5 Exercises to Relieve Knee Pain

5 Exercises to Relieve Knee Pain


Hey, everyone.
I’m Dr. Keller Wortham. And, today, I’m talking about a topic that
is very close to my heart. It’s actually closer to my knees
because, in fact, it is my knees. Today, we are talking about
chondromalacia patella. It’s a long obnoxious fancy medical word
but one that I suffer from time to time and I bet some of you do too,
whether you know it or not. So, I’m going to go into it,
today, talk about what this fancy big long medical word means,
what it means for your knees, and what you can do about it. So, chondromalacia patella is a disease
of the knees that causes knee pain. But, specifically, it is a disease
of the cartilage underneath the kneecap. The medical word
for the kneecap is the “patella.” The “chondro” part
is the collagen or the cartilage. And, the “malacia” is the disease of it. So, that term, again,
chondromalacia patella means disease of the cartilage
under the kneecap. Pretty simple. So, what happens when you get that? Well, chondromalacia patella
is pretty well known to cause pain and kind of a burning sensation
in the knees. It’s usually felt in kind
of the anterior knee, really just right
underneath the kneecap. And, unlike the more
traditional arthritis, this can happen in younger,
more athletic people. It’s often referred to as
“runner’s knee” or “jumper’s knee.” And, if you were playing a sport that
has a lot of repetitive motion, a lot of stress on the kneecap,
you can get this condition and you can start to have
a lot of pain in that area. As I said, chondromalacia patella
tends to be an overuse injury, but it’s also one that
can develop over time. And, there are some things
that can lead to an increased risk of this
particular condition. Not only just having
active lifestyle and playing sports that where there’s a lot of
pressure on the knees, but also some other
alignment things that might be leading to
your kneecap getting irritated. So, just to talk a little bit
about why that happens, let’s talk about the kind of anatomy
and motion of the knee. So, you got a knee,
you’ve got a couple of bones here, you’ve got,
basically, the femur, the upper part of your knee,
your leg, sorry, and you’ve got the tibia, the lower part. And then, you’ve got this kneecap,
which is kind of the fulcrum that allows you to get leverage
across that joint. And, at the bottom of your femur,
you’ve got kind of these smooth mounds and they’ve got cartilage on them. And then, there’s a groove
in the middle of those mounds called the trochlear groove. And then, on the underside of the kneecap,
that kneecap has cartilage as well and it’s supposed
to smoothly glide, basically, in that trochlear
groove to give you a nice, kind of smooth range of motion
of your knee and give you that extra, kind of leverage that you need
to move your leg. So, what can happen in some people is that
they start to get a poor motion or range of motion of the kneecap
in this kind of little valley that exists on the bottom of the femur. And, sometimes that can
happen because congenitally, they were just born with an
alignment that was a little off or in my case,
in case of many members of my family, we have a shallow little valley. So, that kneecap doesn’t get
to sit in it quite as snug and it can kind of rub
out on either side. Some other things that
can do it are muscle imbalances. So, sometimes people will have a very weak
hamstring or a very weak quadriceps. Those are the legs
on the anterior and posterior, sorry, the muscles on the anterior
and posterior portions of your thigh. They can have an imbalance
in their abductors and adductors, which are the muscles that
help you open and close your legs. So, those muscle imbalances
can pull on the kneecap because a lot of them
attach right there on the kneecap. And, they can pull it out
of its proper alignment in that groove. So, those are some of the anatomical
things that can lead to it. And then, of course, as we said, just repetitive motion
from a particular sport can inflame the underside of the kneecap,
that special cartilage that we have that’s supposed to keep things
gliding smoothly. So, if you start to have inflammation
of that cartilage under the kneecap, you’ll notice
because it can get very painful. You might notice
a little bit of a burning sensation. You might feel a grinding sensation. Oftentimes, you might
feel pain just sitting, especially sitting for
long periods of time when you have your legs bent, like in a chair
or in a car, or at the theater. You might notice that
you’re getting pain, that’s because the way
your legs is configured is going to put a little bit
more tension on the kneecap and hold it tighter
against the femur underneath. So, those are some things that
you can begin to notice. You might notice a
decreased range of motion or pain along that
range of motion. So, if you’re having these symptoms,
the best thing to do is get to your doctor so that it can assess you. So, some things they might do
when you go to see a doctor, they might do, obviously, a physical exam,
inspect the knee, see does it look swollen,
does it look red. Usually, with this particular condition,
you don’t get a lot of swelling, you don’t get a lot of redness,
and your range of motion, although, it’s usually a little sore,
is not quite so limited. But some things that we
do see is a grinding or a cracking that you can hear
and sometimes feel. So, if I show you here, if you put your hand on your knee and you
extend it, you might hear the sound, you might actually feel it
vibrating under your hand, your doctor will certainly feel that. They might notice, perhaps,
some relative weakness in parts of your quadriceps muscle,
on the front of your thigh. They might notice
an imbalance in the muscles on the interior and exterior part
of your thigh. And, they can watch the way that
your kneecap tracks in that groove to see if it looks like
it’s pulling off to one side or another. So, if there’s that suspicion, then,
you can move forward and get some imaging to
help confirm a diagnosis. Usually, that involves an x-ray,
predominantly, to rule out other things like
more serious arthritis. Because the real, real way to evaluate cartilage
and inflammation in a joint, is something called an MRI
or Magnetic Resonance Imaging. And, that’s where we can really see
what’s happening within the knee itself and, specifically, what’s happening
on that underside of the kneecap where that cartilage is, the area that’s
concerned with chondromalacia patella. Once you get that imaging,
you can determine how severe your chondromalacia patella is. And, it’s in grades. A grade one just means a little bit
of a softening of that cartilage underneath the kneecap. A grade two means you’ve
got not only softening but you’ve got some
kind of disruption or changes in the texture,
the smoothness that you want. So, you’re seeing some of that
smoothness go away of that cartilage. Grade three is more advanced and that’s where you not
only have that softening and some changes in
roughening of the texture, but you’re also showing some wearing
down or some cartilage loss, some thinning of that protective
cartilage that is on your bone. And then, grade four is
where you are actually seeing a bone underneath
that cartilage. So, you’ve lost so much cartilage that,
now, you’ve got exposed bone. And, bone does not like to be exposed. It has a much rougher surface
than the cartilage. And, when it starts to
rub on other areas or other bones, that’s when you really start to
get into advanced arthritis and pain. That’s a little bit
of the grading of chondromalacia patella. But what I want to show you
are some techniques here that you can do to help correct for those
alignment issues that you might have, help strengthen some
of the muscles that might be weaker, so that you can help prevent that. And then, also, talk
about a couple of things that you can take nutritionally
just to help reduce the inflammation that
occurs in these conditions. Okay.
So, we’re going to move to some exercises. I’ve got five exercises
for you that will help correct chondromalacia patella
and strengthen your legs. And then, after that,
we’ll talk about some exercises you
definitely don’t want to do. Here we go.
Okay. So, five exercises here
that you can do to help prevent or correct
chondromalacia patella. The first one is just called
the straight leg lift. So, you’re going to
just lie on the floor, a mat. You’re going to keep one leg just bent
with your foot flat on the floor and you’re going to extend
the other one out. And, basically, what you’re
doing here very easily is just raising the leg at the hip joint,
about 45 degrees, and keeping it up there. You want to keep it up for about
two or three seconds. And then, you’re going to
lower it back down. You want to feel a nice,
tight quadriceps in this. And then, you’re going to repeat that. Hold it up two or three seconds. Go back down and repeat. And, you’re feeling it engage. You really want to feel your
self-activating the muscle right here. You’re going to
engage the quadriceps and strengthen the anterior
part of your thigh. And, you want to do these
20 times per side. So, I’m going to finish
with that side after 20 and I’m going to go to this side. And, again, raising 45 degrees,
keeping it contracted and up for about two or three seconds,
lowering it down with control. The key is always
you don’t want to go fast. That doesn’t really help you. You’re using a lot more energy
and getting a lot more strength if you just do it
with control and hold it up. I like to keep my foot flexed
and my toes pointed straight up, especially, for this particular ailment. So, there you go. That’s exercise number one,
the straight leg lift. Second exercise, often called the clam exercise, which is
here really to start strengthening the adductors and abductors of your legs. So, you’re going to
lie on your side for this one. You’re going to have
your knees bent and your knees together. And then, you’re basically going to
open and raise up. So, about as vertical up as you can get. Hold it there. And then, slowly go back down. Again, with control. We’re strengthening the outside
of our leg here, the abductors. And, I’m holding it up as high as I can. I’m feeling the whole engagement there. And then, kind of coming back down. And, again, you’re going to do this about
two to three seconds per time and about 15 times per side. So, now after you get done with one side,
holding up there with control and coming back down, you’ll flip over
and do it on the other side. And, this, again–
I’ll get you through in the end. These are things that
you can do multiple times a day but I’ll walk you through
in a summary in the end. So, that’s our second one. Our third exercise
is a little bit like the first one. In this case, though, we’re going to get
something like a roller. Or, if you don’t have a roller at home,
you can get just a towel and roll it up and you can put it
under your knees. You can do it just under one knee
if you don’t have a long one. And, basically,
you’re going to have to lie down. And, in this particular exercise,
you’re just extending at the leg. So, you’ve got a little bit
of a bend in the knee this time and the extension is happening
not at the hip but it’s happening actually here
within the quadriceps to raise the lower part of the leg. So, again, you’re going to do this. In this particular one, you’re going to
hold for a little bit longer. I’d say five to even 10 seconds,
if you can. And then, lower back down
and raise to 5 to 10 seconds again. And, you can do this again
another 10, 20 times per side. And then, you can do the other side. I like to finish with one side
and then do the other one. You could, in theory, go back and forth. But, I think, you’re getting
more continuous use of the muscle and building more strength
if you finish with one side and then work on the other side. So, that is our third exercise. As you saw, these first three exercises
you can do lying on a mat, on the floor. The next two I’m going to show you,
you’ll do stand. Okay.
So, for the fourth exercise, we’re going to do something
called the wall slide. So, you’re going to find a wall, put your feet about six inches
to a foot away from the wall and about hips width apart
and your butt against the wall. You can put your hands
against the wall as well. And, you’re just going to
slide down the wall. You want to just go to about
45 degrees down. You don’t need to get to 90 degrees. If you have issues with your kneecaps,
please don’t go that far. And, certainly, not as low as you would go
on some kind of squat. And then, you’re just going to
hold that 5 to 10 seconds. And then, just push yourself
back up the wall slowly. I can even go a little slower
than I just did. So, I can go down slowly,
just about 45 degrees. I’m going to hold it 5 to 10 seconds. And then,
I’m going to push back up the wall. And, here we go, down again… …and back up the wall. Alright.
So, that is the wall slide. So, do those exercises. I would say you can do a series
of 10 to 15 of those for holding 5 to 10 seconds a piece. That’s exercise number four. Exercise number five. Now, this is getting
a little bit more intense. So, if you do have bad knees
or are a little bit worried about form, then, maybe be
a little more cautious with this one. This is, basically,
called a dumbbell lift. And, you’re going to sit, sorry,
stand with your feet hips distance apart. Again, you’ve got a dumbbell in each hand. You can go with whatever weight
you think is comfortable for you. These are 12 pounds.
You could certainly go lighter. And, if you’ve got strong legs,
you can certainly go heavier. So, you’re going to stand here. And then, you’re going to
just kind of bend over. You’re going to bend over at the waist,
leaning forward with your chest up, making sure that your knees
do not go in front of your toes, keeping your chest and your head up,
and then, coming back up. This is not a squat. You don’t want to be
sitting back on your heels and going into deep squat. This is leading
your chest forward, bending your knees,
again, about 45 degrees, holding it, and then, pushing back up,
tightening your core, tighten the small of your back,
your abdomen and you’re again, going down, keeping your chest
and your head up, making sure that
you’re well planted on your feet. And then, again, the border
of your knees in the front is not going in front of your toes. You want to kind of really be well back. And then, pushing up again. In this exercise, again,
you can do reps of 10 to 15. It depends a little bit
on how much weight you have in your hands. But, this exercise, again, especially,
if you’re keeping your alignment well, your knees safely over your second toe
and not in front of your toes and then you’re holding it,
and then you’re pushing back up slowly, is going to strengthen a lot of those
muscles in your thigh, your upper leg, that are going to basically
help balance out and protect the alignment
of your kneecap. So, there you go. There are five easy exercises
you can do at home. They really take almost
no equipment at all. And, those can help
strengthen the muscles of your legs and your thighs to help keep
your kneecap in alignment. Just a couple of other notes. Some things that you
definitely don’t want to do if you’re working with knee pain
or chondromalacia patella. You don’t want to do deep squats
where you’re going down past 90 degrees. That puts a lot
of pressure on your kneecap. That’s why both in my wall slides
and in those dumbbell lifts, I was really going down
only about 45 degrees. Also, if you’re at the gym,
you want to be very careful about leg extensions. That’s a machine where, basically,
you’ve got a bar here and you’re extending your leg out. Especially, when it’s coming
from a very low angle, that’s a lot of pressure, a lot of fulcrum
tension on your knee that puts a lot of stress on the underside
of the kneecap. So, those are not
very recommended as well. A note on that. Some of those are adjustable
so that you can only do kind of the last portion of it. So, if you’re at a leg extension
and you can just have the bar so you’re just
really doing kind of the last 10 to 15 degrees,
that would be okay. Some other healthy activities
include yoga and Pilates. You might have to modify
some of the poses, so make sure that you’re
working with a teacher that can instruct you there. Swimming is great for the knees. It’s very low impact and doesn’t put
a lot of pressure on the kneecap at all. But you want to avoid things like
running, jumping, some of those big sports like
volleyball, basketball, where you’re really putting
a lot of impact on your knees. You want to make sure that you get
the kneecap well balanced and healed before you start
putting additional stress on it. A couple of other things that
you can add to your regimen, just to help with reducing inflammation
and help improving the joint health are some nutritional products. I love a good natural
anti-inflammatory like curcumin. Smarter Nutrition
has a great curcumin product. It’s the natural
active ingredient in turmeric. So, find yourself some of that. I much prefer it
to things like Advil, ibuprofen. That can have some serious side effects. And, also, it can block some of
the healthy aspects of inflammation. So, go for a natural
anti-inflammatory like curcumin. And, there are also
good joint health products out there. Smarter Joint Food is a
Smarter Nutrition product that has a lot of components
that help increase the health of your cartilage,
that also can help kind of increase the mobility of your joint. So, look for that. You get things that can really improve the function of your cartilage,
improve the growth of cartilage, and things that will also
help reduce inflammation. So, there you go. I hope this was helpful. I certainly have to
do these exercises myself, as I said. Not only a doctor, also, a patient,
something like that. So, if you’re suffering from knee pain and you think it might be
chondromalacia patella, check out these five exercises,
try them at home. And, I bet you’ll be well on your way to
getting back up on your feet in no time.