree than the knees. The key is – and this is true for almost every weighted exercise – moving in a slow, controlled manner.
Putting it all together
There are more than 40 muscles in each of our lower limbs, and of those 40 only a handful act on the knee joint. So while, yes, knee pain can be a major limiting factor when it comes to exercising, you’ve still got lots of options at your disposal. Cycling, swimming and the elliptical machine offer low-impact cardio training; round that out with some hip hinges, leg lifts and balance training and you’ve got the building blocks of a complete lower-body training program, one that may even reverse some of the damage that’s built up over time.
Paul Landini is a personal trainer and health educator in Kitchener, Ont.