Avoid Knee Injuries

Knee injuries can be acute (ligament, cartilage, or tendon damage) or chronic (tendonitis, bursitis, or arthritis). They have a variety of causes: improper lifting of heavy objects, poor flexibility, bad shoes, muscle weakness, failure to warm up before exercise, sports-related injuries, and other accidents. While not all injuries can be prevented — particularly acute injuries resulting from collisions — you can reduce your risk of knee injuries by maintaining a healthy weight, exercising correctly, avoiding high risk sports and activities, and wearing the right shoes.

Steps

Exercising to Protect Your Knees

1. Keep your weight under control. Every pound of excess weight puts about 5 pounds of extra pressure on your knees when you go up and down stairs, so losing excess weight is hugely important for protecting your knees. Studies have shown that people with arthritic knees lose 20 percent of their pain with every 10 pounds of weight loss.
2. Warm up before exercise. A warm up prepares your body for physical activity, thereby both reducing the chance of injury and improving performance. Generally speaking, the less frequently you exercise, the longer you will need to warm up. Some good warm ups include:
   • Starting slow — If you are doing an aerobic activity like walking, swimming, or biking, start slowly for five to 10 minutes, then gradually ramp up to full speed.
   • Step-ups — Step up onto a small stool or stairs, lifting your body with one leg. Step back down with the same leg. Do 10–15 step-ups per leg.
   • Hamstring curls — Lie flat on your stomach and bend one leg so your heel moves towards your buttocks. Repeat 10–15 times per leg.
   • Straight-leg lifts — Lie on your back with one leg bent so your foot is flat on the floor. Keeping your other leg straight, lift it until it is perpendicular to your body. Repeat 10–15 times for each leg.
3. Cool down after working out. Cool down by gradually decreasing the intensity level of your aerobic exercise. Slow down until your breathing and heart rate have returned to normal. Cooling down helps your body to recover and reduces the risk of strains and injury.
   • Light cardio — Walk for five to 10 minutes until your heart rate slows, or bike or row at low resistance for five to 10 minutes. If swimming, swim leisurely for five to 10 minutes.
   • Walking lunges — Do two sets of ten walking lunges. As you step forward, transfer your weight to your front leg and bend both legs until the knee of your back leg is only an inch off the floor. Push off with both legs to step forward onto your other foot and repeat the process.
   • Stretching — Follow your light cardio or lunges with five to 10 minutes of stretching.
4. Stretch to increase flexibility. Increased flexibility in your calves, hamstrings, quadriceps and hips will reduce the chance of knee injury by helping you to move more fluidly and with better posture. Stretching should be done both after warming up and after exercising. To keep your heart rate elevated after your warm up, do standing stretches. Save sitting stretches for after your cool down.
   • Quadriceps (Standing) – While holding onto a support for balance, grab the top of your left foot with your right hand and slowly pull your heel towards your buttocks. Repeat with the other leg.
   • Calf (Standing) — Stand with one leg before the other. Lean forward while holding onto a solid support, putting your weight on your front leg and keeping your back leg straight and the heel on the ground in order to stretch the calf. Repeat with the other leg.
   • Hamstring (Standing) — Standing with your legs spread just beyond shoulder width, lean forward and towards one leg while keeping your legs and back straight. Repeat with the other leg.
   • Standing hip flexor (Standing) — Stand with one foot a bit in front of the other and, keeping your back straight, lunge forward on your front leg until you feel some strain, but no discomfort in the front of the hip of your back leg. Repeat with the other leg.
   • Butterfly stretch (Sitting) — Sit up straight with the soles of your feet pressed together and hold your feet as you lean your upper body forward. Lean until you feel some strain, but no discomfort.
   • Hamstring (Sitting) — Sit and straighten one leg, while keeping the other bend so that the sole of your foot rests against the thigh of the opposite leg. Lean forward towards your outstretched leg while being sure to keep your foot upright. Repeat with the other leg.
5. Perform aerobic exercises to control weight and build muscle in order to protect your knees. Focus on the following non-impact exercises that will keep you in shape without stressing your knees:
   • Walking on level ground
   • Elliptical training
   • Stationary or road biking
   • Swimming
   • Water aerobics
6. Avoid high-impact exercises or ones that put stress on your knees. Running on hard surfaces like concrete or asphalt, and particularly downhill running, can be hard on the knees. Likewise, strength exercises including deep knee bends and squats can strain the knees. If doing them, never bend your knee more than halfway.
7. Take precautions if you run frequently. Warm up in advance and run on a smooth soft surface such as a track or dirt trail instead of cement or asphalt. Walk down hills instead of running. Reduce stride length to lessen the impact on your knees. Be sure to purchase new shoes every 400 to 600 miles traveled to ensure the soles do not get too compressed to properly absorb impact.
8. Strengthen the muscles around your knee. Focus on your hips, quadriceps, and hamstrings, performing 1-3 sets of 8-10 repetitions for each muscle group. The type of exercise is not important so long as you exercise the muscles regularly. Some exercises to consider include:
   • Weight machines — Weights are a good way to isolate particular muscles. Do hamstring curls, legs extensions, and hip abduction/adduction exercises.
   • Lunges — Lunges exercise the hips, quads, and hamstrings (as well as your glutes and calves) in one exercise. Stand straight, then step forward. As your foot lands, bend both legs until your back knee is about an inch from the floor. Both knees should be at about a 90 degree angle. Push off with your legs and move forward as you return to a standing position. Be sure to keep your body upright during the exercise.
   • Squats — With your feet shoulder-length or slightly wider apart, squat down while keeping your back as straight as possible and being careful to sit back rather than lean forward. Continue squatting until your thighs are parallel to the ground. Return to standing.
9. Strengthen your core. Slouching while you walk throws your body off balance and will eventually lead to knee pain. To be sure you stand up straight when you move, you need to do exercises to strengthen your core (i.e. your abs, lower back, and surrounding muscles):
   • Planks — Lie face down with your toes on the floor. Keep your back straight as you raise yourself off the ground, resting on your toes and forearms, which you should place on the floor with your elbows at 90-degree angles. Hold for 15–45 seconds.
   • Back extensions — Lie face down with your elbows bent so that your hands are flat on the floor. Keeping your hips pressed into the floor, arch your back and press with your arms so your head and shoulders are off the floor. Hold for five to 10 seconds and repeat five to 10 times.

Getting the Proper Shoes and Braces

1. Get shoes that are comfortable and have plenty of cushioning. Shoe store salespeople will talk to you about ankle pronation, impact pattern, and plantar shape — i.e. the imprint of the bottom of your foot — but recent studies indicate that to prevent injury, you are best off simply picking a shoe that you find comfortable. It turns out that people are very good at intuitively picking shoes that will work best for their style of movement.
   • One exception to the “pick shoes by comfort" rule is if you have flat feet. In this case, you will probably need special shoe inserts and arch supports.
   • Save high heels for special occasions. Wearing them too frequently can lead to chronic knee pain.
2. Replace your shoes regularly. Particularly if you run or walk a lot, it is important to replace your shoes before the soles get too compressed. If you begin to experience sore arches, shin pain, or achy knees, then it’s time to replace your shoes. It’s better, however, to replace them before pain appears.
   • Keep a log of how far you walk or run each day. Replace your shoes when you have covered between 400 and 600 miles.
   • The specific distance will depend on your weight and running style. Heavier runners and runners with longer strides will need to replace their shoes sooner.
   • If the bottom of your shoes becomes worn down and smooth, replace them.
3. Wear knee braces to reduce the risk of injury during sports or while performing dangerous activities. Braces provide added support to the knee ligaments. Particularly if you are playing a collision sport (football, lacrosse, hockey, rugby), knee braces have been shown to reduce the risk of knee injury. Players of contact sports (basketball, soccer) and sports that requires rapid changes of direction (tennis) may also benefit, as many people engaged in activities that pose a significant risk of knee injury, such as skiing. Talk to your regular doctor, a sports medicine doctor, or an orthopedist about the right brace for you.
   • Prophylactic — For athletes in contact sports. These braces, designed to protect ligaments, attach above and below the knee, with one or two hinged metal bars connecting the sides of the brace.
   • Functional — For athletes in contact sports. These braces protect knee ligaments in a fashion similar to prophylactic braces, with a metal “shell” that is hinged on both sides of the knee.
   • Patellofemoral (sleeve) — For people suffering from knee pain or athletes looking for some knee stabilization. A brace made of elastic material – usually neoprene – that is designed to hold the patella in the proper position and thus reduce chronic knee pain. These braces offer some knee stabilization, but will do little to prevent ligament damage.

Protecting Your Knees During Sports

1. Perform a warm up routine including neuromuscular training. The PEP (Prevent Injury, Enhance Performance) and FIFA 11+ programs are free, 20-30 minute warm up routines that have been shown to decrease the incidence of serious knee injuries by 50% if used regularly. They focus on proper techniques for changing direction, jumping and landing. If you are a player, talk to your coach about adopting one of these programs, or try arriving early to warm up on your own.
   • Prevent Injury, Enhance Performance (PEP) — A 15-20 minute program performed 3 times a week, and consisting of a warm-up, stretching, strengthening, plyometrics (jump training), and sport specific agility drills. PEP was developed by the Santa Monica Sports Medicine Research Foundation, and the exercise details can be found on their website.
   • FIFA 11+ — A 20 minute program performed at least 2 times a week, and consisting of running exercises, strengthening, plyometrics (jump training), and balance exercises. Designed by sports scientists in conjunction with FIFA, it has been shown to reduce the number of injured players by 30-50%. Find the full program here.
2. Learn proper form for your sport. This might mean learning how to keep your pads low and hands out to protect your knees as an American football player, or how to tackle properly as a soccer player. Proper form will both make you a more efficient player and reduce the risk of injury to you and others.
3. Consider wearing a brace when playing collision sports. All sports that involve jumping and sudden change of direction pose a risk to your knees, but collision sports pose the added risk of injury through contact. Consider wearing a knee brace if playing American football, rugby, hockey, or lacrosse.

Tips

• If you feel knee pain developing, avoid further injury by resting, icing down your knee, using compression bandages and elevating the knee.

Warnings

• Consult a doctor within 72 hours if you believe you have injured your knee. Take weight and pressure off of the knee immediately until you can receive professional consultation.

Related Articles

• Maintain Fitness when Injured
• Strengthen Your Knees
• Handle a Knee Replacement
• Know if You Have Arthritis in the Knee
• Tape a Knee

Sources and Citations

See also

• Improve Your Fitness With Proper Sports Nutrition
• Do Water Aerobics
• Cross Train
• Choose a Personal Trainer
• Get Exercise Outdoors
• Do Core Exercises
• Heal Ligaments
• McConnell Tape Your Knee
• Rehab a Sprained Ankle
• Measure Your Thighs

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