Months or years of pain usually leave your knee, hip and calf muscles extremely weak. These weak knee muscles, in particular, are no longer able to act as shock absorbers, so your knee joint receives even more force, causing even more pain.

Knee Strengthening – Where to Start!

The first rule is it’s not NO PAIN - NO GAIN. For those of us with knee pain - it’s IF YOU HAVE PAIN - DO NOT TRAIN. What this means is - if an exercise or activity hurts or causes you knee pain - don’t do it. Modify your activity or do something else. More pain actually decreases your healing ability and makes you worse, not better, over time. Find some activity or sport you can do without pain!

Knee Strengthening Exercises fall into four categories – pain relieving, strengthening, flexibility (stretching), nerve and muscle (neuromuscular) re-programming.

Knee Strengthening – Basic

It’s best when you combine knee strengthening exercises with other natural anti-inflammatory supplements and treatments. Ideally, you perform your knee exercises under the guidance of a qualified medical professional.

#1) Cycling or Biking – A good starting arthritis knee exercise. The knee cartilage does not get its nutrients from blood, but from joint fluid. This joint fluid needs to be moved around in order to deliver the nutrients to the cartilage. Cycling is the best way to do this. At first, use an indoor bike and pedal at the lowest resistance levels of 0 or 1. Spin the pedals at around 100 rpm. Make sure you set the seat position so that your extended knee is almost-but-not-quite-straight. If this bottom position hurts your knee, then adjust the seat until you have no pain.

The reason I recommend an indoor bike is because it’s easier to control while you are building up your strength.

Once you can spin for 15 – 30 minutes with no pain, gradually increase the intensity or resistance level. Cycling is best done three times a week – daily is even better.

As you get stronger, you could switch to an outdoor bike.

#2) Elliptical Machine - Some people find the elliptical machine easier to use because it reduces the bodyweight on your knees. There are two types of machines – fixed-stride- length (older) and variable-stride-length (newer). Most people prefer the latter because they can adjust the machine to accommodate the particular length of their own stride. Again, the idea, at first, is just to move fluid in the knee. Start with level 0 for 15 – 30 minutes. When you can do this without pain, gradually increase the resistance level.

#3) Tai Chi or Chi Qigong – One of the best exercises for knee pain, these ancient Chinese movement arts are wonderful for your knees and overall health. They have two major benefits – nourishing and strengthening your knees, while boosting your natural painkillers called Endorphins. Give them a try. See if you can work up to three times a week.

#4) Swimming – This is a potentially great exercise - but troublesome for some of you with knee pain. The problem is both the flutter and whip kick which often aggravate knee pain. You may need to modify your kick, or kick less, in order to swim without pain.

#5) Walking - This is a wonderful knee exercise for pain reduction because your bodyweight is reduced in half compared to when you run or jog. Start out by walking as far as you can without pain. Gradually, work-up to 30-60 minutes, daily.

Once your knee pain starts to go away, then you’re ready for strengthening exercises. It’s difficult to strengthen your knee when you're in pain. There is a neurological circuit in the body that will prevent you from contracting your knee muscles when you are in pain.

One of the major mistakes some people make is to start full-fledged strengthening before they’re really ready – all that does is flare-up the existing knee pain.

Your knee muscles are probably quite weak from being in pain so long. It’s time to strengthen the muscles in front (called extensors), the hamstrings behind (called flexors) as well as the muscles in the hip.

Lifting weights in a professional gym, a physical therapy facility or a good home gym is the best choice for strengthen your knees. Some of you may be so weak that you should start off with even lighter resistance from Thera-bands. Once you’re stronger, you can move up to weights. The following routine works for both weights and Thera-bands.

Knee Strengthening Exercises - More Advanced

• Knee Extensions

• Hamstring Curls

• Leg Press

• Hip Abductors (opposite of Thigh Master)

• Hip Adduction (like Thigh Master)

Sets and Reps

Train for 15 minutes, three times a week. Start out with 3 sets of 15-20 reps for each exercise. That means that you should repeat an exercise movement 15 to 20 times (that’s one set); wait 1 minute and then do another set; wait and do a third. If you can easily do 20 or more reps, increase the weight so you can only do 15.

Full Range of Motion

Go for a full range of motion - except with the Leg Press. If you have pain at one end or the other of any exercise, always stop short of that point.

When performing the Leg Press, don’t go past 90 degrees as you let the weight down, or extend fully to a straight leg on the way up. Do not lock out at the top. Keep your knees bent slightly at the end range of the movement or else you’ll put too much pressure on your knee cartilage. If the Leg Press is too painful, as an alternative, try 90-Degree Wall Squats held for up to 3 minutes.

Helpful Hints For Better Strength Results

• Squeeze at the end or top of the exercise - contracting your muscles as hard as you can for 2 seconds

• Move the weight slowly to eliminate momentum, counting 5 seconds up and 5 seconds down

Exercise Order

Try the exercises in the suggested order. Start with Knee Extensions, Leg Curls, Leg Press then Hip Adduction and Abduction.

The above is a basic routine for specific knee strengthening. As you get stronger, you’ll be ready for an advanced exercise routine.

Knee Rehab Exercises for flexibility (stretching), mobility, and neuromuscular re-programming are covered another article.

Hopefully, these knee strengthening exercises will help give you long-lasting pain relief and save you from a knee replacement in the future.