How To Fix Your Own Knee Pain


© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine


Dr. Bookspan's methods to fix injuries and improve training are used by military and top rehab centers around the world.
Harvard Medical School clinicians have named her, "The St. Jude of the Joints."


Don't Worry - Knee pain is easy to fix. This summary will show you how to quickly stop common sources of knee pain. Then you no longer will get the pain and your knees can heal. Not all exercise is medicine. Not all medicine is healthy. We change that.

No health insurance needed. Much of costs, time, and worry currently spent in medical treatments are unnecessary, and often unhealthful. It's not health care if it's not healthy. I have developed information through years of research in the lab, and put it here on my web site for the benefit of the world. Get better and the world will be better.

 

A Short History of Developing These Methods (skip this paragraph if you want to go straight to fix knee pain)
I am a trained research scientist. I started lab research studies in the 1970s to find why standard knee and other pain exercises and treatments didn't work. I saw that injury rehab info was not being applied to how people move and live. I applied it. People got better. When I was working on studies of the human body during immersion for combat swimmers, the experimental subjects, the physicians, and others in the lab kept saying they had all these aches and pains. The exercises their PTs and docs gave them did not work or made them worse. I fixed them up. Their doctors started calling me (calling the lab actually, as I don't have a phone) asking how I fixed them so well. They (and their physicians) started coming to study with me directly. In the 1980s, class participants asked me to write everything down for them. I was surprised. I thought they should have taken notes. I typed information sheets for them. More doctors came to me after taking my classes, saying they knew their standard Patient Handouts were ineffective exercises. They asked me to make handouts for their patients. I was surprised. Again. I thought they could do that themselves. I typed Patient Handout sheets for them. I kept collecting data like a good scientist, doing studies to test and retest methods, and develop better ones. In the 1990s I typed everything in several training manuals that became books. One is Health & Fitness In Plain English - How To Be Happy, Healthy and Fit for the Rest of your Life. After two different publishers, the new THIRD edition of How To Be Happy, Healthy and Fit... eliminates wrong things previous publishers added over my objections. Another book is Fix Your Own Pain Without Drugs or Surgery, with patient stories in every chapter showing why patients get better, or don't, and why. Several more books of my life's work tell how to make life pain free, stronger, and more fun. Each book is different.  Fitness and rehab myths and fads come and go, but these methods remain effective over time. Get the books on the BOOKS page, and at the bottom of this article. More about me in Research. Now go get better.

 

To keep this quick and easy for you, much is shortened. The books tell more.
Use this summary to get better now, and get the books to fill in the rest.

Knee Pain - Why?
Most people know that bending and standing badly will cause a sore back. The same is true for knees. Legs have posture and position during movement. After years of bad habits they can begin to ache. Knee pain that comes on suddenly is often the result of gradually pressuring and straining over months or years.

Instead of doing a bunch of artificial rehab exercises then going back to damaging daily life movement, try living and moving in healthy ways. Here is how:


Knee Pain Fix #1 - How To Keep Cartilage Healthy
A common habit that pressures and eventually injures knees is letting your body weight sag inward on your knees and the arches of your feet. The result is an increased inward angle of your leg at the knee.  Knock-kneed position is often a posture that you can control, using leg muscles to hold knees in position.

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 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. It is simple standing straight.


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. Notice if it from letting your body weight sag at the knee and/or flatten the arch of your foot. Straighten your stance by using 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. It should not hurt to stand straight. Don't force. Many people are given orthotics or told to never walk barefoot. This is usually unnecessary. Your own muscles can place you as correctly (or more) than using an artificial shim or orthotic. Practice correcting your own leg position until you can walk with healthy, straight, comfortable 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 can contribute to knee pain, 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 wears on the knees, just like tires that are crooked.
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
Many people don't "lift with the legs" to prevent back pain, because it hurts their knees. Bending knees properly should not hurt, but help heal and strengthen.

Here is how to bend using a half-squat:
- Keep your heels down on the floor. Don't let your heels come up when squatting.
- Keep knees far enough back when you bend that you can see your toes.

Check if you bend by letting your knees come forward. Body weight is shifted to the knee joint. Instead, whenever you bend or lift, even to pick up a towel, keep heels down and knees back, over the ankle. Shift your weight to the heel, off the toes. Feel the difference in thigh and hip muscle use. Done right, pressure should disappear from the knee. 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.

Healthy squatting strengthens legs, hips, and knees. Bad squatting can hurt. It is no mystery. Instead of thinking of squats as an exercise to "do" 10 times, use it for real life. Real built in exercise, back pain prevention, and knee strengthening.

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.

Avoid a lot of squatting on the balls of your feet (heels up). Toe-squatting shifts your weight forward onto your knee joint. Instead, to sit or crouch in a full squat 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 down on the floor. Heel down squatting 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. Keep knees and feet facing the same direction so the knee does not twist. Keep your knees over your feet, not drooping inward.

Go up and down gently, a small amount at first. 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 healthy way to bend is the lunge, with one leg in front and one in back. With healthy knee position you can bend without knee pain and have a daily habit that strengthens knees rather than hurt them. Keep the front knee over the ankle, with your body weight toward your heel, not sliding forward to the front of your foot. Shifting forward transfers 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 to reach things every day.
Keep front knee back toward the ankle (left) not forward (right).

Using the lunge strengthens legs, hip, and knees. Keep your body weight evenly between the front and back leg. Bend both knees to dip straight down, and up again, gently.Use good bending, shown in the left hand drawing above. Done properly, it should feel like exercise for the thighs and hips, not pain in the knees. Instead of thinking of lunges as an exercise to "do" 10 times, just use it for real life. Real built in exercise, back pain prevention, and knee strengthening. Imagine how many times you bend for everything during a real day. Imagine doing that many bends in damaging ways. No wonder things hurt. Now bend right and get real exercise and pain prevention. No gyms, therapy, or pills needed.

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
Do you 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 no mystery when people hurt "even though they are doing their exercises" when they are slouching, 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. It is unnecessary and injurious over the long run. 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 much. Check and see if you are twisting your knee without knowing it. One common way to twist 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. Some people even do this walking and running, by stepping down, then letting the heel swing to the side while the foot stays planted on the ground.

Twisting can wear away at the cushiony cartilage in your knee, called the meniscus. You can strain or tear your meniscus (and cruciate ligaments) suddenly from a big twist, or gradually by letting your weight fall inward, or by moving with your feet and knees pointing in different directions. The leg bones twist, step after step, day after day, year after year.



Another way people injure their knee with twisting 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.



Letting your knees, hip, and ankle joints to sag under your weight instead of using supporting muscles to stand in healthy position loses the benefit of any rehab 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.

 

Putting It All Together
For healthy knees during all movement activities:

  • Keep knees and feet facing straight forward when walking and running, not tilted in or out.
  • Keep body weight on the whole sole, not pressing downward and inward flattening your arches.
  • When stepping up stairs or an incline, put your whole foot down, not just toes. Press through the heel so that your thigh and hip muscles lift you, not just 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 hard impact.
  • Notice if you let your weight crash down with each step. Change to walk, run, jump, and land lightly with shock absorption, instead of stomping. It's better for balance too.
  • Maintain normal heel to toe roll. Stepping lightly doesn't mean walking on your toes.
  • Watch other people’s gait and movement habits. It helps remind you to avoid unhealthy habits - knees swaying inward unsupported by muscles, feet and knees twisting in opposite directions with each step, stomping without shock absorption. People may move that way because it's easier than using muscular effort, but it is not healthy.
  • Notice injurious knee positioning for "fitness and health" moves in fitness magazines
  • Notice your own habits.
  • Use principles learned to identify and eliminate the cause of your own pain.
  • Don't "do knee exercises" 10 times then go back to harmful use and positioning habits that cause the pain.
  • Do send me photos and success stories showing the principles in action. Prizes for best ones.
  • Please do not e-mail saying you are "doing the exercises 10 times" and want me to tell you how to fix your knee pain when you bend, and from bad walking and running. Here is the answer now: If you stop hurting your knees with bad bending and moving and standing and bad exercises, then a major source of pain will stop. It is not the exercises that fix things, it's you.

Start feeling better right now and get your life back. Don't wait.

 

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

 

What To Do Next

Now that your knee is better, think of the hundreds, maybe thousands, of dollars you saved on medicines, treatments, surgery, and depression
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