Here is a short and sharp explanation of why and what we should be doing:
Often people are told to strengthen up their quads and get their legs strong to help knee pain but really is this the best way to do it?
The answer is no. There is a lot of evidence when it comes to anterior knee pain (also known as patellofemoral pain) that rehabbing proximally is much more effective the strengthening the knee and quads alone. Proximally means working on the muscles further up the chain, closer to your spine, such as your:
- Hip abductors
- Hip external rotators
In fact, a thorough systematic review was published recently which showed that compared to quads strengthening:
- There is strong evidence that proximal rehab, combined with quads strengthening had better pain reduction
- Proximal rehab alone and combined with quads strengthening results in better functional gains
- Proximal rehab, was better in the short and long-term.
This basically shows us that when it comes to knee pain, it isn’t often the knees fault. We need to look up the chain at what controls the knee – The hip. Including rehab exercises that improve him strength and neuromuscular control has much better effects in outcome in both the short and long-term and cannot be ignored.
So what exercises should you be doing?
Type of exercise: This should be a combination of closed chain (feet/foot in contact with the ground) and open chain exercises in a comprehensive rehab program.
Frequency of exercise: Exercises that aim at neuromuscular training and stretching/foam rolling can be performed daily, whereas strength training should be aimed for 3 x weekly.
What knee pain exercises work well?
Conclusion: Proximal rehab should be included in all rehab programs for anterior knee pain and if in doubt, go and see your local physio for best results.