bodies_in_motion | Knee strengthening exercise suggestions?

Before I go all out and hire a personal trainer (which, uh, I cannot afford given the dance costs in my life), does anyone have any links to suggested knee and leg strength training exercises for someone who a) does not have much in the way of equipment and b) has knees which are moderately fucked? (Ligament and/or tendon strain, plus arthritis.) Also I have balance issues due to various reasons that are too complicated to get into here.

Please keep in mind that I am not looking for medical or insurance advice and can gauge and manage my own needs in respect to that.

Thank you!

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From:

redbird

One meta-thought is that insurance companies often cover physical therapy with no or lo co-pay, and "my knees hurt and I want to strengthen them" definitely fits under that umbrella.

Beyond that, I have a number of exercises I'm doing for my knees, including "strengthening ASLR," isometric knee extensions, knee flexion and extension, assisted squats, glute bridges, and assisted squats. The isometric knee extensions use a folded-up towel, the quadriceps extensions use a foam roller (about $40 these days, I think), and the assisted squats are assisted by holding onto almost anything at something like chest height. (I usually use my kitchen sink, but have used other people's counters and an odd sort of tall shelf at the Montreal airport.

My diagnoses are osteoarthritis and not-entirely-healed injuries (an old one from hiking, and more recently I slipped on the ice). As far as I know, my tendons and ligaments are okay,

From:

havocthecat

Thank you. But I am not looking for medical provider or insurance suggestions, simply exercise suggestions. I do appreciate the exercise suggestions, though.

From:

ewt

When I had some cycling-and-bendiness-related knee issues, the advice I got was that a lot of the stabilisation muscles in the knees are only active in the last 10% of extension, but tightness in the quads, the hamstrings and the ilio-tibial band can cause patella tracking problems.

Exercises for this:
1) sit on a chair, stick one leg out so your knee is maybe 12% or 15% bent, straighten it, repeat that straightening motion lots of times, then do the other leg
2) stretch your quads often, if doing this standing up is not safe because of balance issues then lie on your side on a bed and stretch the quad of the top leg by grabbing your foot and bringing it up to your bum
3) scarf-aided hamstring stretches -- lie on your back, grab two ends of a scarf,towel or even an exercise band and put your foot in the middle of it; raise that leg, straighten against the scarf to stretch hamstrings and help with general alignment

I am not a physiotherapist etc etc and I don't know if your knee problems are the same as mine. I would say go pretty gently with these at first to get used to the form.

From:

havocthecat

Thank you! Descriptions are great!

From:

harpers_child

My PT Doc says the best bang for the buck is standing one legged on a squishy surface. (I bought a squish mat like they have at PT. You can substitute a pillow or cushion.) Most important is to not lock your knee and keep your hips in line with each other. I started at 30 secs a leg 3 repeats each. Am now up to 90 secs a leg 3 repeats each with my eyes closed. I alternate which leg I stand on. Do it in the hall so I can catch myself on the walls if need be.

If you're having the kind of day that standing upright at all is a challenge, just standing on one leg at all with a hand on a wall is helpful. On bad days I do 30 secs a leg standing in the kitchen with my hands on the counter waiting for my tea to steep.

Squats with your back to the wall for stability. If you can do squats/mini-squats without the wall it's better but safety with balance issues. You can do them with a yoga ball between your back and the wall. Some times that's easier and some days harder. Depending on how my knees are I do anywhere from 10 to 20 in either 2 sets or 3. (My orthopedist jokes my knees are 3 times my actual age. Damage from hypermobility.)

For upper leg and hip exercises I do clams and reverse clams while laying down. Ball between my knees for the reverse. Depending on how my hips are doing anywhere from 10 to 30 and in sets of 2 or 3. Alternating sides.

Leg lifts while on your back.

Marching on the squish mat/pillow/cushion.

That's about as many PT exercises I can remember off the top of my head. (I've been neglecting my assigned exercises.)

From:

havocthecat

Thank you! Those pillows don't look too pricey on Amazon either.

From:

princessofgeeks

A very simple exercise that has helped me a lot, and that strengthens the muscles around the knees, is, when you are sitting in a chair, extend your leg as straight as you can out in front of you. Just hold it still and straight. Work up to a count of sixty. You can do one leg at a time or both legs at a time if you are a badass. Sit up straight and engage your ab muscles while you do this.

You can distract yourself from how hard it is by rolling your ankle.

Good luck.

From:

princessofgeeks

Also I love ewt's No. 1 which does the same thing.

From:

havocthecat

Thanks! Ab muscles, thankfully, are in great shape from all the dance! But that is a surprisingly difficult leg exercise, damn.

From:

princessofgeeks

Yeah, I started with ten seconds! Yikes!

I like it because I can do it while grading papers. Like Kegels while driving!

From:

ghoti

do you flex or point your foot?

From:

rydra_wong

I don't know what

princessofgeeks's answer is, but it might be interesting to try both ways and see if it's different -- sometimes with leg exercises one way is harder and the other, and I don't know why.

From:

princessofgeeks

From the instructions I got, the way you hold your foot doesn't matter. It's all about extending the leg so that the knee muscles work. You can hold your foot however is comfortable, or roll the ankle around.

From:

indywind

Flexed or pointed foot (ankle dorsiflexion or plantar flexion) doesn't matter for strengthening the quadriceps but can give some effect for the lower leg muscles -- specifically, strengthening the tibialis anterior (front of shin muscle) and stretching the gastrocnemius and soleus (calf muscles) when you flex the ankle. The opposite is possible with pointing the foot, but for many people flexing the foot gives more bang for the buck -- the average person seems to tend more toward tight calf muscles and weak tibialis anterior than the reverse; this is especially true for people who spend a lot of time in heeled shoes, even low heels or heel-cushioned sneakers.

My rec is, try both, and spend a little extra time doing whichever one feels harder (mindful of safety, your personal limits, etc.)

Cool party trick which confers no fitness benefit: you will know you have gotten very strong quads and tibialis anterior, and reasonably stretchy posterior chain muscles, when you can sit on the floor with legs outstretched and flex your feet so thoroughly that your heels lift off the floor a smidgen.

From:

ghoti

I am super excited to try this. Thanks for the insight!

From:

indywind

The extra hard version of the seated quad extension, when holding the extension for 60 seconds no longer feels challenging, is to do the leg extension with one leg while standing up on the other one, as for yoga Standing Hand to Big Toe Pose.

Variations / intermediate stages (mix and match) are: - standing up with back against a wall
- holding onto the foot of the extended leg (with your hand if you can reach, or with a loop of towel/strap)
- moving the lifted leg slowly and deliberately between flexed and fully extended)
-and of course, shorter hold for the standing leg extension than you had done seated.

Stuff to watch out for especially when doing the standing version (but can crop up in the seated version too if you're getting tired)
-leaning forward or back to counterbalance the lifted leg; keep torso upright, shoulders above hips (shoulder blades against wall helps when standing, or seated on a bench)
-tilting the pelvis front to back, overarching or rounding the low back
-tilting the pelvis side to side, or leaning sideways, usually lifting the extended-leg side (may notice when seated if the extended-leg side of the butt presses more lightly than the other side; harder to notice when standing unless you look in a mirror, but sometimes setting hands on top of hipbones is illuminating)

The extra, extra hard version is a pistol squat, which I can't talk about because I cannot do it. Yet, or at all with my current knees and ankles, I'm not sure.

From:

rydra_wong

- holding onto the foot of the extended leg (with your hand if you can reach, or with a loop of towel/strap)

There's one interesting option which is holding the foot as you lift and stretch your leg into place, then letting go and seeing if/how long you can hold it there for.

The extra, extra hard version is a pistol squat, which I can't talk about because I cannot do it. Yet, or at all with my current knees and ankles, I'm not sure.

*fist-bump of solidarity*

I don't know if my proportions (long femurs relative to shins and torso) will ever allow me to do a pistol without falling on my arse, but I can dream ...

(Also, one-legged stuff is very very relevant to climbing, so anything that works in that direction is good for me.)

From:

rydra_wong

Anecdotal suggestion I recently heard on a training podcast, which might help explain why foot flexed/pointed can vary the difficulty of different leg moves:

Because the body tends to activate muscles as part of chains, flexing (dorsiflexing) the foot may tend to make it easier to activate the rest of the anterior chain (inc. quads and hip flexors), while pointing the toe makes it easier to activate the posterior chain (the trainer specifically suggested that pressing down with the big toe into the ground can help cue glute activation in some movements).

Trying to mix it up (e.g. activate hip flexors with a pointed foot, or glutes with a flexed foot) is more complicated and therefore challenging.

From:

indywind

Oooh, that makes sense, and is a clearer way of explaining it than I had heard.

Relatedly, consider the effect of reciprocal inhibition -- the reflex (? or tendency, I don't know if it's a true reflex in the strict meaning of the term) that predisposes a muscle/group to lengthen not contract when its antagonist is in contraction. So contracting the quads facilitates stretching the hamstrings and vice versa. This may contribute to why breaking a muscle-activation chain (like extending leg but pointing toes) is difficult: because reciprocal inhibition promotes isolating the muscle group that's acting in opposition to its chain--can't distribute the work across the whole chain so the one muscle group has to work physically harder, while the mind has to work harder coordinating it.

From:

ghoti

my knee PT exercises (for some borderline dislocations probably due to weak quads) were usually some combination of:
leg lifts
clamshells
stair steps
balancing on one leg
hip abduction (adduction?)

From:

havocthecat

I know what all of those are except clamshells and hip abduction (or adduction, whichever), which I can look up! Thank you!

From:

ghoti

Clamshells: lay on your side in sort of a fetal position, but with your back perpendicular to the floor/bed/etc. ankles stay together, but open and close the sandwich of your hips and knees. this one was recommended with one of those elastic resistance bands. 10-20 reps, then flip over and do with the other leg on top.

Ab/duction: standing straight, facing front, and with support on a wall if needed, slowly raise your legs outward from your hip. (in ascii format, go || to |\ and back to ||) legs stay in the same plane front to back. knees don't really bend. do reps on one leg, then switch legs.

From:

rydra_wong

Ab/duction:

Abduction. FWIW, the only way I can remember which is which is that if you abduct someone you're taking them away, so abduction in anatomical terms moves something away (from the midline).

Thus adduction is the opposite, bringing something in towards the midline. So hip adduction exercises generally involve bringing your legs together against resistance (e.g. a band tied to your ankle when you start in the |\, providing resistance against returning to ||).

From:

ghoti

I used to remember the difference, I swear. *headdesk*

From:

rydra_wong

My past knee problems were not the same as yours (right knee tracking wrongly and bad stuff happening), but FWIW, one of the most helpful things for me was a yoga pose, Warrior Two, treated as an exercise in learning correct knee alignment and building the strength/stability to keep it lined up correctly.

My dodgy knee really wanted to skew inwards, so learning to notice that and keep it pointing in exactly the same direction as my foot helped a lot.

I can provide more details if this sounds potentially relevant?

From:

havocthecat

Thank you! That sounds useful and I would love more details!

From:

rydra_wong

Warrior II video from Yoga Journal -- nice little introduction.

For me, Warrior Two really illuminated how my dodgy knee would try to collapse inwards, and the muscular effort needed to keep it lined up properly with my foot (second and third toes, to be precise, as the video says).

Even given that your problem is different, it might still be worth trying for general leg strengthening.

Edited Date: 2018-10-11 03:46 pm (UTC)

From:

redbird

One I came up with on my own, which the physical trainer I was working with for a while, and one PT, agreed was reasonable is to stand up while riding the subway, with a pole in reach but not holding onto it unless I need it. This is something I used to do for fun starting in my teens. If you'd be taking the train anyway (or have a weekly or monthly pass) it doesn't cost anything extra.

This might not be a good idea if you aren't already used to standing while riding the subway. Also, this is specifically for subway trains: bus rides can be too bumpy, because of traffic, even if the street itself is smooth. (Every so often I explain to a friend, or a well-meaning stranger, that thanks but I don't want to sit down, this is physical therapy.)

From:

havocthecat

Thank you!

From:

redbird

You're welcome.

From:

rydra_wong

Tube surfing!

https://www.urbandictionary.com/define.php?term=Tube%20Surfing

I do it for fun too, and it's excellent balance training. People pay good money for machines designed to produce the same effect!

From:

havocthecat

If I am ever in the city and riding the subway, I will keep this in mind!

From:

malnpudl

People have already given you the exercises I got from my physical therapist that have been great for my dodgy knees (and helped with balance, too, in my case).

I would only add a recommendation that you pay close attention while doing each exercise to exactly which muscles you're using. Work on isolating effort to the target muscle group(s) as much as possible in order to get maximum benefit. Those muscles are usually the ones with connections around or near your knee. It's easy to lose focus and start using all kinds of other body parts to achieve a given motion, especially after a number of reps when you're getting a bit tired, so I had to learn to keep at least a significant part of my attention focused on exactly what I'm doing.

From:

lyr

Do you have access to a pool? Water jogging and water aerobics in general (as long as the water is about chest deep) has been the very best thing for my arthritic grandmother trying to rehab her partially replaced knee.

From:

indywind

Other people covered all the stuff I would have said, so I just want to second

malnpudl and whoever mentioned that the ends of your range of motion (almost straight leg but not 'locked', deeply flexed knee but no resting in as deep flexion as is possible) are generally the positions where strength and stability are most needed, and lacking, so do work those but be extra careful.

And add the sort of overall summary thought which a PT put to me sort of like: the best rehab or basic fitness exercises are to take whatever part you're working on through all the positions and motions it's meant to do, carefully and correctly and with gradually increasing resistance / gradually less support.
You can accomplish the resistance and the support any creative way, it doesn't matter -- it's the safe alignment/ focus isolation, gradual titration, and repetition that are important, and sometimes need an expert to inform (e.g. if you've always/never been sportsy, you may not know what's a reasonable starting place or rate of progression, or if you've always been compensating for something and not had a chance to get familiar with safe alignment).

But you're used to self-monitoring and training yourself to dance, so you already know about those principles.