Pain in the front of the knee with going down hill, down stairs, squatting, lunging etc.. can be caused from several structures getting irritated in the knee. But regardless of the cause, there is 1 muscle that is necessary to train for proper rehabilitation. 

THE QUADS! 

This group of muscles on the front of your leg has a direct impact on the stability and performance of your knee joint and we know that in cases of chronic anterior knee pain, the quad on that side is almost always weakened. 

The difficult part for many knee pain clients, is that traditional exercises that would strengthen the quad are the exact ones that cause pain. In this article, I want to share with you some of the nuance of how to improve quad strength and tolerance while training around knee pain. 

What I find most often is that most anterior knee pain clients feel the worse in one of two positions. The first is when locking the knee out straight which happens when the fat pads are irritated in the join. So for these cases, we want to temporarily avoid terminal knee extension when training. 

The second and most common position of irritation is when bending the knee typically approaching 90 degrees or deeper. This occurs when either the patellar tendon or the cartilage under the knee cap is irritated. For these cases we try to avoid temporarily loading in that deep knee bend range of motion. 

What this does mean in both circumstances is that there is almost always a mid-range that is tolerable. And this is where we will want to start with our quad loading work. 

While one of our primary rehab goals is to get the muscles around the knee stronger, we also obviously want to decrease pain and then gradually condition the knee to start tolerating load again. All of this be achieved through frequent dosing of long hold isometrics which is where I like to start with rehab. 

An isometric means we are essentially contracting a muscle but the joint angle isn't changing. For most people, isometrics are a low threat way to ease back into training and they also have an analgesic affect meaning that isometric contractions actually decrease pain (pretty cool!). 

So in the early stages of rehab I prescribe isometric exercises with longer hold times (usually building up to 1 minute) and then these can be performed frequently- several sets per session anywhere as often as 3x/wk up to daily. 

My favorite way to isometrically load the quad is going to be a specific wall-sit variation. I made a youtube video walking you through exactly how to set this up. Watch the video HERE. 

If you are dealing with nagging anterior knee pain, this exercise is a great place to start but you also need a plan to keep the needle moving forward. I encourage you to check out my 5-Phase Knee Rehab Program that will walk you through an entire rehab program. It will give you the structure and guidance needed to fully rehab your knee so that you can get back to running, hiking, squatting etc.. 

To learn more about this rehab program or to get start click the link below. And as always send me an email at [email protected] with any questions or if you just want to chat. 

Performance Knee Program

Yours in health, 

-Jamie