Knee & Hip Exercises

By Jonathan Chu, MD

Interventional Pain Medicine

PM&R

So today, let’s talk about knee pain, and one the very best natural ways of improving it, which is by strengthening the muscle group in front of the knee, which is known as the quadriceps.

So first, let’s talk a little about the most common cause of knee pain, which is osteoarthritis. If you’re someone who is experiencing knee pain and is watching this video right now, there’s a very high likelihood that the cause is osteoarthritis. In fact, it’s estimated that 7.6 percent of the population worldwide suffers from symptomatic knee osteoarthritis, which translates to more than 600 million people.

Now, by osteoarthritis, I am referring to the typical, garden variety of arthritis that most people suffer from. This involves the degeneration of the cartilage of the knee through normal wear and tear over the years and decades. As the cartilage wears down over time and is less healthy and robust, the knee joint is much more likely to develop inflammation, which leads to pain flare ups, stiffness, and sometimes even symptoms of the knee locking up or giving out.

When it comes to protecting the knee joint and stabilizing it, one of the most important muscle groups serving this function is the quadriceps femoris, also just commonly known as “the quads,” which I’m sure you’ve all heard of if you participated in any kind of sports growing up.

Now let’s take a deep dive into the quadriceps itself. It is located in the front of the thigh, and is actually made up of four separate muscles:

1. Vastus Lateralis (which sits on the outside of the thigh)

2. Vastus Intermedius (which sits in the middle)

3. Vastus Medialis (which sits on the inside of the thigh)

4. Rectus Femoris (which sits on top of the other 3)

Of these four muscles, the Vastus Medialis, on the inside of the thigh, is the most crucial for providing stability to the patella and the knee joint, though they all play a vital role.

In the front of the knee, these four muscles all converge into a tough fibrous structure of connective tissue known as the quadriceps tendon, which attaches to the patella, which is your knee cap bone in front of your knee. The tough and thick patellar tendon then arises from the patella, and then connects down to the tibia, or shin bone. Thus, when your quads contract, it serves to extend the leg, via the patella and its tendons. This is obviously an extremely important function that your leg needs to perform during every step you take when walking and running, and even when you’re just standing upright.

Now, as I said earlier, when the cartilage of the knee degenerates over time due to bearing the brunt of everyday life, as well as the various strenuous activities that you may be engaging in, your knee joint will be much more likely to develop painful inflammation and flare-ups.

Thus, the question then becomes, how do you protect the knee joint, slow the rate of cartilage degeneration, and also decrease the frequency and severity of flare ups, and do so naturally?

Though there are a few different strategies you can use to do so, one of the simplest and very best is to work on strengthening the quadriceps muscle. A strong and robust quadriceps muscle stabilizes the knee joint and thus helps to support and protect the joint, decreasing the wear and tear on the joint, slowing the degeneration of the joint cartilage. This decreased stress on the joint also leads to fewer and less intense pain flare-ups over time. In addition, a strong vastus medialis, in particular, will help the patella track properly in front of the knee as you move, which is why many rehab and sports medicine doctors consider this muscle to be the most important of the four.

Now, let’s talk about 3 of the simplest and best exercises for strengthening quadriceps that you can incorporate into your home exercise program right away.

The first is the leg extension, which is a very simple and popular exercise.

To do this, I want you to sit upright in a chair. Then, in your affected leg, you should tighten your quads, and then slowly straighten and raise your leg. You should hold that position for about 5 seconds before you lower your leg again back to the rest position. You should do this for about 7 to 10 repetitions, and try to aim for about 3 sets per session.

Now, if you are someone who is more advanced or athletic, and feel up to it, you can actually add resistance by adding an ankle weight, or go to the gym and use the leg extension machine with a level of resistance that you feel to be appropriate.

As a quick aside, the leg extension machine is actually an exercise that I added to my own regimen at the gym, starting back when I was in my pain medicine fellowship. During that time I started doing a lot of procedures and would be on my feet for 8 to 10 hours a day wearing fairly heavy lead to protect from the fluoroscopy, and so even at only 30 years old I started getting some knee pain while doing the procedures. Fortunately, adding this exercise to my routine actually resolved my own knee pain, and I still do the exercise regularly at the gym to this day. It’s probably my favorite quadriceps exercise because it’s very simple and it works very effectively.

Now the next exercise I want to discuss is the half-squat.

For this exercise, I want you to stand with your feet about shoulder width apart, and then reach your arms out in front of you for balance. Slowly lower your hips about 10 inches, almost like you’re about to sit down into a chair. Hold the squat for about five seconds before pushing up back through your heels and returning to the standing position. You should do this for about 7 to 10 reps, and aim for 2 to 3 sets per home exercise session. Also, if you’re someone who’s quite athletic and want to make the exercise more challenging, you can hold a kettlebell or dumbbell while doing the squats.

I also really like the half squats because they are simple and easy to do, and you can really do them anywhere, even in your office or in a hotel room.

Now the last exercise I want to talk about is the straight leg raise. 

For this exercise, I want you to lay flat on your back on the floor on an exercise mat. Your unaffected leg should be bent with your foot flat. Your affected leg should be held in a straight position. Next, you should tighten your quadriceps muscle and then raise your affected leg about 6 to 10 inches off the ground, and then hold it there for about 5 seconds before returning to the rest position. You should strive to do this exercise for about 10 reps, and aim for 2 to 3 sets per session. As with some of the other exercises, you can actually wear a 5 to 10 lb ankle weight for the exercise if you want to make it a little more challenging.

You can experiment with the 3 different exercises and their variations in order to figure out what feels best for your body, and develop a customized home exercise program that works best for you. Usually you have to be consistent with these exercises for a few weeks before you notice a difference in your pain symptoms, as your quadriceps muscle has to actually get stronger for you to see the effect. The consistent effort is definitely worth it, as most patients who put in the work to build up their quadriceps will notice that their knee becomes far better supported and robust, and also, more importantly, far less painful.

So that concludes my video on the quadriceps muscle, and hopefully you were able to learn why it is so vital for protecting the knee joint and improving pain from osteoarthritis, and also a few very useful, easy, and practical exercises for strengthening the muscle. If you found the video valuable, feel free to like and subscribe, and also check out the official website, which has a lot of free articles and learning resources, link in the description below. This is Dr. Chu with 360 Pain Academy, take care until the next video.

References:

Benzon, H. T., et al. (2018). Essentials of pain medicine (4th ed.). Elsevier.

Braddom, R. L. (Ed.). (2010). Physical medicine and rehabilitation (4th ed.). Saunders/Elsevier.

Cuccurullo, S. J. (2004). Physical medicine and rehabilitation board review. Demos Medical Publishing.