By Gabrielle Finora and Taylor Wallach, RD, CDN, CSCS, ACE-CPT

 

Healthy knees are crucial for everyday mobility, yet knee pain is surprisingly common.  Our knees are one of the most important joints in our body.  Without them, our quality of life can suffer.  Knee pain is often not the result of a serious injury, but from neglecting the many muscles in your knee that support your body’s movement.  In this blog, we’ll explore four exercises that target key muscle groups around the knee to improve stability and relieve pain.

 

Squat Using a Slant Board

Average squats using a flat surface are good for your legs, but adding a slanted board or heel wedge can take your squat game to the next level.  Elevating your heels improves muscle activation and balance by increasing instability during the squat [1].  Studies show that using a 10° incline significantly increases muscle activation, promoting more muscle growth than a squat done on a flat surface [1].

How to Do a Squat on a Slant Board:

 

1. Set-Up: Place the slanted board on a stable surface.
2. Stand on Board: Position feet shoulder-width apart, heels higher than toes.
3. Engage Core: Keep core tight, chest up, arms in front for balance.
4. Lower Down: Push hips back, bend knees, and lower until thighs are parallel, keeping your knees behind your toes.
5. Rise: Press through your heels to stand back up.
6. Repeat: Perform the desired number of reps with controlled movements.

Tips for Proper Form:

 

• Maintain Stability: Keep your core engaged to help stabilize your body on the slanted surface.
• Avoid Knees Caving In: Ensure your knees stay aligned with your toes throughout the movement.
• Control the Movement: Move slowly and with control, especially when lowering, to avoid losing balance.

Walking Backward up a Hill or an Inclined Treadmill

 

Walking backward on an inclined treadmill or up a hill works different muscles than normal forward walking, like the glutes, hamstrings, shins, and core.  While it may feel awkward at first, this exercise has proven to improve balance, stability, and muscle tone [2].  Studies have shown that walking backward can even relieve common knee pain caused by runner’s knee [3].

 

Not only does this exercise help your muscles, but it can also keep your brain sharp.  Because walking backward isn’t how we normally move, your brain will need to make new connections, called “synapses”.  Doing things we don’t normally do forces the brain to adapt thereby improving brain “plasticity”, or function [4].

 

How to Walk Backwards on a Treadmill:

1. Set Speed: Start the treadmill at a slow speed (1-1.5 mph).
2. Position: Stand facing the back of the treadmill, holding the handrails.
3. Step Back: Slowly step backward, one foot at a time.
4. Maintain Balance: Keep your core tight and stay upright.
5. Increase Speed: Gradually increase speed as you get comfortable.
6. Slowly Increase Time: Try walking backward for 5 minutes, and slowly increase the duration as you get more comfortable.

 

Leg Extension with Isometric Hold

 

The next exercise to relieve knee pain is the leg extension with isometric hold, which primarily targets the quads.  Isometric exercises target specific muscles and involve contracting them without changing their length or the angle of the joint.  In other words, you are just holding a position against resistance rather than moving through a range of motion.  Don’t let that fool you- isometric exercises are still quite difficult.  While this type of exercise won’t improve speed or agility, adding it to your regimen will improve muscular endurance and stability and therefore, alleviate pain overtime [5].  In addition, isometric exercises can be a great option for those recovering from injury or currently experiencing pain, as they do not stress the muscles or joints the same way as more dynamic movements. 

How to Do a Single Leg Extension with Isometric Hold:

1. Sit Tall: Sit on a bench with both feet on the ground, core engaged, and posture upright.
2. Lift Leg: Straighten one leg and slowly lift it in the air with your foot flexed. 
3. Hold Position: Hold this leg parallel to the floor for about 5-10 seconds.
4. Maintain Balance: Bring the leg down slowly and repeat on the same leg for a set of 10. 
5. Switch Sides: Repeat on the other side.

Tibialis Raises

 

The final exercise we will talk about is a tibialis raise.  This exercise strengthens the tibialis anterior muscle located along the front of the shin.  It dorsiflexes (think “toes to nose” or walking on your heels) the foot on every step and is critical for running, jumping, and walking [6].  The tibialis anterior also contributes to inversion of the foot, which helps stabilize the ankle and support balance.  If these muscles aren’t strong enough, the impact of daily movement can take a toll on your knees, contributing to knee pain [7]. 

How to do Tibialis Raises:

1. Stand Tall: Stand with your back against a wall, heels a few inches away from it.
2. Lift Toes: Keep your heels on the ground and lift your toes as high as possible.
3. Hold: Pause briefly at the top, feeling the contraction in your shins.
4. Lower Slowly: Lower your toes back to the ground with control.
5. Repeat: Perform for the desired number of reps.

 

Final Comments

 

Knee pain is common and can often be alleviated by strengthening your leg muscles.  Incorporating these exercises into your routine can help to reduce knee pain and lower your risk of injury. 

 

If you are experiencing debilitating knee pain that prevents you from enjoying your life, consider meeting with a physical therapist or personal trainer.  A professional can tailor exercises to your specific needs, providing a more efficient and personalized approach.

 

 

References

1. Cho, M., Kang, J.-Y., Oh, J.-H., Wu, J.-G., Choi, E.-B., Park, S.-E., & Choi, M. (2017). The Effects of Performing Squats on an Inclined Board on Thigh Muscle Activation. Physical Therapy Rehabilitation Science, 6(1), 39–44. https://doi.org/10.14474/ptrs.2017.6.1.39 
2. Cha, H. G., Kim, T. H., & Kim, M. K. (2016). Therapeutic Efficacy of Walking Backward and Forward on a Slope in Normal Adults. Journal of Physical Therapy Science, 28(6), 1901–1903. https://doi-org.proxy.library.cornell.edu/10.1589/jpts.28.1901
3. Abdelraouf OR, Abdel-Aziem AA, Ahmed AA, Nassif NS, Matar AG. Backward walking Alters Vastus Medialis Oblique/Vastus Lateralis Muscle Activity Ratio in Females with Patellofemoral Pain Syndrome. Turk J Phys Med Rehabil. 2019 Apr 25;65(2):169-176. doi:10.5606/tftrd.2019.2445.
4. Bourne, A. (2023, November 27). Why Walking Backwards Can be Good for your Health and Brain. BBC News. https://www.bbc.com/future/article/20231110-why-walking-backwards-can-be-good-for-your-health-and-brain 
5. Laskowski, E. R. (2023, November 18). Are Isometric Exercises Good for Strength Training?. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/isometric-exercises/faq-20058186 ‘
6. Juneja P, Hubbard JB. Anatomy, Bony Pelvis and Lower Limb: Tibialis Anterior Muscles. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www-ncbi-nlm-nih-gov.proxy.library.cornell.edu/books/NBK513304/
7. Bueckert, S. (2024, May 9). Tibialis raises: Perfect This Move for Stronger Knees. Hone Health. https://honehealth.com/edge/fitness/tibialis-raises/