Knee pain is by far the most common site of pain in the human body. From an athlete to an IT professional, from a teenager to an elderly, whether a  male or female, everyone can have knee-related issues and it may lead to major physical disability and decreased quality of life. There could be various reasons for having knee pain depending on the structures that get affected. Cartilage, meniscus, tendon, and ligaments are the commonly injured structures in and around the knee. 



I believe that the knee gets into trouble due to multiple factors that could be related to mobility, strength, biomechanics, etc. A lot of the times the root cause of your knee pain might be an issue in the hip or ankle, for example, people with restricted ankle mobility will be prone to develop pain in and around the knee cap as the knee is trying to compensate for the restricted ankle mobility. This article will give you an insight on the best physiotherapy exercises for knee pain, but I always recommend that before you start an exercise program for knee pain, do talk to your physical therapist to make sure the exercises are safe for you. 



Physiotherapy exercises for knee pain can be divided into two broad groups depending on the root cause. The first group consists of exercises that will help improve mobility and flexibility of the structures that may affect the knee joint, whereas the second group consists of exercises that will help in strengthening the muscles around the hips and knees. In an ideal situation, I recommend doing a combination of exercises from both groups for optimal results.




Group 1- Mobility and Flexibility exercises


Most of the knee pain relief exercises in this group will target improving the flexibility of your tight muscles and also improving the joint range of motion.



1. Quadriceps stretching


Tight quadriceps muscle in front of your thighs is one of the most common reasons for increased stress on the knee joint. And stretching the quadriceps becomes the most integral physiotherapy exercise for knee pain. This stretch can be done in a standing or lying down position though doing it in a standing position is the preferred one and the lying position should be used only if you have difficulty in standing.  


To  do this stretch:


  • Stand next to a wall or use a chair for support and bend one knee to touch your heel to your hip. 
  • Grab your ankle and gently pull it toward your glutes as far as you can comfortably. 
  • Avoid arching your back excessively
  • Hold for 30 seconds and repeat on the other side


2. Pigeon stretch


This stretch mainly targets your hip muscles the Piriformis along with your other gluteus muscles and Stretching exercises for knee pain are always incomplete without the inclusion of a pigeon stretch.


To do this stretch:


  • Start on all fours. Bring your right knee forward towards your right wrist, placing your shin on the floor. Move your right ankle toward your left wrist. This position is such that the shin is perpendicular to your torso. 
  • Now Slide your left leg back and gently walk your hands forward to bring your chest closer to your shin.
  • Hold for 30 secs and repeat it on the other side.


3. Hip flexor stretch


This stretch mainly works on your illios-Psoas and your rectus femoris muscle and tightness of these muscles could be a major factor contributing to your knee pain.


To do this stretch :


  • start in a kneeling position. Lift your left knee and place your left foot on the floor with your left knee at a 90-degree angle. (place a cushioning under the knee that is grounded to reduce pressure on the knee cap)
  • Drive your hip forward. Maintaining a straight back, lean your torso forward.
  • Hold the position for 30 seconds and repeat on the other side.


4. Quadriceps foam rolling


Foam rolling is one of the best alternatives to a myofascial release that is usually done by a qualified physiotherapist or a massage therapist. It helps in loosening up the tight muscle and trigger points within the muscles and can effectively reduce your knee pain.


To perform quadriceps foam rolling


  • Start in a forearm plank position with the roller under your quads, for optimal results roll one leg at a time and place the other leg off the roller.
  • Maintaining a good spinal posture roll up and down covering the entire length of the quadriceps. You can bend your knee to get an additional stretching effect.
  • Do this for anything between 30-60 seconds and make sure that you have covered the entire length and breadth of the muscle.
  • When you hit a tender spot, try and perform small-amplitude rolling movements just around that specific spot.


5. IT band Foam rolling


IT band is a fascia that is present on the outer side of your thigh and ends at the knee joint It is one of the most commonly injured soft tissues in runners. The pain due to IT band inflammation is usually felt on the outer side of the knee. Rolling your IT band may not necessarily loosen up the fascia but the mechanoreceptor stimulation may definitely help in releasing the pain.


To perform IT Band Foam Rolling


  • Start in a side plank position with your top leg placed in front of the body with the knee bent and the foot rested on the ground.
  • Place the foam roller underneath your IT band or the side of your thigh and keep the rolling leg straight.
  • Keeping your spine stable, use your upper body and the bent leg to start the rolling movement up and down.
  • Duration: 30-60 secs and spend a little extra time at the tender spots. Repeat on the other side.


6.Gluteus foam rolling


The tightness of the gluteus can restrict the mobility of your hip joint and in return forces the knees to compensate and end up in an injury. Physiotherapy exercises for knee pain must include foam rolling for the gluteus to solve the problem holistically.


 To perform gluteus foam rolling


  • Start by sitting on the foam roller with both knees bent and both hands placed behind for support. 
  • If you want to roll the right gluteus then place your right ankle on top of your left knee and tilt your body towards the right side so that the entire weight is on the right gluteus.
  • Now use your left hand to pull your right knee towards the chest creating a gentle stretch and the right-hand stays behind for the support.
  • Rollback and forth, isolate the tender spots, and spend some extra time on those spots.
  • Duration: 30-60 secs and a repeat of the other side.



 Group 2 - Strengthening Exercises


Exercises in this group will help strengthen the knee and hip musculature and in return relieve your knee pain.



7. VMO strengthening


VMO or the Vastus Medialis Oblique is one of the muscles of your quadriceps and is the most important muscle that provides stability to the knee cap and makes sure that the kneecap is tracking properly during the knee movements. The weakness of this muscle is often a cause for patella-femoral pain and hence strengthening the VMO is probably the most important knee strengthening exercise which cannot be neglected.


To perform this exercise 


  • Sit on the floor in a long sitting position
  • Place a towel roll or a foam roller exactly under the knee to create an angle of approximately 20-30 degrees with the heel touching the ground 
  • From this position lift the heel off the ground to create an extension movement at the knee joint.
  • Hold the position for 5-10 secs and repeat 10-15 times.


8.Gluteus Bridging


Gluteus Bridging mainly focuses on strengthening your gluteus Maximus muscle which along with the other gluteus muscle provides a stabilizing effect for the knee joint.


To perform this exercise


  • Lie down on your back with your knees bent and foot flat on the ground, make sure the knees and the foot are in line with your hips and your toes are pointed straight.
  • Lift your hips off the ground by squeezing your glutes and making sure the spine is in a neutral position.
  • You can hold the position for 5-10 secs and repeat 10-15 times


9. Clam


Clam exercise is a great way to target your Gluteus medius and Minimus muscles which are the smaller gluteus muscle in your hips. The weakness of these muscles could be a major contributor to increased knee valgus and eventually making it prone to ligament and meniscus injuries.


To perform this exercise 


  • Lie on your side with your knees bent approximately 90 degrees and your feet in line with your hips
  • Place a loop band just above your knees to provide resistance.Open your top knee while your feet are still in contact with each other. Repeat this 10-15 times on both sides.


10. Wall Squat holds


Whenever someone has knee-related pain the quadriceps muscles will end up going in a state of inhibitions and eventually become weak. So you must strengthen your quadriceps muscles overall. And in an early stage of pain, squat hold exercise for your knee pain may come in handy as it doesn’t require any equipment and can be done in any setup.


To perform this exercise


  • Start with your back against a wall with your feet shoulder-width and about 2 feet from the wall.
  • Slowly slide your back down the wall until your thighs are parallel to the ground keeping your back flat and core engaged.
  • At the end position, the thighs should be parallel to the ground and the knee should be bent at 90 degrees  so that the knees are exactly on top of your ankle
  •  Hold this position for anything between 10 - 60 secs and repeat 3 -5 times.


Conclusion


Most of these exercises will help to bring the balance between mobility and strength and if practiced in the right way should bring your pain down. If you experience pain while performing any of these exercises then stop the exercise right there and move on to the next exercise and if your knee pain doesn’t show signs of improvement within two weeks from the start of this physiotherapy exercise for knee pain then make sure you visit your physiotherapist to find the exact cause of your knee pain and fix it from the root cause

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