The knee joint is one of the most common pain points among lifters and the rest of the physically active population alike. But, unlike lower back and shoulder injuries that often seem to occur in a split second, knee pain tends to present as a chronic problem that becomes more painful and limiting to training and function over time.

Chronic achy and painful knees can be just as limiting as those other body parts, but because many athletes seem to accept this pain as part of the athletic life rather than something they have control over, they just keep doing what they're doing—and making things worse.

It's time to start training smarter around chronic knee pain, while also working to bring up glaring weak links that may be helping cause the problems in the first place.

Here are three simple, yet highly effective methods to combat chronic knee pain.

1. Mobilize the Front Side of the Body

Chronic front-sided knee pain that occurs at, below, or adjacent to the knee cap is perhaps the most common knee pain condition, and it can be caused by a multitude of reasons. But many of these complex problems can be improved, if not eradicated, by paying some attention to the front side of the leg.

The quadriceps group is comprised of four key muscles that all play roles in extending the knee, and that all attach onto a common quadriceps tendon.

However, one particular quadriceps muscle tends to be a linchpin of pain in the lower body. The rectus femoris, which travels along the midline of the thigh, has attachment points that cross both the hips and the knee. This makes it a key area to mobilize for helping to alleviate both chronic tightness in the hip flexors, and pain at the knee.

The most effective way to alter the relative tightness of this muscle group is the rear-foot-elevated hip flexor stretch. Done properly, it can also improve control and coordination of the hips and core, allowing you to create mobility that actually transfers into movement patterns. This is why it's an essential part of the warm-up in my lower-body workout in Unstoppable: The Ultimate Guide to Training Through Injury on BodyFit Elite.

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But here's one other key note: Rather than simply focusing on stretching, I recommend taking a bi-phasic stretching approach, meaning pulse in and out of the end range stretched position with micro-movement oscillations for 30 seconds. Then, hold the stretched position for an additional 15 seconds.

2. Strengthen and Stabilize the Back Side of the Leg

New-found mobility must be hardwired into your body's movement circuitry, and nothing does it like good-old strength training.

To rebuild painful and achy knees, we must place an emphasis on strengthening the posterior chain of the body, and in particular, the glutes, hamstrings, calves, and even the lower back. While there are many exercises and methods that target these tissues, the goal should always be to maximize muscular training while minimizing unwanted joint stress.

Exercises like calf raises, hip thrusts, glute bridges, and back extensions, all of which focus on one key muscle group working at a time, can be great for training around knee pain. Just ensure that you create a strong mind-muscle connection to keep quality up, and make every rep count.

However, because the hamstrings cross both the knee and hip joints, a little extra care for this area is essential. Seated or lying machine curls can do the trick for adding more training volume into the back side of the body, but for alleviating knee pain and bringing up dysfunctional movement patterns, I prefer to program exercises that target the hips moving into extension while the knees flex. Three of my go-to moves, in order of difficulty, are:

  • Exercise ball hamstring curls
  • Hamstring curls on heel slides
  • Glute-ham raises

Save room for these in your lower body training, and it will create a synergy of two of the biggest muscle groups in the body, the glutes and hamstrings. As I noted in my article "3 Fixes for Mysterious Knee, Back, and Elbow Pain," the stronger these hip muscles are, the less your body will feel the need to overwork the smaller, more intricate knee joint.

3. Improve Ankle Mobility

Big strength movements like squat variations are full-body exercises. However, it's easy to forget that the feet are the only part of your body in contact with the ground as you perform squats—and plenty of other movements.

This makes the feet and ankles pivotal regions to build mobility, stability, and function, if you want it to transfer into marquee activities like running and squatting. Put another way, as it's been famously quoted, not even a Ferrari can perform on flat tires.

So, if you're continuing to battle chronic knee pain even after mobilizing the front side of the body and strengthening the back, maybe your ankle mobility just needs a bit of a tuneup.

While ankle mobility restrictions can be as unique as the person who has them, most can be broken down into two key categories:

  • Soft tissue mobility deficits from tight calf muscles
  • A joint restriction in a part of the ankle complex called the talocrural joint, which allows plantar flexion and dorsiflexion of the foot

We can improve each of these two unique restrictions by either mobilizing the ankle joint, or working the soft tissues of the back side of the leg in order to alleviate chronic tightness.

For soft tissue work, focus on foam rolling and stretching the gastrocnemius, or true "calf muscles," as well as the deeper soleus muscle. For ankle joint mobility restrictions, I love the three-way ankle mobilization, which can open up mobility very quickly, allowing you to utilize it instantly in your training.

You Deserve to Train Without Knee Pain

Stretching your quads, adding in a few sets of hamstring curls, and touching up your calf or ankle mobility—these are minor things that only take minutes out of your week. But if you've been suffering from knee pain, they might be the best spent minutes of your week. Just like getting your upper-body training ratios in order can transform your shoulder health, just a little consistent work here will compound over time.

To see how these knee-friendly training principles translate into a full lower-body workout, or to learn other principles of pain-free training for the knee, back, and shoulder, check out Unstoppable: The Ultimate Guide to Training Through Injury.

About the Author

John Rusin, DPT, CSCS

John Rusin, DPT, CSCS

Dr. John Rusin is a coach, speaker, and writer who runs a sports-performance physical-therapy practice in Madison, Wisconsin.

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