Knee Pain?
Look Up and Down and All Around

By Margo Scheet

Urban walkers and hikers alike find knee pain to be one of the most common injuries keeping them from sticking to their exercise program. Why is knee pain so prevalent among the general public? Examining the joints above and below the knee can shed light on the issue.

The knee joint is at the mercy of the foot and the hip. Any biomechanical faults that plague the foot, ankle, or hip can easily affect the knee. Consider the basic motion the knee joint performs: extension and flexion, forward and backward movement within one plane. If the knee is allowed to move within this one plane, it often will operate without complaint. Now consider the motions we have available at our ankles and hips: Flexion and extension, side-to-side movement, and rotational movement.

It is this variety of joint motion that allows us to move in many directions; however, for the single-plane knee joint caught in the middle of two very dynamic siblings, it can spell trouble. If our feet roll in too much (over-pronate), or roll out too much (over-supinate) they can pass problematic forces to the knee. Weak hip and trunk muscles can alter the way the femur (or thigh bone) moves, thus causing poor alignment at the knee.

So what do we do? We have to keep the foot and hip in line with the knee. This means wearing shoes with good support and properly strengthening our hip, gluteal, abdominal, and back muscles (commonly referred to as the “core”). It also means walking with good posture and using caution when walking on surfaces that ask the knee to work at an angle.

For many years, the common advice given to people with knee pain was to “strengthen your quads.” The quadriceps are the series of four muscles that run from the front of the hip down the thigh. Although strong quadriceps do help to control knee motion, more and more medical professionals are realizing that the quadriceps alone cannot save the day. It is also important to keep the muscles on the sides and the back of the hips strong. In other words, we need to use the rear end to help the knee.

When done properly, squats and lunges can help build hip strength; however, if you are currently suffering from knee pain, you’ll need to build up to these motions with exercises that are less taxing to the legs. Talk to your doctor or see a physical therapist to assist you with an exercise program that is safe for your knees.

So what can you do on your next walk to help your knees? Start by standing tall and keeping your abdominals tight. Don’t forget to swing your arms as you stride. If you are walking uphill, lean forward slightly so you can use those powerful hip muscles.

Walking downhill requires special attention. This shouldn’t be the easy part of your walk. If your knees are flexing rapidly and your feet are pounding the ground, you probably are allowing extra shock to go to your knees. Proper form downhill means controlling the descent.

Are you a city or suburban walker? Watch the slope of the road. If you are always walking the same loop in the same direction, you might be continuing to load one of your knees with more force. Reverse your walk once in a while or look for asphalt roads or paths that allow your legs to be level, rather than one leg being lower or more angled. Concrete sidewalks are a less forgiving surface than asphalt. If you can find a hard-packed dirt trail, consider doing some of your walks on this surface. It is easier on the joints.

Solving the puzzle as to why your knees hurt can be a challenge. Remember there are many factors that can affect how your knees feel when you walk. That means there are many ways you can improve your comfort while walking. Talk to a physical therapist if you have chronic knee discomfort or pain; that individual can help you create a plan to take charge of your pain.

Margo Scheet is a physical therapist at BioSports Northwest in Seattle, WA. She specializes in biomechanics, gait analysis, and custom orthotics to help runners and walkers alike discover how they can move with less pain. Margo can be reached at margo@biosportsnw.commargo@biosportsnw.com