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This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2023. For the original video go to https://www.youtube.com/watch?v=wWvSNIbnYv4
Brad: Do you like to walk but you're limited by knee pain? Particularly if you're going up steps, it kind of hurts. It’s probably arthritis or it could be something else.
Mike: But we have five easy exercises to help fix this knee pain.
Brad: Alright. If you're in your fifties or older and you've been gradually getting more knee pain with walking, it's probably arthritis, you're thinking. There are exercises you can do to improve the situation and sometimes even actually make it go away.
Mike: And often as we age, if you have knee pain, it can lead to weight gain, which is less fun yet, and it can lead to feeling depressed. So we want to help alleviate this knee pain to get you moving better and feeling better.
Brad: That's right. So we've picked out our best five exercises to work with the knee, get the range better, get it feeling better, get that synovial fluid in there where it needs to so it feels as you want, and get active again.
Mike: So first, we're going to talk about the knee mechanics and then we're going to talk about different standing and walking habits you may be having causing this knee pain.
Brad: I wanted to have Sam give us a hand here or perhaps a knee to show a little arthritic education. Now, in the knee joint, the arthritis that often occurs is between the femur and the tibia. You have these two surfaces, they should be shiny and smooth with that nice pristine cartilage. However, after time, with age, it may be a mechanical thing. If you're a little bow-legged or outward, you’ve got knock knee, then one side gets more worn out than the other. So that's where that's going to happen.
Brad: But there's one spot that a lot of people aren't aware of, is the kneecap or the patella. Now Sam's patella is kind of screwed on there. It has more mobility than this, but it's underneath here. That can also be arthritic and that is a good source of pain going up and down stairs. So we'll show you some stretches that'll help work with that joint as well.
Brad: Alright, for the first exercise, we're going to look at the knee extension. In other words, getting the knee straight. What can happen over time is the knee doesn't fully extend because of arthritic changes. What we need to do is work through that. A good way to assess it, Mike’s going to demonstrate how you may do it on a bed or a couch. I'm going to show you how to do it on a chair with a stool. Let's say my right knee is my sore knee, and Mike's sore knee is the left one. Put your two knees up together and straighten them out and you'll see that the sore knee may not fully extend. Like the one below, you can see fully extends all the way down. It feels good. That's normal, nice, and straight. The right one goes down and we have an inch or more difference, and you can just tell, it's not going down like the other one. Then we need to work on that.
Brad: We'll show you a couple of options because you don't want to get after it too aggressively. You can get really sore. Bob always tells his story about one of his patients who got after it too aggressively. When he came back, he was a little upset, so Bob had to calm him down. They backed off and they got him going again, so just a little caution with that. All right, so what you'll do is bring the leg straight out. Now, if you have a stool with wheels, it works really well. If you're doing it on the bed, Mike will show that. Using the stool I straighten and stretch. If you get sharp pain, you're going too hard. If you've got just a little pain, work it. Do five or 10 repetitions, and if each time it feels like it's going a little better, you're doing good.
Mike: So if you're on the bed, you're going to be in a long sitting position. If my knee is stuck in a flexed position, I'm going to focus on trying to push the back of my knee into the bed. If this is problematic or you can't do it as well, you can put a pillow under your heel to get a little more height there. And then sometimes you can start pushing down. Now you may not be able to get all the way to the mat, just do what's comfortable and what doesn't feel painful. Oftentimes when your knee is bent like this, your hamstrings are going to be tight, so you're going to feel a little pull in there. Don't be too aggressive, you can get a hamstring strain. Then you're starting from ground zero all over again. So just take it easy, go nice, slow, and controlled. Hold it down for a few seconds, and then relax.
Brad: That's right. So this is not going to straighten out in the first one or two days. As a matter of fact, the first day, I would only do it once, and see how sore you are the next day. If it feels fine, then you can start to push a little more, up to 10 repetitions, no more than 10. And then you may want to do it twice a day. Go the next day, and see how it feels. You may go up to three times a day, morning, afternoon, and evening. But that's as much as you want to go after it. And then you may take a week or two weeks before you actually get it where it needs to go. It's possible that there's enough arthritic damage in there that it may not come back. That's just what you have to find out. Now, I did talk about the patella or the kneecap. That's the next thing to assess. And the key to this, is I'm not going to put a stretch on the knee, we're not concerned about that. We do want it as straight as it comfortably can be. Then you're going to completely relax the quads because if your quadriceps are not relaxed, your kneecap will not move. This is because they're directly connected to each other. Now I'm completely relaxed in the quads and if your quads are relaxed, you can do it just with your fingertips. You can use this method with your thumbs and just go back five or 10 times. You might find that one way is painful. The other way feels okay. Do not push into the painful range too far. Just a little bit, work it again in the same manner. And you can go forward and backward. You can do some angles in there. The whole idea is to see how mobile it is, compare it to your other knee cap and they should be about the same. And that can work out. That's one of those things that sometimes is a little faster to mobilize than the whole knee with extension. Mike, any additions?
Mike: You will know if your knee is not relaxed, because if I'm tightening up right now, that kneecap is not moving. So you have to get it to relax and then you will start to see the movement. And just do what is pain-free. If it's hurting every time, don't push more into it. Just do a nice slow, controlled pain-free motion.
Brad: Well, we went into detail a fair amount with that, but it's important that you get it right and you don't have a situation where you're really in pain the next day and then you say bad words about Mike and I. We don't want that. Okay, let's go to number two. This is a pretty straightforward and simple one. It's just being aware of your standing habits in regard to your knee position. Now what happens is some people, they'll stand with their knees fully extended; we call that end range, all the way till it stops going. People often stand like that at full extension for a long time. That, after time, can really beat up the knee and when you walk, it can cause problems. So all you want to do is look at your knee and go full extension. And if you're there and you say, "Well, that's the way I stand all the time," simply a little flexion in the knee and hold it like that and you may find out a whole other story about when you're standing for long periods of time. You can stand longer with less pain. Mike, why don't you talk about how that feels.
Mike: So this is going to make your muscles engage more and take pressure off your actual joint. So if you're having knee pain, this is going to put pressure on your joints, your hip joint, your knee joint, and your ankle. This is going to allow the quads to activate and the glutes to activate more, taking pressure off of that joint. And this is how muscles are supposed to function. It is easier to stand like this because you're basically stacking your bones on top of each other, keeping in place disengaging muscles, but you want to make those muscles work because you're going to have less pain there.
Brad: Right, and just another little tip. This is one that I know Bob talked about with one of his patients, that works so well. We're going to call this soft knee. So it's a soft knee when there's a slight bend in it, but actually, stagger your feet. Go ahead and stagger. So that's an option for you, just stand. If you have a job that you're working, you may put your staggered left foot in front, and after so many minutes, stagger the other direction and then maybe a squared-off stance and just vary that position. Taking pressure, putting it on one knee, a bit more on the other, and it helps rest that knee a little bit. It's a good little strategy.
Mike: And it's important to stagger front to back. You don't want to lean on one side, because you're probably going to lock that knee out again.
Brad: Right. That's another thing some people do, they just put all their weight on one knee, maybe from a habit, from an injury.
Mike: Well, you do it all on one leg, when it's tired then you switch to the other leg. I used to do it. Then I learned better.
Brad: Okay, the next one is how to walk. Change your walking mechanics to eliminate or actually reduce the impact on those knees. We call it walking with soft knees. Mike, why don't you explain it in detail?
Mike: So most people commonly walk with a heel strike landing on your heel first. This is going to put the forces from the ground into your ankle, then your knee, hip, back, et cetera. It works its way up. If you're having knee pain, you're taking that shock directly into your joints. So what we recommend is walking with soft knees. It's very similar to standing. In order to do this, you're going to stand and land more on your forefoot. You can see here my heel is still elevated. I'm kind of exaggerating, you don't have to walk exactly like this, but this is how you will begin. When you do this, this activates your glutes more to fire again, as well as your quads.
So you're going to be using your muscles versus putting all that pressure on your joints. It's going to lighten the load and impact forces on that arthritic knee. So when you walk, you can see I'm doing a large distance heel strike. This is a no-no. In order to walk on your forefoot, I'm not going to step this far forward. I'm going to start taking smaller steps. As I'm here, I can feel my glute start to activate. If you want to do this at home, probably not outside, you can put your hands on your buttocks. With a heel strike, I don't feel anything on my right side. Now I'm putting my forefoot down, as I step through, I feel my butt muscles start to engage and activate. So you might look a little silly walking around town like this, but if you want to do it in your own home, start practicing forefoot or soft knee walking. Did I forget anything?
Brad: Bob used to walk around like that in the neighborhood when he was practicing.
Mike: He probably still does.
Brad: They're used to it.
Mike: So it's a little harder to do this if you have standard shoes as well because you're going to have an elevated heel. I have flat shoes on. If you want to start this and you don't have any, you can try walking barefoot in your house if you feel safe doing that. That's just where you can start and slowly build into it. It feels a little different, but over time, you get acclimated.
Brad: That's right. And if you feel relief from pain when you're doing that forefoot walking, it's even more motivation to continue. It does take a while, I have to admit.
Mike: Yeah, you've been walking the same way for however old you are. So, it takes a while.
Brad: Right. Now we're going to talk about negotiating up and down steps. If you have knee pain, a lot of times people have more pain going down steps than up. But it varies from person to person and knee to knee actually. So I'm going to talk about changing your mechanics of walking. If we look at my feet, and this is how I normally walk up, my toes normally point out a little bit. That's normal for me.
Brad: Let's say I'm having pain in my right knee with that. I'm going to try two different options. The first one is to rotate my foot out a little bit and see how the pain responds to that mechanics. And if it feels better, then you're going to change your mechanics to walking like a duck going up and down the steps. As long as it's less painful, you're aligning the joints so that the cartilage is actually lining up in a more healthy manner.
Brad: You can also try pointing in a little bit. Now for me, that's awkward because I'm a natural retroverted hip. So if I go this way, I really feel awkward and it probably would not do anything for my knee pain if I had it. But you can try it.
Brad: Some people's bodies are different. So outward and inward and then see how that works. If your knee pain is really severe, it doesn't matter which way you point your foot, then the next option is, to go ahead Mike, you show him this one.
Mike: So what you're going to do is lead up the stairs with your good leg. So say my left leg is bothering me, I'm going to lead with the right and then I'm just going to step to. I'm just going to do one step at a time, use the rail as you need, leading with the good leg. Now on the way down, you're going to actually lead with the bad leg, because as you see, as I'm going down, my good leg is supporting my weight here as I'm going down, the right leg is doing the work. So make sure to use the rail. Once you get here, bring this foot down. Bad foot down, bad foot down. So, you remember this by thinking good people go up to heaven and then the bad people go to the underworld, because I won't say the other word. So up with the good and down with the bad is the trick here.
Brad: And if you get a knee replacement or a hip replacement, they'll tell you exactly the same thing. So you'll be ready for that if it does get to that point. So, very good. The idea is that you go up with the good, down with the bad, until that knee settles down, and then get back to your normal gait going up and down the stairs. Alright, let's go to the last and final trick. Now this option is absolutely the easiest and the fastest way to get rid of knee pain when you're walking. The only thing is it's the least desirable by most people. So if my right knee hurts, and every time I put weight on it you start limping and you try to grin and bear it and act like it doesn't hurt. Well if you're going to unload it, you simply take a cane, and it'll really take a lot of weight off of that painful joint and allow you to walk much smoother. You just have to adjust the cane properly and walk properly and it really will help, I guarantee you, even though you may not like it. So get a nice, fancy cane that makes you feel cool. It does help, I've had people do it. So if the right is my sore knee, what I'm going to do is use the cane in the other hand. A lot of people get that wrong because they watch that Dr. House. Yeah, that guy on TV, he walks with the cane on the wrong side. Painful knee on right, cane on the left. If you drop your hand down with good posture, the handle should go right about at the crease.
Brad: It doesn't have to be exact, but if it was up here, I would change the height. Typically canes are adjustable. If you have a wooden cane, you can always cut it off and make it shorter but you can't cut it off and make it longer. So you need to make sure it's the right length and you are able to adjust it. So here we are, when my right foot goes forward the cane goes forward and we walk through, and you simply put weight through your arm. It takes weight off of the sore knee and because you have a wide base, it really helps your balance and you're much more stable. So it's a win-win situation for pain, your stability, and your ability to walk. And the idea is that typically arthritis comes and goes, it kind of gets worse and better.
Brad: You're going to use this on those bad days and do the exercises, do the range of motion exercises, one or two of them that you'll find help. And then you don't need the cane all the time just on those bad days is the goal. Anyway, I would say, don't let that knee pain get you all hung up. Try all these. Some of them won't work for you, some will, and do the ones that work.
Mike: Let us know in the comments below what works for your knee pain.
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