The Med Gym
Exercise and Healthy, Happy Knees
By David Drinks
The health of your joints comes down to more than just your age. Joint deterioration is not merely a result of getting older.
Although many people, including those in the medical world, are quick to blame aging and genetics for the onset of joint problems, the fact is that many factors dictating your joint health are within your control.
Factors such as how you move, what you eat, your body weight, and how you manage stress all play large roles in whether you’ll develop arthritis and other musculoskeletal problems.
Barring a previous traumatic injury to a joint, arthritis and other degenerative joint conditions are not bound to happen due to aging alone.
Instead, the following risk factors play a much larger role in long-term joint health and your risk of developing degenerative joint conditions such as arthritis than your age alone:
Joint wear and tear from improper movement.
Poor stress management, leading to poor lifestyle choices.
Sub-optimal diet and eating habits.
While all of these risk-factors can majorly affect your long-term joint health; in this article, I’ll primarily discuss how improper movement and improper exercise techniques influence the long-term health of the knee joint.
To start out, let’s look at some misconceptions about exercise and knee pain.
Misconceptions about Exercise and Knee Pain
There are, I’m sure, many misconceptions out there about exercise and knee pain. While I probably won’t hit them all, here are some of the most common misconceptions that I hear:
Exercises requiring bending of the knees, such as squats, cause knee pain.
Lifting heavy weights to build lower body strength causes knee pain.
Knee pain is caused by the tightness of the muscles surrounding the knee (e.g. the hamstrings, quads, or calves).
Knee pain is caused by aging.
Knee pain is caused by genetics (i.e., my parents have bad knees so I’m prone to having bad knees).
While these six common misconceptions may at times contribute to the onset of knee pain, they are rarely the main driver of knee pain. I’ll explain this further in a minute, but first, let me tell you what I believe to be the primary causes of knee pain.
The Primary Causes of Knee Pain
Poor alignment of the knee joint.
Suboptimal movement patterns.
Muscle strength imbalances around the knee.
Poor tissue quality around the knee.
Lack of mobility and/or stability of the foot, ankle, and hip.
Previous traumatic injury to the knee.
As you can see, the primary causes of knee pain have little to do with the specific exercises you perform, your age, or how tight your hamstrings are.
Rather, knee health has everything to do with your quality of movement. Therefore, proper joint alignment plays the largest role in long-term knee health.
Following proper alignment, proper movement patterns ensure that the knees stay healthy as you perform exercises in the gym and as you move about in everyday life.
With that in mind, let’s look at the common misconceptions listed above, and compare them with the real causes of knee pain.
#1: Exercises that require bending of the knees, such as squats, cause knee pain
Squats are a common lower body exercise that involves significant bending of the knees, and they are often thrown under the bus as a cause of knee pain.
However, squats in and of themselves do not cause knee pain. It all comes down to how you perform squats. If you perform them with poor alignment at the knee joint, and suboptimal movement patterns, then squats will lead to knee pain.
On the other hand, if you perform squats with good joint alignment and proper technique, they will be beneficial for knee health.
An example of poor alignment during a squat would be allowing the knees to cave inwards as you descend into the squat, or as you push back up out of the squat. The following video gives an example of this, as I talk about the importance of hip strength in keeping the knee joint aligned during functional movement:
When the knee collapses inwards during the squat, the load on the knee is not evenly distributed. Instead, there is a large amount of force directed at the inner part of the knee which can lead to uneven wear and tear on that part of the knee and ultimately pain.
To fix this, think about pressing your knees out to the side as you squat down as if you were trying to resist someone pressing your knees together. The knees should remain in line with the mid to outer portion of the foot.
A great drill to teach you how to press the knees apart as you squat down is a banded squat shown here:
Another example of a poor movement pattern during the squat would be the case where you rock forward onto your toes during the squat movement and allow the knees to shoot in front of the toes.
This is a faulty movement pattern because you’re not engaging the hips and hamstrings, but rather primarily using the quadriceps to perform the squat. As you might imagine, this leads to an imbalance in strength around the knees.
I recently filmed a whole Technique Tuesday video on this exact technique flaw:
When squats are performed with good alignment and proper recruitment of the quads, hamstrings, and hip muscles, they become a great exercise to build strength and power in the lower body while simultaneously improving knee stability and health.
#2: Lifting heavy weights to build lower body strength causes knee pain
Many people are scared to squat large amounts of weight or lift heavy weights in general because they think that doing this will cause their joints to deteriorate.
However, this couldn’t be further from the truth. In fact, lifting heavy weights with the lower body - when done with the proper form, of course - serves to build balanced strength around the knees, and to develop a tolerance to stress in the knees. The result of this is that you will have knees that are stronger and more resilient in the long-run.
As I mentioned already, imbalances of strength around the knees are one of the primary causes of knee pain. Lifting lots of weight with the improper techniques we talked about just a minute ago will almost definitely cause knee problems.
Lifting with improper technique leads to imbalanced stress on the knee joint, and it also leads to imbalances in strength between the muscles around the knee joint.
For example, squatting with too much weight on your toes will lead to the quads developing a disproportionate amount of strength compared to the hamstrings and hip muscles. This imbalanced strength can further lead to improper movement patterns and increased stress to certain structures within the knee.
However, lifting heavy with proper form and proper progression will result in balanced strength around the knees and increased tolerance to stress.
#3: Knee pain is caused by tightness of the muscles surrounding the knees (hamstrings, quads, and calves)
This misconception comes from the fallacy that if something is tight – or feels tight – we necessarily need to stretch it. While this is sometimes the case, not every “tight” muscle needs to be stretched.
First, you must consider if the tight muscle is the problem, or if it is just a symptom of the real problem that is caused somewhere else in the body.
For example, tight hamstrings are many times the result of poor stability of the core and pelvis.
In this case, the hamstrings are tight because they are making up for a lack of stability elsewhere. If you simply stretch the hamstrings, you’ll never fix the problem. But if you address the root cause of the issue by working on core stability, then you get rid of the problem as well as the symptoms of that problem.
Another case in which it is counter-productive to simply stretch the muscles is the case in which someone has very lax/unstable joints.
This is another scenario in which the muscles may feel tight because they are making up for a lack of stability in the joints. If you simply stretch the muscles to alleviate the tightness, you are not addressing the root cause, and possibly even contributing to it. Someone with unstable, loose joints needs increased stability around the joint, not increased stretching.
In addition to cases in which you have a lack of core stability or lax and unstable joints, some people may also have poor soft-tissue quality in the muscles around the knee.
This may be the case if you have had a previous injury, like a strained hamstring. In this case, there may be scar-tissue that has developed in the muscle, which leads to a lack of flexibility and strength in the muscle.
Massage therapy and self-myofascial release techniques like foam rolling can be effective means of improving soft-tissue quality.
So, the bottom line is that “tight muscles” are rarely a cause of joint pain, but rather they are a symptom of a deeper issue which is the true cause of joint pain. Seek to treat the cause and not the symptoms, and you will set yourself up for success.
#4: Knee pain is caused by aging
The fourth misconception is the point I lead off with, and that is that knee pain is caused by aging. To say this would be an oversimplification of the matter, to say the least.
Sure, aging plays a role in the deterioration of the joint, and to some extent, there will be joint degeneration in everyone if you live long enough. However, just growing older is not the main cause of knee pain.
I know many people who have bad knees and knee replacements, but I also know many older people who have perfectly healthy knees.
The fact is that the long-term health of your knees can be up to you. Being aware of the real causes of knee pain, and doing things to address them can ensure that your knees stay happy and healthy for the long-haul.
A smart exercise program that teaches you how to move in proper alignment, promotes balanced strength around the knees and maintains good soft-tissue quality and mobility, will go a long way in ensuring that your knees stay healthy as you age.
#5: Knee pain is caused by genetics
Finally, genetics is a popular scapegoat for many diseases and joint problems, but it is not nearly as large of a factor as many make it out to be.
For example, many people blame the development of various chronic diseases on genetics, because their parents had the same diseases. However, in the book, “Disease-Proof: The Remarkable Truth About What Makes Us Well” Dr. David L. Katz maintains that you can reduce your risk of developing any chronic disease by 80 percent by doing four simple things – not smoking, eating well, being active, and maintaining a healthy weight.
So, lifestyle factors play a much larger role in the prevention of chronic disease than genetics in most cases. Perhaps it was your parent’s lifestyle that brought about much of their health situation (whether it was good or bad), and not just their genetics?
The same goes for knee health. By focusing on all of the things discussed in this article, you can develop and maintain good knee health for the long-run, despite your genetic predisposition.
To wrap things up then, there are many misconceptions about knee health and what causes knee pain. Some people blame knee pain on squats, some blame it on tight hamstrings, some blame it on getting older, and others blame it on their parents.
However, not every older person has knee pain...even if their parents had knee problems. The key is that these individuals don't have the primary causes of knee pain that I highlighted today.
So, if you want to exercise for knee health, then you must focus on proper joint alignment, proper movement patterns, balanced strength around the knees, and good soft-tissue quality around the knees.
If you can do these things, you can maintain knee health throughout your life. You can exercise to promote knee health instead of doing exercise that promotes knee pain!
Want to learn more about training your body to Move Better, Feel Better, and Live Better? Our exercise programs at the Med Gym are custom-made to get you exactly what you need.
Whether you come into the gym or work with us via Med Gym Online, we can help you get on the right track with your movement and fitness.
Contact us here to talk about how we can help you develop an exercise routine that focuses on your knee health and so much more!