It’s not uncommon to experience some form of discomfort in your knees as you get older—about 25 percent of adults are affected by knee pain, which is a 65 percent increase of the last 20 years, according to the American Academy of Family Physicians (AAFP). Most often, the culprit is knee pain from muscle imbalances, meaning some of the muscles around the joint (namely the thighs, hamstrings, and calves) are stronger, tighter, or weaker than others causing unnecessary stress to the joint and the tendons that attach to it.
“For example, overly tight quads can place a lot of compressive forces on the patellofemoral joint, while a weak quad will lead the body into dangerous compensatory movement patterns such as using the trunk, lower back, inner thighs, and a jerking motion with momentum in order to complete a task,” explains Chung Wang, PT, a physical therapist based in New York City. “This is when you observe people with weak quads squatting with knock knees, then straightening up with their knees first, followed by their trunks separately. The lack of strength of the quads will put undue demand on not only the knees, but the lower back as well.”
Other common causes of knee pain include the onset of osteoarthritis, or the deterioration of the cartilage that protects and cushions the ends of bones in your joints, excessive trauma to the knee, repetitive movement patterns—particularly when it comes to running and jumping, as well as jobs that requiring a lot of kneeling—or overloading the joint by trying to lift too much weight before your body is strong enough to support the load.
How to avoid knee pain from muscle imbalances
For the knees to be working properly without injuries or pain, they need to be strong, flexible, and the muscles surrounding them need to maintain their optimal length-tension relationship. This means that they’re all contracting and stretching the exact amount they’re supposed to in order to perform any movement—and none of overworking to compensate for any that aren’t working hard enough. The key to making this all happen is to listen to your body and not push it past its limits in terms of strength or muscular endurance.
“Remember, the human body will always instinctively seek the most energy efficient manner to complete a task or movement, even if this means sacrificing proper and safe exercise form,” says Ryan Waldman, DPT, physical therapist based in New York City. “For example, if a runner overtrains and progresses a regiment too aggressively, while the strength and endurance reserves are running low, the body will distort movement patterns to get the task done. This will lead to all sorts of problems such as repetitive and overuse injuries, because the body is now putting unusual strains on certain structures.”
So this is why you want to stick with a progressive training plan that helps you gradually get stronger and be able to go for longer over time—while also padding in plenty of time for recovery to your body has a chance to adapt and heal. A proper warm up is also needed if you’re a frequent exerciser, and if your knees hurt after running. “All joints in the human body need adequate and appropriate types of warm-ups,” says Dr. Waldman. This could include a general warm-up like dynamic stretches and a slow 5 to 10 minute job prior to a workout, or a specific warm-up, which involves doing targeted stretches that’ll activate and prime the muscles groups you’ll be using by performing similar movement patterns to the ones you’ll do during your training. An example of this could be bridges before a squat-heavy lifting session.
Exercises to help ease knee pain from muscle imbalances
First off, if you’re experience acute pain of any kind, you should see a doctor and get cleared to exercise first. Then if you’re experiencing knee pain from muscle imbalances (as in general discomfort or achiness), one of the best ways to address it is by strength training the muscle groups surrounding the joint, focusing on proper form. Try incorporating these four exercises from Dr. Waldman and Wang into your weekly regimen.
1. Squat
“When people say squats are such an important exercise, they’re not kidding,” explains Dr. Waldman. Squats, when performed with proper form and care, will engage all the lower leg musculature from the ankles to the thighs. The glutes, hamstrings, and particularly the quads are loaded to develop the necessary strength vital to everything we do.
How to: Stand with feet wider than hips, toes pointed slightly turned outward, arms extended overhead. Without letting knees fall inward, slowly sit back into heels as you bend your knees to lower down like you’re sitting into a chair. Keep your chest broad, and back straight, allowing your torso to slightly tip forward as you sit back. Lower until your glutes are just below your knees (or as far as you’re able), then pushing through your heels to stand back up.
Do 3 sets of 8–10 reps
Fine-tune your squat form by watching this video with tips from certified trainer Megan Roup:
2. Leg press
“If our muscles which support our knees cannot adequately slow down the acceleration of gravity, there will be increased loading of the knee joint architecture,” explains Wang. “Too much and too frequent of undue stress to the knee joint, you will have knee pain.”
How to: Sit on leg press machine, feet a bit wider than hip-width apart, knees bent, back flat against seat. Pressing equally with both legs, push through heels to straighten legs. Slowly release the weight back down, and repeat right before weight hits resting point.
Do 3 sets of 8–10 reps.
3. Banded walks
“Guess what muscle is vital for the stability of our two-legged form of locomotion: the gluteus medius,” explains Wang. (That’d be a small, side butt muscle that sits in concave part of your outer hip and helps stabilize your pelvis.) “Therefore, exercises that concentrate on resistive strengthening of the gluteus medius muscle can help with knee pain.”
How to: Place a small resistance band around the thighs, just above the knees. Stand with feet about shoulder-width apart, so there is tension on the band. Pushing the knees outward and always keeping tension on the band, step one foot out sideways, then keeping the other knee from falling in, step the other foot in the same direction. Take 10 steps in one direction, then 10 in the opposite direction. That’s one set.
Do 3 sets of 20 total reps.
4. Calf Stretch
“Believe it or not, your calves are also very important when it comes to knee pain, and a lack of calf flexibility will exacerbate all types of knee pain,” says Dr. Waldman. “Stretching the tissue where the muscle meets the tendon can increase pliability and help reduce pain.”
How to: Stand facing a wall. Place your hands on the wall in front of you at about chest height, and step one foot back to stagger your stance. Keeping your back foot completely planted and leg straight, bend front knee to lean into hands, and stretch the back calf muscle. Hold for 10-15 seconds, then switch sides. That’s one set.
Do 2 sets.
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