Reading Time: 6 minutes 53 seconds
You'll never appreciate how important your knees are until they hurt and affect your mobility. Pain in the knee can be debilitating or just mild and annoying, but it cannot be ignored.
Knee pain may come from over-training, from arthritis and normal aging, and from injury. Regardless of the cause it can bring training, fitness, and even walking to an abrupt halt. Even milder cases of knee pain can seriously limit movement and workout routines.
If you have clients with this kind of joint pain, take it seriously. Depending on the circumstances you may need to send her to her physician for an evaluation.
But, if it's all been checked out and she has the green light to keep working out, you can help her manage that pain with the right exercises for both knees and hips—a joint that shouldn't be ignored when it comes to knee pain.
Pain in the knee joints is pretty common, unfortunately. Most of us experience it to some degree, especially as we get older.
There are many potential causes of knee pain, and although you're not expected to diagnose it as a personal trainer, it does help to know what could be underlying your client's symptoms.
Trying to understand what is causing a client's knee pain is important for a couple of reasons:
You may need to encourage your client to see a doctor. If the pain doesn't abate, gets worse, is severe, sudden, and acute, or is accompanied by other symptoms, your client needs to see a doctor for a diagnosis.
As a trainer, understanding the cause of knee pain can help you correct it. If you know it's due to injury, strength imbalances, or over-training, for instance, there are things you can do to help your client manage that pain.
Unfortunately working out and training can be the cause of knee pain. It's great to be a go-getter when it comes to exercise, but this positive attitude can also back fire. Over-training and working the joint too hard can lead to pain.
Working out with bad form can also be damaging to the knee joint. For instance, when performing squats or lunges, muscle imbalances might cause the knee to cave inward or collapse. This puts the joint in a vulnerable position. In addition to the risk, extreme discomfort is likely to occur because the joint isn't intended to move in this direction, especially with load.
Noting and correcting form is easy for an experienced trainer, but muscle or strength imbalances can be more difficult to work with. Having a sound knowledge base of functional anatomy will help you identify which muscles might be tight and others which might be weak. Keeping your client performing strength exercises correctly is a great place to start when attempting to avoid complications associated with muscle imbalances.
In some cases, the cause of pain in the knee is obvious because there's been injury. A client who plays basketball, for example, may have twisted his knee and experienced sudden pain. You know that's an injury and you can recommend a visit to a doctor or sports medicine practice as well as work with him on changing his workouts.
Anyone at any age can have arthritis, but most common is osteoarthritis. This is the wearing down of joints that occurs with time and use. Eventually we all get some degree of this type of arthritis, and it often affects the knees. It causes pain, swelling, redness, and mobility limitations.
This doesn't have to hold back your female clients, though. Studies have shown that when women went through guided hip strengthening exercises, they saw significant improvements in knee pain relief.
When women in these studies did only knee strengthening exercises, they experienced some pain relief The addition of hip exercises made the real difference, which is a strategy you can extend to any of your clients with knee pain, not just women.
Add foam rolling and stretches to your clients' healthy knee routines to round out your pain-management strategy. Stretching the knee and the muscles and connective tissues around it can loosen up tightness in the joint, making it easier and less painful to move. Have your clients try these rolling and static stretches.
When the calf complex is tight, it forces the knee to flex more than it would during normal movement. Tight calves can also cause the feet to turn outward and the knees to cave in. Using a foam roller or tennis ball, position the calf on the equipment and apply light pressure to tender areas, usually on the outside of the muscle.
Today's society has tight hip flexors, which can cause many issues for movement. Specifically, tight hip flexors can cause the knees to move inward and reduce strength in the gluteal complex. In a plank position, place the foam roll under the hip and roll the center of the quadricep. You can also roll the outer-area of the quad to reduce the chance of the knee moving inward.
After foam rolling the calf complex, clients can further improve muscular balance by stretching the calf. Facing a wall, step one foot back and drive the heel into the ground. Lean the upper body forward until a stretch is felt in the back of the lower leg.
When the adductor complex is too tight, it can pull the upper leg in and place the knee in a vulnerable position, causing discomfort and microtrauma. Have clients take a wide stance, with the feet in the same line as one another. Then have them lunge to the side until they feel tension in the opposing inner thigh.
With one foot flat on the ground in front of the body, and the leg bent at 90 degrees, very gently bend and place the other knee on a padded surface on the floor. Tighten through the hamstrings and glutes until the stretch is felt in the front of the bottom leg, the rectus femoris.
As long as there is no serious injury or underlying medical reason that your client has knee pain, strengthening muscles in the legs and hips is helpful. Guide your client through these exercises with good form and set an appropriate schedule, like two to three sets of 12 to 15 reps for each move a few times a week.
Performing squats on one leg at a time will help ensure the legs are balanced from right to left. More importantly, however, you'll engage your balance mechanisms which can help prevent injury to the knee. Also, this exercise is great to see if the knee tends to internally rotate, causing strain. By performing this exercise at a slow and controlled pace, clients can focus on form and create better movement and overall strength.
Hip bridges engage both the hamstrings and the gluteal complex, which are helpful in reducing or avoiding joint discomfort at the knee. Lying on the back with knees bent and feet flat on the ground, lift the hips up and squeeze the glutes.
Similar to both the single-leg squats and the hip bridges, this exercise if helpful for balance, identifying and correcting imbalance, and hamstring and glute strength. With the stationary knee relaxed and foot pointed straight ahead, bend at the hips, push the glutes back, and lower the weights to mid-shin. Lift back up to the starting position.
Lying on your side with one leg on top of the other, bend the knees to 45 degrees. With feet together, lift up the top knee and leg and squeeze through the glute medius. It's a small movement, but one that will help stabilize the knee during side to side movements.
With a resistance band around the ankles, side step to the right several times. While completing the movement, keep the knees slightly bent and remain in a hip-flexed position.
In basic plank position, with forearms, hands, and elbows pressed into the floor, lift one foot off the ground and hold for several seconds. This will help develop core strength evenly and with activation on one leg.
Check out this earlier ISSA blog to learn more about IT band syndrome and some good corrective exercises.
Knee pain can drive anyone to inactivity, but for most cases being more active is better for the joints. Yes, there are times and situations that call for rest. In general, though, people who are active are more likely to have healthy, pain-free knee joints.
Another major factor in knee pain is weight. The more weight clients have to carry, the more stress is placed on the joints, causing damage and pain. Regular activity not only keeps joints healthy, but it also helps your clients maintain a healthy weight, which reduces pressure in the joints.
You, as a trainer, can help your clients manage their knee pain. Know when they need to see a doctor, and when they need to rest, but otherwise guide them through some of these exercises, setting up a regular routine appropriate to each individual, and keep them active.
If you want to learn more about using exercise to correct muscle imbalances and reduce risk for injury, you can become a Certified Corrective Exercise Specialist. This will help you work with active and sedentary clients to live pain and injury free.
Dolak, KL, et al. (2011). Hip Strengthening Prior to Functional Reduces Pain Sooner Than Quadriceps Strengthening in Females with Patellofemoral Syndrome: a Randomized Clinical Trial. Journal of Orthopaedic and Sports Physical Therapy. 41(8): 560-700.