For Knee Joint Pain, Strengthen Those Quads

Wed, 10 Oct. 2012 - 2:13 a.m. MT
Credit: ARA Staff - American Running Association

Osteoarthritis, old injury, posture problems, inactivity—these are all causes of joint pain. And among the most frequent chronic injuries runners, in particular, suffer is knee joint pain. Simply walking across level ground puts up to 1.5 times your body weight on your knees. That means a 200-pound man will deliver 300 pounds of pressure to his knee with each step. Running, of course, dramatically increases this load on the knees even more.

To avoid or alleviate knee pain from running or other activity, strong quadriceps are vital. There are numerous exercises that strengthen quadriceps, all of which lead to crucial muscle mass in support of fragile knee joints. Let’s look at specific, and in several cases perhaps lesser known, exercises you can do to strengthen quadriceps muscles. Some require fitness machines, but others merely free weights, and still others simply pit your body against gravity.

We’ve purposely chosen five exercises for quadriceps that use distinct mechanisms to strengthen: barbells, dumbbells, by cable, body weight only, and with plate-loaded lever (as in Nautilus and other gym or home machines). Finally, we’ll look at some useful stretches, as flexibility is also tantamount to pain-free load-bearing exercise.

First, it’s useful to learn a bit about muscle movement classification. The following descriptors of muscles in action will help you understand what you’re achieving in relation to other muscles with each of the below quadriceps exercises.

The ways muscles move and the names we give them

Target – the primary muscle intended for exercise.

Synergist – an assisting muscle to accomplish a given movement.

Dynamic stabilizer – a muscle that simultaneously shortens at the target joint and lengthens at the adjacent joint with no appreciable difference in length. Assists in joint stabilization by countering other motion-causing muscles’ forces.

Stabilizer – a muscle that contracts with no significant movement, as when maintaining straight posture.

Agonist – a muscle that causes significant movement.

Antagonist stabilizer – also assists in joint stabilization by countering other motion-causing muscles’ forces. These muscles act to maintain joint alignment as well. For example, abdominal muscles contract to counter the opposing spine muscles in a deadlift or squat to prevent hyperextension of the spine.

Antagonist – a muscle that significantly moves the joint opposite the agonist muscle.

Strong antagonists and antagonist stabilizers are important to consider when strengthening any target muscle. As we noted above, strong abdominal muscles contribute to proper spine health. It’s important, then, to also strengthen the muscles opposing the quadriceps—that is, the hamstrings—though here we examine only quad strengthening exercises.

 

Type: Barbell

Single-leg split squat

 

Instructions

Stand facing away from a bench. Position bar on shoulders and extend leg back and place top of foot on bench. 

 

Squat down by flexing knee and hip of front leg until knee of rear leg is almost in contact with floor. Return to original standing position by extending hip and knee of forward leg. Repeat.

Comments

Keep torso upright during squat; keep hip flexors flexible. Forward knee should point in same direction as foot throughout movement.

Muscles

Target: quadriceps; 

Synergists: gluteus maximus, adductor magnus, soleus; 

Dynamic Stabilizers: hamstrings, gastrocnemius; 

Stabilizers: erector spinae, gluteus medius, gluteus minimus

 

 

 

Type: Dumbbells

 

Front squat

 

Instructions

Stand with dumbbells grasped to sides. Bring dumbbells up to shoulders so the side of each rests on top of each shoulder, with elbows flaring outward. 

 

Bend knees forward while allowing hips to bend behind, keeping back straight and knees pointed in same direction as feet. Descend until thighs are just past parallel to floor. Extend knees and hips until legs are straight. Return and repeat. 

Comments

Keep head facing forward, back straight, chest high, arms straight to sides, and feet flat with equal distribution of weight through forefoot and heel. Knees should point in same direction as feet.

Muscles

Target: quadriceps; 

Synergists: gluteus maximus, adductor magnus, soleus; 

Dynamic Stabilizers: hamstrings, gastrocnemius; 

Stabilizers: erector spinae, upper and middle trapezius, levator scapulae

Antagonist Stabilizers: rectus abdominus, obliques

 

 

 

 

Type: Cable

Rear lunge

 

Instructions

Stand grasping handles of two fitness cables strapped to heavy weights (such as two table legs) on either side of you on the floor, creating two very low pulleys. With feet shoulder width or narrower and arms straight down to sides, step back with one leg while bending supporting leg. Plant forefoot far back on floor. 

 

Lower body by flexing knee and hip of supporting leg until knee of rear leg is almost in contact with floor. Return to original standing position, returning rear leg next to supporting leg. Repeat movement with opposite legs alternating between sides. 

Comments

Keep torso upright during squat; keep hip flexors flexible. Forward knee should point in same direction as foot throughout movement. A long lunge emphasizes gluteus maximus; short lunge emphasizes quadriceps. 

Muscles

Target: quadriceps;

Synergists: gluteus maximus, adductor magnus, soleus; 

Dynamic Stabilizers: hamstrings, gastrocnemius; 

Stabilizers: erector spinae, upper and lower trapezius, levator scapulae, gluteus medius, gluteus minimus, quadratus lumborum, obliques

 

 

 

 

Type: 

Body weight

 

Single-leg squat

Instructions

Stand facing or to one side of a wall with one hand on it for support. Stand on one leg by wrapping other leg around back of supporting leg so top of lifted foot is on outside of supporting leg's ankle. 

 

Squat down by bending knee forward and hip behind. Keep back straight and supporting knee pointed in same direction as foot supporting. Descend until thigh is just past parallel to floor. Return to standing position with minimal assistance from wrapped leg. Repeat.

Comments

Supporting knee should point in same direction as foot throughout movement. The movement can be made easier by assisting more with wrapped leg. For greater challenge, raise lower leg up to buttocks. 

Muscles

Target: quadriceps;

Synergists: gluteus maximus, adductor magnus, soleus; 

Dynamic Stabilizers: hamstrings, gastrocnemius; 

Stabilizers: erector spinae, gluteus medius, gluteus minimus, quadratus lumborum, obliques, rectus abdominus

 

Type: 

Body weight

Lateral step-up

 

Instructions

Stand between two weight benches, one to each side. 

 

Lift leg and place foot on bench, slightly in front of knee of other leg. Stand on bench by straightening bench leg and pushing body upward. Step down returning feet to original position. Repeat with opposite leg alternating between legs.

Comments

Keep torso upright during exercise. Stepping knee should point in same direction as foot. A modest degree of knee rotation is ok. Using shorter benches or steps will make this movement easier. For greater challenge, use taller benches or boxes. Barbells and dumbbells can also provide additional resistance.

Muscles

Target: quadriceps;

Synergists: gluteus maximus, adductor magnus, soleus; gastrocnemius (following leg)

Dynamic Stabilizers: hamstrings, gastrocnemius (leading leg); 

Stabilizers: erector spinae, gluteus medius, gluteus minimus, quadratus lumborum, obliques

Antagonist Stabilizers: rectus abdominus, obliques

 

 

 

 

Type: 

Plate-loaded lever

Hack press

 

 

Instructions

Sit on leg machine seat with back of hips against back pad. Place feet on platform shoulder-width or slightly wider. Extend hips and knees. Disengage dock lever if it does not automatically disengage. 

 

Lower seat by flexing hips and knees until either is near complete flexion. Raise seat by extending knees and hips. Repeat. 

Comments

When finished, engage dock lever, and lower to starting position. If insufficient hip flexibility forces pelvis to pull away from back pad at lower portions of movement, lower sled just slightly until this corrects. Keep knees pointed in same direction as feet. Do not allow heels to rise off of platform; push with both heel and forefoot. 

 

Placing feet slightly high on platform emphasizes gluteus maximus. Placing feet slightly lower on platform emphasizes quadriceps.  

Muscles

Target: quadriceps;

Synergists: gluteus maximus, adductor magnus, soleus; 

Dynamic Stabilizers: hamstrings, gastrocnemius

 

 

Three Valuable Stretches

 

 

Type: 

Body weight

 

Lying quad stretch

Instructions

Lie prone on mat or floor. Grasp top of ankle or forefoot behind. 

 

Pull ankle or forefoot to buttocks. Hold stretch.

Comments

A thickly folded towel can be placed under upper hip if lumbar spine hyperextension would be uncomfortable. A thickly folded towel can be placed under knee to further stretch rectus femoris.

Muscles

Target: rectus femoris; 

Other: quadriceps

 

Type: 

Plate-loaded lever

Lever quad stretch

 

Instructions

Flip seat all the way back. Stand facing bar with supporting foot slightly forward under, or near apparatus. Grasp handle bars for support. Place top of other foot back on top edge of shin pad. 

 

Squat down with back straight and chest up while positioning hip straight and close to back of heel. Hold stretch.

Comments

Rear knee should be completely flexed to keep emphasis on quadriceps.

Muscles

Target: rectus femoris; 

Other: quadriceps

 

Type: 

Towel-assisted

 

Towel quad stretch

Instructions

This variation on the classic standing quadriceps stretch, employing a towel, is likely familiar to most runners. However, it deserves mention for simplicity and effectiveness.

With foot on floor place towel around ankle. Grasp both ends of towel behind ankle with closest hand. Stand on opposite leg and touch wall or stationary object with other arm for balance. Pull foot to buttocks with towel. Straighten hip by moving knee backward. Hold stretch.

Comments

Alternatively, hip may be initially extended, then ankle can be slowly pulled towards buttocks. With either technique, do not allow knee to flare outward.  

Muscles

Target: rectus femoris; 

Other: quadriceps 

 

 

To reduce the pounding, reduce the pounds

These exercises and stretches will directly strengthen the musculoskeletal support system around your knee joints. But remember, too, that like any regular physical activity, they can also simply help shave off unwanted pounds. Being overweight raises your risk of developing osteoarthritis in a weight-bearing joint like the knee. Each pound you lose reduces knee pressure in every step you take. One study found that the risk of developing osteoarthritis dropped 50 percent with each 11-lb weight loss among younger obese women.

Joint pain affects millions of people—not only runners. The daily throbbing and aching are all too familiar to millions of people for whom the pain doesn’t only limit exercise. It can make you think twice about everyday pleasures or tasks like going for a walk, lifting your grandchild, or putting groceries in your car. 

Yet even for previously inactive people, sedentarism is clearly not the answer. Limiting your movements for a long time can weaken muscles, compounding joint trouble and set off a cascade of further problems. Pain pills and hot packs may offer quick relief, but these fixes are always temporary. The right set of exercises can be a long-lasting way to tame joint pain and postpone or avoid surgery on a problem that has been worsening for years. 

And it is those of us who try to stay fit with regular running, walking, or other load-bearing exercise that are often vulnerable to repetitive use injuries culminating specifically around the knee. By following these quadriceps strengthening drills one to three times a week, you can likely take back your training and continue the activity you love for a long time to come.

 

ExRx, Quadriceps Exercises, http://www.exrx.net/Lists/ExList/ThighWt.html

 

Harvard Health Beat, Nov. 29, 2011, “The secret to joint pain relief — exercise” 

(RUNNING & FITNEWS® November / December 2011 • Volume 29, Number 6)




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