4 levels of exercise for chronic knee pain

What is knee pain?

Knee pain can be a debilitating condition, impacting upon function, independence and quality of life. Some knee pain resolves quickly (acute knee pain) while other knee pain persists for an extended period of time (chronic knee pain). For the purpose of this article, we will be referencing chronic knee pain.

Chronic knee pain refers to knee pain that has persisted for a period of time >3 months. This is common, particularly throughout the lifespan as the knee joint begins to ‘wear out’ and deteriorate. One way of reducing knee pain that is safe, effective and cost efficient is through exercise therapy. This method is often overlooked due to reproduction of pain, but these concerns can be reduced by following a simple tiered exercise plan as detailed below.

Level one exercise: Static knee contraction

A major component of rehabilitation for any form of chronic knee pain involves strengthening of the large muscle that sits above the knee joint (Quadriceps). Strengthening this muscle allows for increased stability of the knee joint when moving, and in turn reduced pain with movement. The starting point for rehabilitation of chronic knee pain should always involve the static knee contraction exercise. This exercise is completed in any position where the knee can be easily extended and fixed into position (such as laying with legs straight or sitting in a chair with legs elevated). To complete this exercise, simply press the back of your knee down into the chair or bed, activating the muscle above the knee. This exercise can be completed with both knees or one knee at a time depending on pain. This exercise is effective as it acts to increase the strength in the muscle above your knee joint without movement of the knee joint and as such is often pain free to complete. If this exercise is completed with <5/10 pain reproduction, youre safe to move on to level two.

Level two exercise: Seated knee extension

The second level of knee exercise involves straightening the knee joint through range of movement. This exercise is a progress from level one, as it involves movement of the knee joint as well as muscle activation. To complete this exercise, begin seated in a chair with your knee bent. Slowly straighten out your knee joint, activating the muscle above the knee, hold for two seconds and then lower your leg back to the floor. If this exercise is completed with <5/10 pain reproduction, youre safe to move on to level three.

Level three exercise: Sit to stand

The third level of knee exercise involves straightening the knee joint while weight bearing through your legs. This exercise is a progression of the previous exercises as it involves a weight bearing component, increasing muscle activity. To complete this exercise, begin seated in a chair of comfortable height to repeatedly stand from. Simply stand up from the chair and sit back down on the chair repeatedly until fatigued. When completing this exercise, you can use your arms to assist if needed when standing or sitting from the chair. If this exercise is completed with <5/10 pain reproduction, you're safe to move on to level four.

Level four exercise: Step up/down

The fourth level of knee exercise involves straightening the knee joint while weight bearing through one leg at a time. This exercise is a progress of the previous exercise as it involves weight bearing through only one leg at a time, increasing weight through that leg. To complete this exercise, find a step of comfortable height to repeatedly step up and down. Start by stepping onto the step with one foot (if only one painful knee step up with that knee first) and then lifting your other foot onto the step. Slowly step back off the step to complete the exercise and repeat the exercise until fatigue. When completing this exercise it is recommended to hold on to a bench, bar or rail for safety.

General tips for carrying out exercises

• Always begin with level one exercise and progress through the levels providing no pain >5/10 is felt with each level

• Complete each exercise 1 x daily to begin and increase amount of times per day as able

• Complete as many repetitions of each exercise as able, stopping at 15 if not limited by fatigue

If you're unsure where to start, experiencing difficulties with exercises or looking for a comprehensive assessment of which level is safe for you to complete, enlist the help of a Making Moves Physiotherapist today.