How to Grow Strong Knee Joints

[ read time ~ 6 minutes ]

I grew up in the Midwest, and my grandma had an exceptional garden. She did not rush the harvest of the corn, green beans, lettuce, radishes, or zucchini. But she did optimize their growth.

She planted marigolds near the tomato plants to discourage pests. And she fertilized with what my mom referred to as "black gold" or cow manure. (As a child, I was not impressed by its fragrance, but Uncle Marvin and Uncle Glen assured me that it “smelled like money.”)

These practices did not necessarily speed up when Grandma’s vegetables would be ready to eat, but they did improve the outcomes. Fertilizer increased the size of the produce. And the crop was more plentiful when fewer insects fed on the plants.

My grandma’s gardening wisdom also applies to healing and strengthening knee joints:

Fertilize frequently.
Discourage Pests.

Part 1: Knee Joint Fertilizer

Fertilizing fortifies plants. It creates an environment for them to thrive. Likewise, there are ways to help knees thrive-- methods of supporting and strengthening deep inside the knees.

The Quad Set is an exercise that improves the quality of the fluid inside of knee joints. By tightening the muscles on the front of the thighs, it thickens the joint fluid to provide better cushion and lubrication. Consistently performing Quad Sets -- completing about 10 repetitions, repeating this several times per day, and doing so over multiple weeks -- is also associated with less knee pain.

Another way to “fertilize” the knee joint is by gently moving it. Moving the knee with the right amount of pressure promotes the integrity of the surfaces inside the knee. These surfaces consist of a substance called cartilage. Cartilage covers and protects the end of bones. When cartilage is healthy, it provides a smooth, firm surface for movement to occur. When cartilage weakens, it is softer, and it’s frequently referred to as chondromalacia. (“Chondro-” is latin for cartilage, and “-malacia” means softening.)

Moving with the right amount of force strengthens cartilage by making it more firm.

But if too much force is used during movement, it will cause the cartilage to weaken. For example, if bodyweight squats cause knee pain (during the exercise or even the following day), the force on the knees is harmful. In this case, rather than strengthening the cartilage, the squats are actually weakening or softening the cartilage.

The solution requires making the exercise easier and easier until the knees do not become painful or swollen during or afterwards. In the case of squats, lying on a Variable Incline Plane allows someone to perform the squats with only a fraction of their body weight. For a demonstration, watch this.

Another way to use less body weight during a squat is to sit down and stand up from a chair using arm assistance. This does not not require equipment, but it’s also not as precise because it’s difficult to measure how much assistance the arms are providing. And in many cases of knee pain, the knees demand a decrease in pressure that requires more strength than the arms can produce.

Other methods to achieve knee motion include easy cycling and some elliptical machines, especially those that can be used while sitting. (This one is an example. Note: I have no financial interest in this model or in any of the equipment I recommend.)

Options for gentle knee motion that do not require exercise equipment include sitting in a rocking chair. By resting your feet on the floor while you rock in the chair, a gentle, lubricating motion occurs in the knees. Or many of my clients perform Sitting Sliders by using a furniture mover, a dust cloth, or something that decreases the friction under their feet to effortlessly create knee motion.

All of these forms of knee motion need to feel good or neutral to realize the benefits for the cartilage. If Sitting Sliders are uncomfortable, this video shares five options to improve them.

(For more information on this topic, read my colleague Doug Kelsey’s article How Knee Joint Cartilage Heals; watch my YouTube video How do I Get Rid of Sitting Knee Pain? ; or read my article Can You Rebuild Knee Cartilage?)

Part 2: Eliminate Knee Joint Pests

Pests damage plants. And activities that cause knee pain or swelling damage knee joints. The first step in eliminating the offending activities is identifying them.

Some will be obvious. When knee pain occurs while walking down stairs, sitting at a desk or in a car, and running, these are all aggravating activities.

But other activities are more mysterious culprits. They are difficult to identify when knees feel fine during the activity, but knee pain, and possibly swelling, occurs later.

Someone may hike without any discomfort, but wakes up the following morning with a stiff and sore knee. The initial reaction to the knee pain, when walking from the bedroom to kitchen, may be confusion: “That’s strange. I wonder why my knee is hurting. It was fine yesterday when I was hiking, and hiking is definitely harder than walking in my house.”

Since cartilage doesn’t have nerve supply, there is not an immediate message sent to the brain that the forces -- in this case, from hiking -- are more than the cartilage can withstand. The message is not delivered until hours later, or even the next day, and comes from the inflammation (i.e., irritation) of the nearby joint lining, a tissue that does have nerve supply.

Given this delay in experiencing symptoms, people tend to unknowingly continue activities that hurt their knees. The knee pain fades, they go hiking again, and their knees hurt the following day. This type of pain may become more intense over time.

Regardless of whether the activities causing knee pain are obvious or not, they must be eliminated to facilitate strengthening.

Strong knees and healthy plants are both difficult to achieve when pests are abundant-- even in the presence of good fertilizer.

To learn how some of my clients have strengthened their painful knees, read about Andrew*, Amanda*, Bill*, or Keith*.

My colleague, Doug Kelsey, PT, PhD, and I have developed Better Knees for Life, a program for people with tolerable knee pain. Better Knees for Life offers step-by-step instructions that can be performed at home with very little equipment.

What people are saying about Better Knees for Life :

"...well thought out, easy to understand and implement."

"It is almost like a computer algorithm. (That's how clear it is!)"

"BKL (Better Knees for Life) is an outstanding program -- with graded exercise programs and guidelines for advancing, and outstanding support with the Zoom sessions."

"I've already recommended BKL to 2-3 friends because of the noticeable difference in reducing pain in my left knee."

Better Knees for Life helps you get stronger, feel better and maybe best of all, feel more in control of your life.

To determine if working with me is a good fit for you to strengthen your painful knees, schedule a Strategy Session by clicking here.

Help your friends: share this article by clicking a button below.

*pseudonym

As I was cleaning out my closet, I found something from roughly 18 years ago.

A cycling jersey.

(It’s pictured below.)

But I’ve never been a competitive cyclist.

When I moved to Austin almost two decades ago, I was looking to meet people in my new city.

So I attended a Saturday cycling workshop.

We learned bike maintenance, and then we went on a hilly group ride.

I had such a great time!

But the following day, I had burning, achy pain on the front of my knees.

And it didn’t just go away on its own.

At the time, I was struck by how something that I was told in physical therapy school – that biking is good for your knees – had somehow caused my painful knees.

What was going on?

When I stopped to think about the people whom I had helped in my initial years as a physical therapist, I recognized that:

Some of them reported that biking made their knees feel better.

But others who rode a stationary bike for several minutes in the clinic reported that their knees felt worse.

And sometimes they didn’t feel this increase in knee pain until the next day.

Fast forward to today:

My knees feel great.

I enjoy rigorous hikes, weight lifting, yoga, pickleball, and yes, even hilly bike rides!

And I’m frequently asked this question:

When it’s strong, your cartilage is a firm substance.

And when it’s healthy, your synovial fluid is thick.

Stronger, healthier knees – your cartilage and your synovial fluid – are able to withstand more force (more "squishing") without pain.

If your knees are not strong and healthy enough to withstand the forces from your activities, your knees will likely become sore, achy, stiff, or swollen.

4 ways that force affects your knees

> If you don’t place enough force on your knees, your knees will weaken.

This occurs when someone is more sedentary for a season or an extended period of time.

> If you place too much force on your knees, your knees will weaken.

Force that exceeds what your knees can withstand occur with:

high force applied quickly (during a single impact, such as a fall or a car accident),
low force applied over a longer period of time (staying in a certain position, like sitting or standing), or
repetitive forces (movements, including hiking, running, squatting, biking, and pickleball).

> If you place the right amount of force on your knees – not too little and not too much – you’ll maintain your knee strength.

This means, if you're experiencing either constant or periodic knee pain, those sore, achy, stiff, sharp, or swollen sensations don't go away.

> And if you start with the right amount of force on your knees, and then gradually place more and more force on your knees, your knees will get stronger.

Step 1. Identify your biking tolerance.

This involves determining the type, duration, and intensity of biking that feels good or neutral for your knees.

The type of biking you choose may be a stationary bike, a road bike, or a mountain bike.
The duration refers to how long you ride your bike.
The intensity of biking is determined by factors including how fast you pedal and the resistance you’re using. (Resistance may be set on a stationary bike. On a road/mountain bike, the resistance will depend on elevation changes and on the gears you choose.)

If you get knee pain, stiffness, or swelling during or after biking, you have exceeded your knees’ tolerance for biking.

Allow those symptoms to resolve before your next bike ride.

(If you’d like some additional guidance with this step, watch this video.)

Step 2. Establish your biking baseline.

Using the type, duration, and intensity that you identified in step one, ride your bike 3 times per week on non-consecutive days.

Repeat this during a second week.

IF you experience any knee soreness, stiffness, swelling, or pain, adjust at least one biking variables (the type, duration, and/or intensity of your biking) until you can complete step two without causing knee symptoms.

You’re ready to move on to step three when you have found a type, duration, and intensity of biking that you can perform three times per week for 2 weeks – without causing knee symptoms.

Step 3. Advance your biking.

Option A: Increase your biking duration by roughly 10 - 20%.

Let’s say your baseline for biking was 20 minutes on Tuesday, Thursday, and Saturday.

In this case, advance to 24 minutes on three non-consecutive days the following week.

IF your knees feel good or neutral during and after these 24-minute rides, continue advancing your biking duration by 10 - 20% in the subsequent week.
IF you experience knee pain, swelling, or discomfort following these 24-minute rides & these knee symptoms resolve completely within 36 hours, continue with three 24-minute rides the subsequent week.
IF you experience knee pain, swelling, or discomfort following these 24-minute rides & these knee symptoms persist for longer than 36 hours, do two things: (1) allow your symptoms to resolve before continuing, & (2) drop your duration by at least 10% during the subsequent week. (For example, instead of three 24-minute rides, bike for 21 minutes on three non-consecutive days.)

Option B: Gradually increase the resistance while you’re biking.

So if your baseline for biking was 20 minutes on Tuesday, Thursday, and Saturday, you’ll continue to ride for 20 minutes on three non-consecutive days, and you’ll gradually increase the resistance.

Resistance is measured and adjusted most easily on a stationary bike.

It’s possible to increase resistance while riding a bike outside by starting on a flat road, then one with some rolling hills, and progressing to steeper or more frequent elevation changes.

During the week that you make a small increase in your bike’s resistance:

IF your knees feel good or neutral, continue advancing the resistance during 20-minute bike rides the subsequent week.
IF you experience knee pain, swelling, or discomfort & these knee symptoms resolve completely within 36 hours, continue with that same small increase in resistance the following week. (Hold off on increasing the resistance additionally.)
IF you experience knee pain, swelling, or discomfort & these knee symptoms persist for longer than 36 hours, do two things: (1) allow your symptoms to resolve before continuing, & (2) decrease your resistance during the subsequent week.

Pro Tip: Choose either Option A or Option B – not both.

My clients know this is what I frequently refer to as “limiting the variables.”

If you experience an increase in symptoms after simultaneously making two types of changes, such as increasing duration and resistance, it’s difficult to interpret what your knees are saying.

Are your knees saying they didn’t like how long you biked?

Are your knees saying they didn’t like how hard you biked?

Or are your knees saying that the duration and the resistance were fine, but both increases together were too much?

Having this level of insight gives you greater clarity on how to proceed.

Step 4. After three weeks of advancing your biking, repeat steps one through three.

When you’re able to advance your biking (duration or resistance) during three separate weeks – without experiencing an aggravation in knee symptoms – reassess your bike tolerance (step one).

This involves determining the type, duration, and resistance of biking you can do while your knees feel good or neutral, during and afterwards. (Review how to do this within step one above.)

Using your newly determined bike tolerance, ride your bike 3 times per week on non-consecutive days.

Repeat this during a second week.

When you’re able to complete two weeks of biking three times per week – without causing knee symptoms – you’re ready to move on to step three. (For additional guidance, review step two above.)

Finally, repeat step three (above).

Takeaways:

When you’re using your quadriceps or hamstrings, these leg muscles pull your thigh bones and shin bones together.
This “squishes” everything in between – in particular, the cartilage and the synovial fluid in your knees.
When these parts of your knees aren’t strong enough to withstand the forces from your activities, knee pain, swelling, or stiffness results.
By placing the right amount of force on your knees and gradually increasing these forces, your knees will get stronger.
Stronger knees will allow you to be more active without knee pain.

Let's build Better Knees together!

How to Grow Strong Knee Joints

The 5 step process to strengthen your knees with a bike:

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