Strengthening and Stabilizing Exercises for the Knee

The knees are one of the hardest working joints of the body, and they are a common site of injury, pain and degeneration. Keeping the knees healthy to protect against injury and healing a current knee injury depends on strengthening and stabilizing the muscles that surround the knee and keep it securely in place.

Leg Extensions

The quadriceps muscle group on the front of the thigh is the largest muscle group of the leg and helps to support and stabilize the knee. Weak quadriceps muscles will lead to weakened and impaired knee joints. A leg extension is a simple way to strengthen the quadriceps muscles and stabilize the knee. If you have an injury or are new to exercise, start by sitting in a chair with both feet flat on the floor. Slowly straighten one leg at the knee joint so that the leg extends straight out from the hip. Hold for a one-second count and release. Repeat 15 to 20 times and then switch legs. To make this exercise more challenging, use ankle weights or a leg-extension machine at the gym, gradually increasing the weight as your quadriceps muscles become stronger.

Modified Leg Extension

Another good exercise for strengthening the quads and stabilizing the knee is the modified leg extension. You can do this exercise at home every day and you do not need access to any gym equipment. Sit on a chair facing a wall with your knees about one foot away from the wall. Keep one foot flat on the floor and press the toes of the other foot into the wall and push, as if you are pushing the wall away from you with your foot. You may want to wear shoes for this exercise as it can be hard on the toes. Hold for a five-second count and release. Repeat five to 10 times on each side.

Swiss Ball Hamstring Curl

The hamstrings on the backs of the thighs are another major muscle group that attach to the knee and help stabilize and protect it. Lie on your back on the floor with your feet propped up on a medium-sized swiss exercise ball. Press your heels into the ball and lift your buttocks off the ground as you slowly pull the ball toward you using your hamstring strength. You will need to use your abdominal muscles to help balance your body. This exercise is tricky, so it may take a few tries to get it right. When you have pulled the ball in as close as you can, slowly roll it back out and release your buttocks to the ground. Repeat 12 to 15 times.

Calf Raises

The calf muscle along the back of the lower leg comprises two muscles: The soleus and the gastrocnemius. The gastrocnemius attaches to the knee and acts as a knee flexor. Keeping this muscle strong will help in stabilizing the knee during flexion, or bending, or the knee. An easy exercise to strengthen the gastrocnemius muscle is a calf raise. Stand on the edge of a step on the balls of your feet so that you are looking up the stairs. Allow your heels to hang over the edge and slowly let them drop down below the step so that you feel a stretch down the back of your lower leg. Now, press into the balls of your feet and rise up as high as you can on your toes. Repeat 15 times.

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Exercises that will help Strengthen the Joints

– Ride a bicycle
Unlike walking, running, aerobic dancing and other weight-bearing activities, bicycling is gentle on your joints and can be done by people of all ages.

– Stretch

Often overlooked or just plain neglected, stretching exercises are a vital way to strengthen your joints, keep you limber and feeling good at the same time. Fitness experts recommend doing at least a half an hour of stretching two or three times a week, but every day is even better, if only for a short period of time.

Many age-related stiffness is simply the result of inactivity. In fact, in one recent study, a group of nearly 1,000 adults enrolled in the same exercise class over a twenty-five year period experienced modest declines in strength and aerobic fitness, but no loss of flexibility.

– Climb the stairs

This form of exercise is probably one of the most efficient ways of strengthening the bones, muscles and joints of your lower body. What’s more, stairs are everywhere, and they’re free. You don’t need a membership in an expensive health club; the stairs in your home or at the mall will do just fine.

– Swimming
Even if you can’t swim, you can use the pool for an excellent workout to help strengthen those joints. Remember, if it’s hot and humid outside, you surely won’t want to exercise. But a quick trip to the swimming pool will not only cool your off, it can set you on the road to a healthier lifestyle.

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Published by Bupa’s Health Information Team, July 2009.

This factsheet is for people who have a knee injury, or who would like information about it.

Knee injuries are common, especially when taking part in sport. Injuries to soft tissues, such as ligaments and tendons, are the most common, though damage to the bones is also possible.

About knee injuries

The most common knee injuries are:

  • a sprain – one or more ligaments is overstretched through twisting or pulling; the ligament may be torn or ruptured
  • a strain – a tendon or muscle is overstretched
  • damage to the cartilage in your knee – the cartilage is a crescent-shaped disc called a meniscus, that acts as a ‘shock absorber’ in your knee
  • overuse – this is most common in people who run

Knee ligament injuries

Ligaments connect one bone to another. The ligaments outside your knee joint are called the medial collateral ligament and the lateral collateral ligament. They provide your knee with stability and limit the amount it can move from side to side.

  • The medial collateral ligament is on the inner side of your knee and is taut when your leg is straight. It’s a strong ligament but can be sprained or completely ruptured (torn) if you twist your straightened leg at the same time as being knocked sideways, for example, when being tackled in rugby.
  • The lateral collateral ligament is like a thin, strong cord that runs on the outer side of your knee connecting the bottom of your thigh bone to the top of your fibula (one of the bones in your lower leg). It’s not usually damaged on its own, but you may need to have it repaired if you have damaged other ligaments.

Medial and lateral collateral ligament injuries may be classed as follows:

  • grade 1 is a sprain with no tearing of the ligament
  • grade 2 is a partial tear of the ligament
  • grade 3 is a complete tear of the ligament

The ligaments inside your knee joint are called the anterior cruciate ligament and the posterior cruciate ligament. Cruciate means in the form of a cross – the anterior cruciate ligament crosses over in front of the posterior cruciate ligament. These ligaments provide stability to your knee, when it is in different positions, particularly in the forward and backward movements of the knee joint.

Other soft tissue injuries

The other soft tissues around your knee can also be injured. Soft tissue means any tissue in your body that isn’t bone.

If you play a sport that involves twisting your upper leg while your foot is planted on the floor, you may tear the cartilage in your knee. The cartilage becomes worn down (degenerates) as you get older, making it easier to tear even after a very minor injury.

Overuse of your knee can also result in tearing a patellar tendon. Your patellar tendon connects your kneecap (patella) to your thigh muscle.

Illustration showing the different parts of the knee

Symptoms of knee injuries

The symptoms for most ligament injuries will be similar, no matter which one has been damaged. These may include:

  • pain
  • swelling
  • instability – you may feel like your knee is giving way or that it’s locking

You may feel a popping or snapping sensation at the time of the injury, or even hear a popping sound. You may also find that you can’t stand properly on the affected leg, or put your full weight on it.

You won’t feel any direct pain if you injure the cartilage in your knee, but you may have some pain or discomfort from the swelling that follows an injury. Pain may develop on either the inside or outside of your knee joint (depending on which knee you have damaged the cartilage) and you may see some swelling.

If you have any of these symptoms, visit your GP or physiotherapist for advice.

Causes of knee injuries

You may injure your knee if:

  • it receives an impact or is moved beyond its usual range of movement, for example if you have a fall or land awkwardly
  • you play a sport that combines running, jumping and stopping with quick changes of direction, such as football
  • you have a condition such as osteoarthritis or gout, or are very overweight
  • your knees hit the dashboard in a car accident – posterior cruciate ligament damage is sometimes called the ‘dashboard injury’ as this is often how it occurs

Diagnosis of knee injuries

Your GP or physiotherapist will ask about your symptoms and examine you. This may include feeling for fluid in the joint by pressing gently over your kneecap, especially if your knee doesn’t look severely swollen. Your GP or physiotherapist will ask you to describe how the injury happened, where your pain is and what type of pain it is.

Your GP or physiotherapist may test for injury to your knee ligaments or soft tissues by bending and flexing your knee, and moving your leg into different positions, while you lie or sit down.

Your GP or physiotherapist may also ask you to perform movements such as stepping, squatting or hopping.

Your GP/physiotherapist may refer you for other tests in a hospital or clinic. These may include an MRI or ultrasound scan or occasionally X-ray. These tests can help to diagnose more complicated or severe injuries.

Treatment of knee injuries

The treatment you will receive will depend on what damage you have done and how bad the damage is.

Self help

You should follow the PRICE procedure to manage any type of soft tissue injury to your knee. PRICE stands for the following.

  • Protection. Protect your injury from further harm.
  • Rest. Rest the injury for the first two to three days, then reintroduce movement so you don’t lose too much muscle strength.
  • Ice. Apply a cold compress such as ice or a bag of frozen peas wrapped in a towel to help reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
  • Compression. Compress the joint by bandaging it to support the injury and help decrease swelling.
  • Elevation. Elevate your knee by resting it above the level of your heart and keep it supported.

There are certain things you should not do in the first three days after your injury to avoid doing further damage to your knee. These can be remembered as HARM.

  • Heat. This includes having a hot bath or using a heat pack.
  • Alcohol. Drinking alcohol can increase bleeding and swelling in the affected area.
  • Running or other forms of exercise.
  • Massaging the injured knee. This can cause more swelling or bleeding.

You may need to use crutches or wear a brace to make sure that you keep weight off the affected knee.

Medicines

You can buy painkillers such as paracetamol or ibuprofen to treat mild and moderate pain. Your GP may prescribe stronger painkillers if your pain is severe. As well as easing your pain, painkillers may help to any reduce inflammation and swelling. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.

Physiotherapy

If your injury is more severe or complex, your GP may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen your knee and stretch your muscles. These exercises will vary depending on the kind of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your knee.

Braces to support your knee are occasionally used during rehabilitation, usually when an injury has been severe.

Surgery

In some situations, you may need to have surgery to repair the injury to your knee. This is likely to be the case if:

  • you have ruptured your lateral collateral ligament
  • you have damaged your anterior cruciate ligament and you do a lot of sport, or have also torn cartilage or your medial collateral ligament – you may need a reconstruction operation, which involves taking a graft of tendon (usually from your kneecap) to replace the damaged ligament
  • more than one ligament or tissue in your knee has been damaged
  • you have torn your patellar tendon
  • your knee remains painful or locks after a meniscus injury

Prevention of knee injuries

There are some precautions you can take to try to reduce the risk of damaging your knee ligaments.

  • Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.
  • Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven.

Video

See our video about knee injuries:

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.

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Back Pain and Tips to Protect it

Bruno-Back

Back pain and back injuries are very common in our society. In fact, approximately 60 to 90 percent of all people will experience at least one back injury in their lives. Half of these people will experience multiple episodes of back problems.

Many will undergo surgical procedures, and roughly 10 percent will see their condition become chronic. The ultimate cost to society in lost productivity and health-care resources totals in the billions of dollars. An even higher price, however, is paid by the people who have lost the ability to participate in the activities they most enjoy.

Back problems can make fishing, golfing, or even just playing with children and grandchildren fraught with pain. In the worst cases, a back problem can interfere with even the ability to get dressed.

Despite all this, people still take their backs for granted, not realizing the dangerous positions they put their backs in every day. Almost everything you do requires the use of your back, and back problems are rarely the result of a single activity or accident. Most injuries occur over a period of years or even decades, as a result of various factors how you sleep or sit, what you eat, or how you deal with the emotional stresses at home and work.

Protecting Your Back in Bed

You’d think it would be difficult to injure your back while sleeping. While unconscious your muscles are relaxed and you’re not lifting or carrying anything. But the truth is, if you have a bed that does not offer your back enough support, it could be the reason why you wake up with back-stiffness. Also, if you are in a position that is bad for your back and you stay in it for eight hours while you sleep, you could be damaging your back without knowing it.

Protecting Your Back at Work

Your office is like your home-away-from-home. Yet, almost not consideration is given to how comfortable you are while sitting at your desk. The wrong type of chair, a keyboard or monitor that is positioned at the wrong angle, or just sitting in one position for too long can all add up to significant back problems.

Protecting Your Back While Exercising

It’s a vicious cycle. If your back hurts, you will probably stop exercising. But if you stop exercising, you are more likely to injure your back. Even if your back is bothering you, it is important to get at least a little exercise. Movement keeps the joints in your back lubricated and loose.

Stretches for Your Back

Keeping your back flexible is a big part of keeping your back injury-free. When your back tightens up, you are more likely to pull or strain a muscle.

Exercises for Your Back

The muscles in your back not only support the spine, but they hold up your entire upper-body. Your back muscles need both strength and conditioning to perform their functions properly.

Protecting Your Back While Lifting

Most people who throw out their back do so by attempting to lift an object incorrectly. Lifting puts more stress on your back than any other activity with the possible exception of carrying. If you can master lifting correctly, you have made a major stride in protecting your back.

Protecting Your Back When Moving Objects

Transporting or carrying an object may not provide the immediate, traumatic stress that comes when trying to lift an object, but it can do just as much damage to your back. There are several techniques you can employ to help you move objects that won’t result in a trip to the emergency room.

Diet and Back Pain

Watching what you can eat can also help protect your back. Most obviously, if you do not carry a lot of weight on your front, it will take a lot of strain off of your back muscles. But in addition to the benefits of maintaining a healthy weight, the right foods can also prevent back injuries. If you are tired and fatigued from lack of nutrition, you are much more likely to pull a muscle or acquire another back injury.

Stress and Back Pain

Stress and tight muscles go together hand-in-hand. If you are carrying a lot tension in your upper back and shoulders, you are ripe for a back injury. In this section, we will help you recognize when you are experiencing high stress levels and need to be careful of your back. We will also offer some tips for dealing with your stress such as visualization.

Protecting Your Back in the Morning

While you’re getting ready in the morning to start your day there are a host of bad habits that could put stress on your back. For instance, when you stand at the sink, brushing your teeth, do you support your back?

Protecting Your Back in the Car

Many of us spend a significant portion of our days in the car. Strangely, little though is given to how comfortable we are in our cars, or what damage our car seats could be doing to our backs.

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Steps to Strengthening Your Rotator Cuff Muscles

The rotator cuff is a group of four muscles, supraspinatus, infraspinatus, subscapularis, and teres minor. They surround the shoulder joint and provide stability while the shoulder joint is moving. These muscles are extremely important in all shoulder movements, especially overhead and rotational. Knowledge about ways to strengthen these muscles can help improve function and prevent injuries.

Step 1

Begin with isometric contractions, where you make a muscle contraction without causing any joint motion. Push into a wall going forward, out to the sides, rotating inward and rotating outward.

Step 2

Use light weights to strengthening through the complete range of motion. Raise arm up in front of you, out to the side as if doing jumping jack, rotating outward and rotating inward. The rotation should be done with elbow bent and in standing/sitting or laying on your side.

Step 3

Increase resistance as you can tolerate, but research shows in oder to improve overall muscle strength you need to use 60-80% of one repetition maximum.

Step 4

Progress to diagonal and more functional motions that required higher level of stability. Do exercises that require you to elevate your shoulder by taking it across your body and then rotating inward or outward.

Step 5

Train the muscles ability to react quickly and improve power production. Performing activities such as throwing and catching require the shoulder muscles to react quickly and forcefully in order to slow the momentum of the throw.

Step 6

Preform shoulder strengthening activities in weight bearing position such as hands and knees, which requires complex shoulder girdle stability.

Step 7

Then progress these childbearing activities to be done on an unstable surface such as a Swiss ball or soft mat to challenge kinesthetic awareness.

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Recovering from lower back pain

Back-Pain

In the large majority of the lower back pain cases, the pain is the result of a strained muscle, poor posture or improper lifting. In most of these situations, there are plenty of options in home remedies that can ease the pain and get you back on your feet, enjoying your daily activities. If your lower back pain is caused by an injury of some sort, it is best to apply ice to the affected area every few hours for the first day or two. You can then replace the ice with a heating pad every few hours until the pain subsides. You can also take an over the counter pain medication like acetaminophen or ibuprofen to relieve the discomfort. Ibuprofen has anti-inflammatory properties, making it a good choice in pain relievers for lower back pain.

Rest can also help to relieve lower back pain, as long as it is only done for a day or two. Most medical experts will agree that the quickest way to heal a back is by getting back in action as quickly as possible. Continue to take over the counter pain medicine as needed to allow you to resume your daily activities. Walking is a good exercise to get your back in shape without putting undue strain on it.

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