Bothersome knees are the worst. They affect almost every activity imaginable from running, going up stairs, and even sitting! For a joint that seemingly only does one thing (hinge back and forth), it seems like a lot can go wrong with it. Of course, there is a component of rotation, but that is beyond the scope of this article.

In my experience, most knee pain (barring any acute mechanism of injury) is relatively simple to address. Outside of acute injury, creaky and bothersome knees really come down to poor strength and mechanics of the hips (particularly the glutes), hamstrings, and quadriceps.

So the long term solution is exercise and strength training (big deal. That tends to be the solution to every problem). But what can we do to get some short term relief?

Tack and flossing the VMO: My secret move

This is probably the simplest thing I do in my practice. If there’s a “problem spot” at the knee that I consistently come across, it’s the bulk of muscle on the inside of the knee aka the VMO (vastus medialis oblique, for the cultured).

If a patient presents to me with a vague, dull to sharp pain across the knee and there wasn’t an obvious mechanism of injury, I will usually try this first. Apply moderate pressure into the bulk of muscle on the inside of the knee and just “search” around. You’ll likely find a tender or tense spot that may reproduce some pain in the knee. Once you find the spot, hold pressure and straighten and bend your knee repeatedly for up to 30 seconds to a minute.

Why does this work? It’s hard to say. Some people will say that it’s a “trigger point” but that doesn’t mean much in clinical terms. It’s more likely that it’s addressing a mild entrapment of the saphenous nerve.

Whatever is the case, it’s such a low effort and low risk move that I just try it out if the patient fits the pattern and it usually works at least 90% of the time in helping with temporary relief of knee pain. It never fails to impress students who get stuck with me how quickly we can improve people’s movement and pain with such simple tools.

The long term solution

Like I mentioned earlier, painful knees usually come about from poor strength and mechanics of the hips, hamstrings, and quadriceps. A more comprehensive view would also include the mechanics of the foot and ankle. Remember that the knee is a relatively stable joint that is sandwiched between two very mobile joints. If the hips and ankles aren’t doing their job, then a lot of that stress will end up at the knee.

The greatest evidence shows us that strengthening and exercise-based interventions are best practice when addressing knee pathologies. In fact, our first line of defense for conditions like knee osteoarthritis is strength training of the hips.

We absolutely cannot just rub and Theragun our way out of pain. It’s a short term bandaid on the pain but doesn’t address the core issue. Indeed, if left unaddressed, further problems may haunt us later in life such as difficulty walking, going up and down stairs, and even standing up from a chair.

It bodes well to perform exercise to strengthen our lower body. Indeed, after doing relatively basic strength training with me for a few months, my dad told me that his knees don’t hurt as much and he is able to stand from a very low camping chair with ease. More importantly to him, he is able to stand from a chair while holding his grandson.

In the most basic form, simply performing an exercise or training program that includes leg exercises such as squats and variations of hinging is a good start. Beyond that, we can start to add variation such as single leg squats, glute bridges, hamstring curls, and deadlifts of all kinds.

For the sake of this article, here is a fairly simple routine for people to do.

Basic Program for Knee Pain

1. Glute Bridges: 3×10-20

This is probably the most basic and the most effective exercise to improve hip strength. Simple lay on your back, bend your knees, squeeze your butt, and lift your hips up towards the ceiling as high as you can.

A simple cue is to squeeze the butt and push your heels into the ground.

Pro-tip: An EMG (electromyography) study showed that the closer your heels are to your butt, the more muscle activity there was in the glutes (this is a good thing). This makes sense since this position will place the hamstrings in an extremely shortened position, reducing their contribution to the movement.

2. Superset: A. Band Seated Hip Abductions: 3×1-20, B. Squats 3×10-20

I try my best to include exercises that require no equipment, but this is one that will require a short band to go around your knees. These are usually found for less than $10 so it’s not a significant investment.

This superset (just a fancy word for exercises that are paired together and performed in an alternating fashion) trains the lateral glute muscles and teaches you to engage your hips during squats and other movements.

For the seated hip abductions, sit on a chair or bench with the band around your knees. Place your feet about hip or shoulder width apart. Push outwards against the band as far as you can without compensating. Repeat 10-20 times.

Immediately following the seated hip abductions, start the squats. In the same starting position, push your knees out against the band enough so that your knees are above your feet. Stand up, continuing to push against the band tension. Perform 10-20 squats in this fashion.

Repeat this circuit for a total of 3 sets.

3. Prone Band Hamstring Curl: 3×10-20

Using the same band from the previous exercises, lay on your stomach with one end of the band around your foot and the other around your ankle. Bend the knee that has the band around the ankle to engage your hamstring against the resistance of the band. Switch legs. Repeat 10-20 times.

4. Single Leg Squat Balance and Reach: 3×5 in each direction

This is a more advanced exercise but can be done by anyone. This will combine all of the movements and muscles that were worked during the previous exercises and put it all together into a comprehensive task.

First, imagine 3 lines: One that extends directly to your side, one that goes 45° behind you, and one that extends directly backwards. Start by balancing on one leg. begin squatting down and simultaneously try and reach your other foot along the line that is directly to your side. Only go as far as you can without falling, without pain, and without letting your working knee cave inwards. Return to the starting position.

If you have problems with balance, do this in front of a counter so you have something to hold. Repeat this with the line that is 45° behind you and the one that is directly behind you.

As you do this, think about 2 more things: First, I want your foot to be working hard to maintain stability in the working leg by raising your arch and pushing your big toe into the floor. Second, keep your butt engaged throughout the movement. As you get stronger, you will be able to squat lower and lower without compensation.

How Often Should I Do This?

You can perform these exercises everyday, every other day, or simply as a warmup routine before your normal workouts.

Wrapping up

Keep in mind that this is a very basic program to just get you started, but it hits all of the fundamental things for healthy knees. Also keep in mind that this is also assuming that there was no acute injury to the knee (although some of these exercises may be helpful in that).

Of course, a comprehensive treatment plan is always unique to the individuals needs, but this is a great starting place.

90% of most orthopedic problems will go away if only more people just lifted weights and performed strength training.