Fix Your Own Knee Pain

Knee Pain - Why?
Most people know that bending wrong all the time will give you a sore back. You know if you stand with your back in bad posture it will eventually hurt. The same is true for knees. Legs have posture and position during movement. After years of bad habits they begin to ache. A knee injury that may begin suddenly is often just a "last straw" after pressuring and straining over months or years.

Knee Pain Fix #1 - How To Keep Cartilage Healthy
Probably the most common habit that pressures and eventually injures knees is letting body weight fall inward on your knees and the arches of your feet. This bends your leg slightly inward at the knee (sometimes more than slightly inward). Letting your body weight sway inward makes several problems.

You probably already know that if you plant your foot and turn your body in a different direction, it will twist your knee. This twisting often injures the cushiony cartilage in your knee, called the meniscus. You can strain or tear your meniscus suddenly from a big twist, or gradually by letting your weight fall inward, which makes the leg bones twist in a similar way, day after day, year after year.

Letting ankles and knees sway inward is a bad habit that damages knees.
It is not a "condition," it is something you can control using your own muscles
to hold your ankles and knees straight.

Letting your weight fall inward on your knee joint, instead of holding your weight up on your leg muscles contributes to other cartilage injury than just meniscus. It strains and wears the cartilage on the side of the knee, and stresses the anterior cruciate ligament (ACL). Stretched ligaments don't hold your bones in line, allowing them to rub and grind at unhealthy angles. Letting knees sway inward also interferes with normal thigh muscle use and how your kneecap moves when you walk. When you let your weight slump on your knee joints instead of using your thigh muscles, the kneecap can start to move slightly sideways instead of up and down each time you move your knee to walk. This rubs the cartilage on the inside of your kneecap. The friction can eventually break down and wear away the cartilage. This is called degenerative change.

Many people are told to accept the degeneration as aging, along with all the pain and disability that accompany it. They may be told they are flat-footed, or have a problem called pronation (which roughly means turning inward) or "knock-knees." But often, the cause is avoidable. Letting the foot and knee roll inward is easily corrected by using your leg muscles to hold your body weight, instead of letting body weight sag onto the joints of your ankle and knee. It is the same as not letting your shoulders round forward.

Just like tires that are crooked, knees that tilt inward will wear out too soon.
The cure for tire wear is not to stop driving (give up activity) or change the tire (wear orthotics or have surgery). It is simple to check why the tire is crooked and fix that.

Alignment work is the same for bad knee and foot posture. Learn how to hold your leg in healthy straight position by using your muscles, not just letting your weight sway and slump onto your knee joints.

Look in a mirror. See if your kneecaps face inward or your arches flatten downward. See that it is your body weight that flattens out the arch. Now straighten your stance by using your leg muscles to lift your weight off your arch, gently, without rolling too far to the outside of the soles. Like any new habit it may feel strange at first. Many people are given orthotics or told to never walk barefoot. This is unnecessary. Practice correcting your leg position until you can walk with healthy, straight leg positioning that keeps weight on your leg muscles, not on the cartilage and joints of your knee.

Many people are told that turning ankles in and letting arches sag cannot be fixed or that if you try to hold straight you will cause harm. Think of a beginning skater. They let their ankles sag inward until they learn to hold their feet and ankles straight in healthy position. It is just practice in holding position, not something that cannot be changed. Another myth is that you need"supportive" shoes or boots to hold your ankles. You can hold your own position using your own muscles. By relying on a shoe, you can atrophy your muscles, making you less able to stabilize and balance. All over the so-called third world, mountain guides walk the uneven paths in flip-flops.

Knee Pain Fix #2 – Check for Duck Feet
Walking with feet turned out contributes to knee pain, to tightness of the foot and leg, to hip and heel pain, and predisposes to bunion because you push off each step on the side of the big toe, pushing the toe inward. "Duck-foot" can result from letting weight fall inward, from tight Achilles tendon, tight side of the leg (ilio-tibial band or IT band), tight bottom of the foot (plantar fascia), even tight big toe (hallux rigidus) that doesn't bend and allow normal foot motion.

Turning out when you walk pressures the knees,
just like tires that are crooked, will wear out too soon.
To fix tire wear, you don't stop driving or change the tires, and you don’t just keep driving that way.
You check why they are crooked and fix that. Alignment work is the same for bad knee and foot posture –
learn how to hold them straight by using your muscles, not just letting them sway and slump.

Find the source of your turned out position, sometimes nothing more than bad habit. Use your muscles to walk straight. This keeps body weight on your muscles and off the joints of the hip, ankles, foot, and knee. There are some who say that straightening bad ankle and knee posture will just cause pain in the hip. If you only turn feet in without correcting the source of the problem, the rest of the leg turns in with it, making more stress. There is no need for that. Keep your entire leg position healthy and there will be less pain, not more.

Knee Pain Fix #3 – How To Keep Knees From Hurting When Bending, Exercising, and On the Stairs
Another common problem is bad bending. Many people don't "lift with the legs" to save their back because it hurts their knees. The good news is that bending knees properly will not hurt, but help heal and strengthen. Here is how:

Don't let your heels come up when squatting. Keep your heels down with your body weight back toward your heels. Most people bend by letting the knees come forward. Body weight is transmitted through the knee. Instead, whenever you bend or lift, even to pick up a towel, keep heels down and knees back, over the ankle. Rock weight to the heel, off the toes. Feel the difference in muscle use to the thigh. Pressure will disappear from the knee. Keep knees far enough back when you bend that you can see your toes. Don't let your back arch; keep hip slightly tucked. Use a mirror to practice healthy knee position. Or put the front of your knees against a bench or other object to train yourself to keep them from slouching forward.

To strengthen your legs and knees, do this squatting exercise, down and up, with weight back toward the heels. Go up and down gently at least 10 times. Done properly, it should feel like exercise for the thighs and hips, not pain in the knees. If you do squats in a gym, don't prop up your heels or stand on your toes. Stand flat on your whole foot, rocking weight back more to the heel.

Another good way to bend is to use a lunge. When you bend by putting one leg in front and one in back, use healthy knee position. Keep the front knee over the ankle, with your body weight toward your heel, not pressing forward on the front of your foot. That throws your body weight through your knee joint, instead of keeping it on your leg muscles.

Bend properly using the lunge for all the many dozens of times you bend every day.
Keep front knee over ankle (left) not forward (right).

To strengthen your legs and knees, do this lunge exercise, down and up, with your body weight evenly between the front and back leg. Don't lean forward or back. Bend both knees to dip straight down, and come up again, gently, at least 10 times.Use good bending, shown in the right hand drawing above. Done properly, it should feel like exercise for the thighs and hips, not pain in the knees.

Avoid squatting on the balls of your feet with your heels up. That position throws your weight forward onto your knee joint and squashes your knee at an angle under your body weight. The bad knees of professional baseball catchers come from chronic squatting on their toes. Instead, to sit in a full squat, whether to rest, to do chores, or to go to the bathroom in the woods (or wherever else there is no "sit-down" toilet as in much of the world) keep your heels on the floor. This is a customary sitting posture in much of the world. This reduces pressure on the knees and is a great stretch for your Achilles tendon. Don't let your feet turn out or let your body weight press inward on your knees or arches. Keep your knees over your feet, not drooping inward.

When going up stairs, keep your weight back toward the heel of the foot that is stepping up. Most people don't step this way because their leg muscles are too weak. They throw their weight forward, stepping up onto the toe. This transmits body weight onto the knee joint in a vicious cycle of weakness and pain. Keep weight back and knee pain will disappear.

Retrain your bending habits to help your back and knees at the same time, and give you free leg exercise too. You can become more mobile and strong while reducing your knee pain, by using your muscles instead of throwing your body weight on your knee joint.

Knee Pain Fix #4 – Your Own Body's Shock Absorption
Many people walk, run, exercise, jump, and step heavily, letting each foot flop down without muscle use to decelerate. Shock transmits to the joints of your ankle, knee, hip, back and neck, and can strain your calf muscle and Achilles tendon.

Instead, when going down steps or a hill, for example, use muscles to step down lightly. Use the leg still on the upper step to decelerate. Instead of just falling onto the lower step, keep weight on the upper leg to lower yourself lightly, then add shock absorption from the leg that steps down. Bend the knee and use thigh muscles as you touch the ground. You will get free leg exercise, burn more calories, and reduce shock and wear on the knee.

Use the same principles for normal walking and running. Use it for exercise classes using a step bench or balance platform. It's horrifying to see people stomping, flopping, slamming, and straining knees and Achilles tendons, and calling that an exercise class.

Knee Pain Fix #5 – Don't "Lock-out" the Joint with Hyperextension
Some people stand and move while "locking" the knee out straight, even pressing it backward. This posture is sometimes called "splay-legs," or "splayed knee" and makes the leg look more crescent-shaped than straight. It puts body weight onto the joint while pressing the joint slightly out of place, putting damaging forces on the cartilage. Many people push their knees into hyperextension when standing and walking. Others "bang" the joint into straight position in exercise and aerobic boxing classes. This locked out position is sometimes taught in yoga and dance classes. Pain is commonly felt after long sitting or upon waking. Instead, stand and move without locking the joint straight.

"Locking" the knee out straight, or pushing it back in hyperextension damages the joint.
Stand, walk, and move without banging the joint straight.

Knee Pain Fix #6 - Good Range of Motion Without Twisting
Your knee joint is shaped to bend and straighten. Unlike your shoulder or hip it is not supposed to "swivel" or twist in the joint very much. Check and see if you are twisting your knee without knowing it. One common way to hurt your knee is to plant your foot, then turn your body in a different direction without also moving the foot. People often do this going down stairs where the stairs turn. Or when changing direction in sports and running. Remember to pivot lightly on your feet, not twist the knee.

Another way people twist their knee is deliberately - thinking they are stretching it. They are stretching, but what stretches when you twist your knee sideways is the ligaments that hold the knee together. Overstretched ligaments can make the joint unstable, allowing the bones to rub and grind. That hurts and also slowly injures the joint.

Your knee joint is not shaped to bend and twist to the side at the same time.
That can overstretch the joint and make it too loose, so that it rubs and wears out sooner than it should.

Knee Pain Fix #7 - Ilio-tibial Band or "I.T. Band"
Your I.T. band is a fibrous band that attaches from the side of your hip (your ilium, which is the top of your hip bone) to the side of your knee (tibia bone). That's why it's called "ilio-tibial." Tight I.T. bands can yank on the side of your knee, leading to knee pain, and even change the way you walk. When a tight band pulls and rotates your leg to the outside, it can add to walking "duck-footed" with your feet and legs turned out instead of facing straight forward, which leads to other pain and problems.

A commonly taught stretch for your I.T. band is done standing sideways at arms-length from a wall, crossing the opposite leg in front of the leg nearest the wall and leaning toward the wall. A more effective stretch is done lying down: Lie face up on a floor or bed, or wherever you're comfortable and flat, with legs wide. Cross one ankle on top of the other with both legs far to one side. Keep both legs straight and make sure you lie flat with both hips touching the floor. Hold for a comfortable stretch - at least for a few breaths - then switch sides.

The most common IT band stretch is the standing stretch (left) but a more effective stretch is done lying down (right).
A properly done IT stretch will feel good and help your knee, hip, and other things

Role of Body Weight in Knee Pain
Some people are told they have knee pain because they are overweight. When I check them, I often find they stand, bend, and walk with weight poorly distributed on the joint. When we change that, the pain diminishes. I have seen patients, some greatly overweight, who say that retraining gait and stance stopped their knee pain, so that they can go out and walk and exercise for the first time. People who are not overweight, but walk with poor mechanics, poor positioning, or poor shock absorption can put more weight on their knee joint than a heavier person who walks in a healthy manner.

Strengthening Exercises and Knee Pain
Like weight loss alone, strengthening alone doesn't fix knee pain from poor mechanics. Plenty of muscular people have pain. They may do their knee exercises, but strengthening is not what changes their leg posture or bad walking and moving habits. Many people are not strong enough to bend properly, so they bend with weight on their joints, instead of their muscles. The best exercise is to bend properly for all the many dozens of times you bend for things every day. Use the squat and lunge described in #3 above to strengthen while you retrain healthy ways to move for all your regular life activities. It will strengthen and retrain your knees, save your back, and give you free exercise all day.

Putting It All Together
For healthy knees during all movement activities:
- Keep knees and feet facing straight forward, not tilted in or out.
- Keep body weight on the sole, not the arches of your foot.
- When stepping up stairs or an incline, don't step toe first. Put your whole foot down press through the heel so that your muscles lift you, not your knee joint.
- When stepping down, step toe first, bend your knee upon contact for shock absorption, and step down lightly with your weight held up on the leg on the upper step. Don't clomp down with impact.
- Walk, move, exercise and sit down with shock absorption. It's called "a spring in your step." It looks good, and is healthy.
- Walk and run by rolling heel to toe. Although you will step lightly, don't do it by trying to walk or run on your toes.
- Watch how other people move. It's easy to find people who stomp down without shock absorption, knees swaying inward, unsupported by muscles.They may exercise this way because it's easier than using muscular effort, but it is not healthy.
- Don't "do knee exercises" 10 times then go back to harmful use and positioning habits that cause the pain.

Allowing body weight to sag into joints instead of using supporting muscles loses the benefit of the exercise, and slowly wears joints. Keep knees in healthy positioning during walking, standing, lifting, and moving for better healthier, exercise. You'll get exercise and free knee rehab without going to the gym.

How Long Does It Take To Stop Knee Pain?
If your pain comes from mal-positioning your knees, hips, ankles, and legs, you should feel the pain stop or lessen when you reposition to healthier ways. If you're not feeling better right away, check what you are doing compared to what is presented above. Are you over compensating? Are you pushing too hard the other way? Are you walking heavily instead of lightly? Are you tightening or clenching any muscles? Are you doing bad exercises that lean on or twist the knees? Check this article on Bad Exercises, this one on bad stretches, and The Ab Revolution, to strengthen so that you do not have to exercise on your knees.

Make sure there is not something else contributing to your pain. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.

He had no legs that practised not his gait;
– LADY PERCY. In William Shakespeare's KING HENRY IV, PART II


Bad bending, with knees forward, puts weight on the knees	Good bending with knees back and heels down puts weight on your muscles, and off your knees. It's good exercise, and healthy for your back and knees.