If you have had knee problems or are in the process of contemplating knee surgery, the following question mostly likely has crossed your mind: How do I strengthen my knees?

Throughout the years, I’ve encountered this same question probably over a hundred times by everyone from your neighborhood doctor, to those you might expect such as seniors, or to those you may not expect, like those under 30. You will need to identify what your knee problem is, what muscles are linked to protecting your knee joint (and learn how your knee joint works,) and you will also need to know what exercises and stretches to perform to aid in the recovery of an ailing knee or what exercises to do to be proactive in knee protection.

Before I get into the meat of the exercises and stretches that you can do to aid in the protection of your knee(s), I will briefly discuss the knee joint and how it works.

• First, the knee is a joint. Therefore, the actual structure of the knee does not contain musculature that can be “strengthened” directly as most people perceive. The knee itself, cannot actually be strengthened. It is the surrounding musculature (and ligaments & tendons) that actually give the knee its protection and that will help prevent knee injuries from occurring in the first place.

There are ligaments (attachments that bind bone to bone or bone to cartilage) and tendons (attachments that bind muscle to bone) that have elasticity to allow the knee to function properly. If these are damaged in any way; strained, torn, ripped, or broken, then the knee will fail to work properly and knee surgery is eminent. A surgery will be needed to get the joint to work again, and relieve the injured person from ongoing pain. Rehabilitation can be ongoing and be as long as 12 months or more.

Knee ailments are common and the degree of severity varies greatly from a basic knee sprain, to that of a complete knee replacement. Many people are familiar with hearing that another NFL player blew out his Anterior Cruciate Ligament (ACL), and some have heard the just as common Posterior Cruciate Ligament (PCL) horror stories. The ACL is one of the primary knee stabilizing ligaments in the center of the knee. It prevents hyperextension and excessive rotation of the knee. The PCL works together with the ACL to provide stability of the knee. These two ligaments cross each other which allow the knee to extend and flex without lateral movement.

These are the primary muscles that are involved in “knee protection”:

• Quadriceps (4) 
• 1) Rectus femoris
• 2) Vastus lateralis
• 3) Vastus medialis
• 4) Vastus intermedius

&

• Calves (3) 
• 1) Gastrocnemius (Visible calf muscle)
• 2) Soleus (Deep muscle, not visible to the eye)
• 3) Tibialis anterior (front outside portion of calf)

& both

• Sartorius muscle (assists in knee flexion, a synergist) 
• Tensor fasciae latae (TFL) (aids in knee extension, synergist) 

Knowing what muscles surround your knee and knowing that they are either the primary muscle movers, or that they are the helpers (synergists) will allow you to approach your “knee strengthening” in an informed and decided way. Otherwise, you will just be guessing, just like 90+ percent of the gym members that take on their own guess work for building their workout program to try to get the results they desire. Guessing leads to basic strain or injury, or additional injury most times and, at worst, leads to an exasperated injury.

The best advice is to see a sports medicine doctor that specializes in an injury like the one you have. These professionals will give you solid direction and recommend exercises to assist you in your goal of strengthening your knee(s). These professionals will also provide your trainer or physical therapist with things not to do (known as contraindications.) But, I know how many people absolutely love to seek advice of everyone but the sports medicine doctor. They will go to their family, friends, someone they know that had a knee injury once, their trainer, and the Internet to see what they can do for themselves before they will go see a sports medicine doctor or their practitioner.

• A note about seeing a doctor: If you have seen a doctor about your injury, congratulations. If not, I recommend you do. The information contained here will most likely meet and exceed what your doctor will tell you, mostly because they have limited time with you, and also because most doctors are not anatomy professors or exercise kinesiology experts.

The great thing about having specialties in medicine is that it allows a doctor to further study, learn, and practice medicine in an area that he/she is passionate about. That is why going to a specialist can be the best thing for you. The specialist cares specifically about what he is practicing and is allowed to focus mostly on that subject. Therefore, many times, your general practitioner will write you a prescription to see a specialist as his training is inferior, or just not as vast, on a particular subject as that of the specialist. Keep in mind, however, that if you see a surgeon, his ideas will most likely be about surgery; whereas if you see a Naturopathic Doctor (N.D.) they will most likely be focused on “natural” healing remedies and seek solutions that do not involve surgery. It is again up to you, the consumer, to make a judgment on who you see and who’s outlook/prescription that you like best for your knee issue(s).

• Note: Some potential homework of interest to you will be to compare a medical schools syllabus against that of a Chiropractic College syllabus. You will find a great disparity in focus on anatomy and physiology between that of a medical doctor (M.D.) and that of a doctor of chiropractic (D.C.).

Your knees are a vital part of your locomotion. Without either one, your movement will be severely limited, obviously. So begin today and take part in knee and body preventative maintenance if you don’t already have a knee injury or other ailment. Your knees, and all the fine parts that put you together, will be appreciative for your focused and hard work put in by your thoughtful time allocation and pure sweat.

Ok, so now you have a base knowledge of how the knee works and of who to see for solutions. Now you are interested in the knee strengthening exercises and stretches.

• Note: A good website to get an overview of the following exercises is www.bodybuilding.com. Regardless of whether you are into bodybuilding or not, this site will add to your understanding of what the exercises are that I am reviewing for you. Also know that I do not endorse this site or receive royalties from them. I have only reviewed the portions of their site for the items that I have included as a link for you.

Additionally, the amount of repetitions that you do will depend on your individual body needs, strength, and/or limitations. You may do just one set of 10-15 repetitions per exercise if you are in the beginning phase, which is okay. This is where paying a professional to give you an exercise plan comes in to play. You can see a certified personal trainer, an exercise physiologist, or a physical therapist or sports therapist most times for this exercise plan. You will want to have a letter from your doctor stating the contraindications to exercise, as well, if you are able to see a doctor. This is a crucial element for an exercise professional in the development of a safe and progressive exercise plan for you. Do not lie to your exercise professional about your limitations or pain. Be accurate and concise. Most people want to do what they think they should do and fail to plan on their own and they either get discouraged or get injured further. You only have two knees, do your best to take care of them and do not leave the process to chance or to guess work. See my article How to Choose a Personal Trainer for guidance on selecting an exercise expert. The first exercise typically recommended for helping protect your knee is the Leg Extension.

You most likely want to steer away from exercises such as the lunge, squat, hack-squat, or anything involving lateral or bi-lateral movement with an exercise ball that places dynamic tension on your knee joint.

• Quadriceps

The Leg Extension primarily works your Quadriceps. These are the large anterior muscles (on the front of your leg.) Sometimes an individual will have pain in the raising phase of the Leg Extension, but not in the negative, or lowering phase, of the movement. If this is the case, you will need a partner to assist with the raising phase of the movement (allowing you to extend your leg fully without any weight pressure at all) and then control the lowering phase from top to bottom, as gravity pulls down. This is important as whenever you do weight bearing exercises, you do not want the presence of true pain (true pain is different than muscle exertion in the sense that the pain is not coming from the muscle exertion or fatigue but elsewhere.) You can also do this exercise from a chair simply by sitting with good posture and extending one leg out at a time to full extension. This will work the muscles and sometimes this is the best place to start for safe progression. ALWAYS error on the side of caution.

• Hamstrings

Next, to keep your muscles balanced for your knee joint, is the seated Leg Curl. This exercise will work your Hamstrings (the large muscles on the upper back of your leg.) I emphasize “seated” as there are many weight machines that are built for the hamstrings that have you lay down on your stomach with your head below your waist which causes blood to rush to your head. There are also other machines that have you standing up, but the ability to balance and use your core strength (many times) will prevent quality/perfect movement for the hamstring being worked. For these reasons, I would recommend only using the seated hamstring curl machine until your body is in a phase of maintenance and can handle additional body/muscle stressors. Think safety and muscle isolation.

• Calves

To work the calf muscles, you will be standing up or sitting down. You don’t actually need to be on a step or calf machine. In fact, if you are just beginning exercise, I would recommend that you simply stand on the floor and use a wall or other immovable surface to help keep your balance. To strengthen your calves, do calf raises. Try to keep your heel in line with your big toe, as this will work the whole muscle and keep your body from depending on just its muscle strengths, rather than including its weaknesses.

The next calf exercise is in a seated position. The previous exercise works the calf muscles by standing. You must be in a seated position with your legs at a comfortable 90 degree angle. This can also be performed without a weight machine, though there are machines built also for just this exercise. The simple act of keeping your knees about a fist distance apart, while seated, and raising your heels up and down (again keep your heel in line with your big toe) will activate your calves and give them additional strengthening. In effect, your calves are working most when you are standing and/or in motion. Your calves are primarily responsible for your locomotion.

• Stretching

You will want to stretch the muscles you work with. If you are in the novice or beginning stages of exercise, you can do basic stretching everyday, and be okay; provided you are using safe and effective stretching techniques. However, if you are an athlete or professional athlete, it is arguably best to allow your muscles to rest for a day, prior to stretching that same muscle group after weight bearing activity.

• For example, if you work your quadriceps out today, do not stretch them today (they have already undergone microscopic muscle tearing via the exercising you’ve done) and allow them to recover for at least 24 hours before stretching them. The reasoning falls in line with common sense. If you have broken your muscle down, and then you stretch it, you can unintentionally tear the muscle or otherwise cause an unneeded strain. So, after the 24 hour basic recovery for the muscle group you worked, you can stretch them.
• The latest recommendations are ambiguous at best when it comes to stretching, but most professionals, myself included, recommend that you insert a minimum warm-up prior to stretching. A light ten to fifteen minute warm-up should be sufficient to get the blood moving in your body and allow your muscles to be warm for your stretching. Also, if you are a senior, elasticity tends to disintegrate with age in the ligaments and tendons, so do not push the limits of your stretches; or you may find yourself getting injured. I tell my clients that are 50 and over to stretch to approximately 80-85% of their maximum potential. Most guidelines will recommend seniors over 60 to stretch to no more than 90% of their maximum potential. As I say, error on the side of caution, no injury is worth the risk.

I do two types of professional stretching with my clients. One is Proprioceptive Neuromuscular Facilitation, better known as PNF, stretching, and the other is Active Isolated Stretching (AIS) which is the Mattes method. They are both fairly similar in technique. There are subtleties that can be found between them, and the key is to find which one you like best. There are two basic types of stretches, individual and partner assisted. Of these stretches, you can either do them actively or passively. I stretch my clients passively, which, in short, means that my client actively contracts their muscles, relaxes them, and then does their own stretch. I am in place to guide the muscles and passively assist them to get a better stretch than they could get on their own. Believe me, if you’ve had these stretches done to you you know, it is like having ice cream and cake; they are fantastic. You can learn and do these stretches on your own, to some degree. I highly recommend that you become versed on these techniques as they will last you a lifetime! And, if you have a companion or best friend, you can do them together once you have learned the proper methods. You will find that there is nothing better!

You will want to stretch your quadriceps, your hamstrings, your TFL (remember from above: Tensor fasciae latae (TFL) (aids in knee extension, synergist), and your calves, for the exercises that are listed above. You can also include Myofascia Release (with a foam roller or human touch,) which will be discussed momentarily.)

I’m going to direct you to Amazon to find two of the better books and manuals that I have found available over the last many years, for reference:

The first is:

• Facilitated Stretching by Robert E. McAtee (PNF),

and the 2nd is:

• Active Isolated Stretching (AIS) The Mattes Method.

Again, I don’t receive anything from Amazon as royalties, I’ve just found that they typically have the best price on these Texts. You can go anywhere that you want to find them. Usually you can find these books both for around $15-30 each.

I also highly recommend that you learn about Myofascial Release. This is a method of relieving congestion within your muscles and can relieve pain in the muscle region itself and be a major source of relief. The technique is by direct pressure from an outside source, a professional trainer or sports therapist, for example. I’m all about having options too, however, so you can also do many of the release techniques by yourself. Simply buy a foam roller at your local sports store or online. If you are balance challenged, you may want to consult a professional before venturing into the use of the foam roller by yourself. There are instructions that typically come with the foam roller, or if not, a simple Internet search can give you a variety of methods to use it. This tool comes in a variety of lengths usually from 1’ in length to 3’ in length, most commonly. There are also different types, but the most standard are about 7” in diameter.

• Additional sources on Myofascial Release:

Information:

Myofascial Release-what it is.

Foam Rollers: Find Foam Rollers Here!

• Massage

I highly recommend massage! Visit any massage therapist and they will talk indefinitely about the benefits and science behind why massage is important to your health. When you are exercising or injured, massage can be one of the most relieving methods of stress and/or strain throughout your body and mind. I give a general recommendation to my clients-If they can afford it I recommend they get a weekly massage, or a monthly massage at a minimum.

• Keep in mind, too, that when it comes to your complete fitness, the strength and flexibility mentioned here are only two of the three components to the triad of fitness. The third element not covered in this factoid is cardio conditioning. Cardio allows you to expand your stamina and endurance while allowing your lungs to expand and pass much needed oxygen to your muscles for recovery. Strength training makes your muscles stronger and assists your joints in taking away unneeded pressure from them, in addition to adding bone density which is important to women and to men as we age. Flexibility allows your body to not be bound by severe tightness and restrictions internally that may otherwise result in injury.
• So, if you look at it like this, your cardio conditioning will allow you to recover more efficiently when you are strength training. Your strength training will allow you to work harder in your cardio. Your flexibility practice will help ensure you do not strain a muscle in your cardio, and your flexibility will allow your muscles to grow or tone to their full potential with your strength training.
• If you do not include any one of these three components, your performance will not reach its full potential.
• Nutrition is also a vital component to reaching your ultimate health level, but is not covered here.

These knee strengthening exercises and stretches will enhance your probability of continued knee health and/or assist in your recovery from an injury or surgery.

Finally, I wish you the absolute best in your journey to rehabilitating your knee(s) or during the process of recovery. If you don’t have knee issues, great! Get your muscles strong and work on your flexibility to prevent future potential injury.

Thank you for your time, attention and your votes!