Question: My 70-year-old mother has been a daily walker for decades but now knee pain is keeping her from walking every day. She wants to avoid any kind of surgery altogether, or at least as long as possible. What are some exercises she can do to strengthen her knees?
Answer: Chronic knee pain in a 70-year-old is usually the result of osteoarthritis. The menisci – the tough, fibrous tissues between the knee bones that cushion against direct bone-on-bone contact – get thinner, more brittle, and can tear more easily as you age. Performing the right stretching and strengthening exercises that target the muscles that support the knees may help ease pain, improve range of motion and flexibility, lessen the stress on the knee, and reduce the risk of future injuries.
With any type of joint pain, it’s best to talk to a doctor before starting an exercise program. Your mother will need to know what the underlying problem is. Once given the “go ahead,” physical therapists and personal trainers with a background in corrective exercise can help select the exercises that are safest for your mother. They can also recommend modifications based on her knee pain and the underlying cause.
Exercising a knee that’s injured or arthritic may seem counterintuitive. In fact, exercise is better for the knee than keeping it still. Not moving the knee can cause it to stiffen, which may worsen the pain and make it harder to do daily activities.
Exercising a knee that’s injured or arthritic may seem counterintuitive. In fact, exercise is better for the knee than keeping it still.
When practitioners of corrective exercise assess movements, we look for movement imbalances. Walkers primarily challenge muscles that flex and extend the hip, knee and ankle. What weakens over time are those that help with side-to-side and rotational movements in all three joints. Additionally, older adults tend to develop a falling-forward gait. Basically, they are catching themselves with their quadriceps (front of thighs) when they land on their heels versus propelling themselves with their hamstrings (back of thighs) and glutes (buttocks) when they push off their forefoot.
The conventional wisdom is to focus on strengthening the quadriceps. Corrective exercise focuses on adjusting the client’s gait, which often includes strengthening probable weaker muscles in the calves, hamstrings and hips (glutes and external rotators). It also teaches the client the necessity of and the techniques for preparing for exercise and then recovering from exercise as a means to mitigate pain, prevent injuries and protect joints.
I’ve worked with many a skeptical client who reluctantly tried a corrective exercise program such as the one listed below. My private joy is their amazement when they realize a few weeks later they can challenge their knees as much as or more than before they started working with me.
I also recommend trying yoga and/or tai chi as an exercise routine that can gently challenge the knee from all directions. I strongly caution against learning this exercise routine by watching videos only. It’s essential that a professional observe and make corrections to movement habits that contribute to the pain and discomfort but that most people are unaware they’re doing.
A general program your mother can do four or five times a week would be:
- Warming up for five-plus minutes;
- Preparatory stretching for five-plus minutes;
- Corrective exercising for two sets of 10 reps; and
- Recovery stretching for five-plus minutes
Examples of dynamic warm-up movements:
- Marches/jog in place
- Half-lunges and squats
- Shoulder rolls
- Hip and arm circles
- Torso rotations
Examples of preparatory movements:
- Heel and calf foam roll and active stretches
- Quadriceps foam roll and active stretches
- Hamstring and glute foam roll and active stretches
Examples of corrective exercises (two sets of 10 reps)
- Standing calf raises
- Standing half squats
- Standing hamstring curls
- Seated lower-leg extensions
- Lying straight-leg raises (front and back)
- Lying clamshells or bridges
Examples of recovery movements:
- Heel and calf foam roll and static stretches
- Quadriceps foam roll and static stretches
- Hamstring and glute foam roll and static stretches