Strengthening Exercise Program to Prevent Knee Injuries and Reduce Knee Pain
25 years ago, in L.A. I bought a wheelchair because of crippling knee pain. I currently train and compete in ballroom and Latin dance regularly. Walking even a block caused extreme pain and I was completely unable to go down stairs. I went to many doctors who told me I would need to give up dancing. After two years of pain, I found a doctor and physical therapist who gave me some exercises which turned my life around. Since doing the exercises regularly, my partner and I have won 4 times the United States Senior 1 (age 35-45) Ten Dance Championships. A number of other dancers and students have mentioned knee problems to me and, when they have tried my exercise program, have gotten better, so I am writing this article in hopes that other ballroom dancers who are presently suffering from knee pain may benefit.
Please note that I am not a doctor nor medically trained professional, but am simply attempting to pass on exercises that have been given me, notably by my career saving physical therapist, Stephen Venables, of Kaiser in San Rafael, CA and Dr. Garrick of St. Francis Hospital in San Francisco, author of Anybody's Guide to Sports Medicine, who cares for the San Francisco 49ers and San Francisco Ballet.
I do the exercises below everyday and can then dance and train normally. However, if I skip the exercises, I will have a flare up, which usually lasts up to about two weeks. I include below only the exercises and treatments that have worked consistently for me over the last 20 years.
1. STRENGTHEN VMO
Orthopedist Dr. Garrick states that 95% of knee injuries can be prevented by simply strengthening this muscle. Early on in starting these exercises, most people can barely find this muscle. So, before starting the most important VMO strengthing exercises, the step ups, you need to get these muscles to start working with contraction exercises. Dr. Garrick actually gave me a machine that he used on the football players that artificially forced the contraction of this muscle, but without a machine you can easily ask your muscles to contract yourself with a little practice.
A. VMO CONTRACTIONS
Sit on the floor with your legs out stretched in front of you. Put a rolled up towel washcloth under your knee and put your fingers on the area where you would feel your VMO contract, just diagonally above your knee cap and closer to the center of your body. Press your knee down into the towel. You should feel your VMO contract.
Hold the contraction for 5 seconds, then release for 5 seconds.
Repeat 5 times.
You can do this exercise every few hours for a few days or until it feels like this muscle is easily activated. Then it is time to move on to your life saving exercise, the STEP UPS!
B. STEP UPS
Start by placing one book about 3 feet away from a wall. Stand between the book and the wall and put one hand on the wall and the other hand on the outside of your hip.
(Note the drawing below doesn't show girl stabilizing with a wall - She would have her left hand against a wall. Also, you want to start with just one book and gradually work up.)
You are going to step up diagonally up away from the wall sideways onto the step. As you do this, you want to feel that your hips stay parallel to the floor. We are trying to get the VMO of the book-stepping leg to work to lift us onto the step. Then slowly step down, so that you are again between the wall and the book. Do 20 step ups on this leg, then turn around and do the same with the other leg. You will do a total of 3 times 20 on each leg.
As you get stronger, you can add more books to your step, or use a step at the gym and gradually increase the level of the step. You want to be constantly strengthening your VMO, so beware of your hip's tendency to shift so that stronger muscles can take over instead. It is much better to use a very low step and strengthen your VMO then to just strengthen muscles that don't need strengthening. Also make sure that you are pushing up with your whole foot or more up with your heel, rather than with the ball. (Do not do this exercise in high heels!) You want your weight to be moving up behind and to the inner side of your knee, not at all over the front of your knee.
2. STRETCH HIP FLEXORS
Now we want to stretch out muscles that tend to get tight in our many sitting activities throughout the day and that might have a tendency to pull on our knee cap.
The stretching exercise I like the best is a kind of modified runners's stretch in which I put one bent leg up against a wall and then lean in towards the leg with the other leg outstretched behind me. I like this because even if I am in a flare up, this exercise puts no pressure on either knee. I do this for about 3 times 20 seconds on each leg and make sure to do it if I have been sitting for a while, before I dance. Of course, the best thing is to interrupt long periods of sitting with a few stretches periodically so that they never get a chance to get very tight.
(The image below is of a standard runner's stretch. If her front foot was against the wall and her back leg very close to the wall, it would be the stretch I am talking about)
3. EXERCISE BIKE
Getting on an upright (not recumbant) exercise bike for a minimum of 20 minutes a day brings all your muscles together and really gets your legs ready for any activity. If my knees are flared up, I cannot do much bike or very little with almost no resistance. But once the pain is gone, I can get back on the bike and just ice immediately afterwards, to get back into my regular exercise routine. It is even better if you use the bike aerobically, as the circulation is great for healing and great for your health in general! But, if you are too tired to use it aerobically, just the motion of going around in circles using your VMOs and ham strings is great.
Considerations: Mainly you want to err on too much resistance than too little. You never want the bike to be running you. Your leg muscles should always be making the pedals work. You can play around with seeing which muscles engage when you sit in slightly different positions. You want your knees to be very slightly flexed at all positions. Check with a physical therapist or experienced trainer if you are unsure about the best bike setting. It should be comfortable. If it is not comfortable your body is telling you there is something wrong.
ACTIVITIES TO AVOID
You probably know what activies to avoid as they are the ones that tend to cause you pain. But, some activies, you might avoid
1. Kneeling and putting pressure on your knee cap
2. Long periods of staying in a sitting position. You may notice that traveling or sitting for long periods of time, your knees start feeling kind of gel like or stiff. It is really worth it to make yourself get up every hour or so, move around, and stretch. Your body will thank you later.
3. Initially going down stairs - I found great methods to use hand rails or to walk down stairs backwards or sideways. It looks silly, but is much less painful. Once your knees are stronger, and past a flare up , you will be able to go down stairs again.
TREATING FLARE UPS
1. ICE IMMEDIATELY - Frozen peas are your friend. If you can remember to carry along a few bags in a lunch cooler before your activity, you will be ready just in case. Also, a venti cup of ice at Starbucks is the exact right amount of ice for 2 ziplocks. While sitting in my car, I put the ice bags on my knees, then tie them on with a scarf or tights, so that the ice is in contact with the soft areas around my knees. Wear the ice bags until your knees are almost numb, then take them off.
The whole inflammation cycle has a life of its own, if you can just prevent it immediately before it gets a chance to start, your knees can often be ready to go the next day if you ice immediately, even if you have begun to feel some irritation with your activity.
2. DIXIE CUP ICE MASSAGE - When you get home, it is time for ice massage. If you freeze water in dixie cups, it is the perfect size for you to use to massage your knees. Make little circles with the dixie cup around your knee, so that the ice is in direct contact with your skin, until you melt the entire dixie cup. The massaging motion speeds the reduction of inflammation and speeds healing. I have definitely noticed a much faster recovery from a flare up when I used the ice massage, then when I just used ice.
Don't give up! If your doctor says you have to live with constant knee pain, see a different doctor, then another, and another! Because, chances are there is a way past your pain and once you find it, you will be so thankful to live the life you want to live with your body!
See also Knee Exercise video