STRETCHING
The first step in injury prevention is maintaining proper muscle length on both sides of the leg. The stretches are basic, but should be done on a consistent basis (see diagrams below). All stretches should be performed as two, 30-second holds, once a day.

Hip Flexor Stretch

Hamstring Stretch

Quadriceps Stretch

Calf Stretch

STRENGTHENING
The next step is strengthening. When strengthening to prevent knee injuries, the focus is at the hip and trunk. In order to produce controlled movements, you must have a strong base for the leg. At the hip, there are two groups you want to focus on, the hip abductors (outside of the hip) and the hip external rotators (deep in the buttocks). When performing these exercises the movement should occur at the hip joint, not in the low back. In order to prevent back movement, gently pull your belly button toward your spine, engaging the abdominal muscles, without holding your breath. Hip Abduction: Lay on your side, with the bottom knee bent and the top knee straight. Keep your abdominals engaged and lift the top leg toward the ceiling, without allowing your pelvis to roll back. Repeat three sets of 10 repetitions on each side. Hip external rotation (Clamshells): Lay on your side, with both knees bent to 90 degrees and the legs stacked on each other. Roll your pelvis forward slightly, angling your belly button toward the floor. Keeping you pelvis in that position and your feet together, lift up the top knee as if your legs were a clamshell. Again, do not let the pelvis roll back and repeat three sets of 10 repetitions on each side.

Hip Abduction

Clamshells

MOTOR CONTROL TRAINING
Once you are stretched out and have the strengthening exercises mastered, it is now time to incorporate everything and learn how to control your movements. When standing, the alignment of the knee as it bends is controlled by the hip. You may find that when you squat down, your knees have a tendency of coming together. This is because the femur (thigh bone) is rotating in, causing the knee to follow. This movement is prevented by the hip external rotators, which luckily you have already started to strengthen. When performing the following exercises, it may be helpful to do them in front of a full-length mirror so you can watch your knee movement. To begin your training, start with the 3-way Toe Touch: Stand on one leg, keeping your hips level. Reach forward with the foot, tapping the toe on the ground, while slightly bending the other knee. Watch the knee alignment of the leg you are standing on, to make sure the knee does not collapse in. Come back to the starting position. Repeat the movement, tapping the toe to the side and back. Perform three sets of 10 laps on each leg. When this activity has become easy and you want a challenge, progress to the Balance Reach (as above), again paying attention to the knee alignment.

The key to any stretching and strengthening program is consistency. While these exercises will not prevent all knee injuries, they are a great start to helping you stay active and keep that annoying knee pain at bay.

3-Way Toe Touch

Balance Reach