You have an idea of what’s causing your knee pain, and now you’re looking for effective treatments. Maybe you’re concerned about adding medications. Perhaps you’d like to try a non-invasive treatment. You think that more exercise might help, but what about physical therapy for knee pain? Does it work? Here are some of the key benefits (and ten exercises to get you started).
Is physical therapy good for knee pain?
We know that exercise is good for overall health and wellness, but what about physical therapy for knee pain? Does it actually work?
The short answer is yes.
In 2014, a study looked at which types of exercise were best for reducing pain and improving function in people with knee pain. Across the types of exercise studied, supervised exercise of all kinds was the most effective. It’s not enough just to get out on your own—a professional therapist made the difference.
This confirms earlier research findings that clinical exercise produced double the improvement over people exercising on their own.
Another recent study even showed that group physical therapy was effective at reducing knee pain. This is crucial for people who are concerned about covering the cost of private physical therapy appointments.
Finally, a meta-analysis of studies looking at the effect of exercise on knee pain found significant improvements in function and quality of life and a statistically significant reduction of pain. These results were true immediately following the exercise and for many months after.
Goals of knee pain physical therapy
Physical therapy for knee pain focuses on four main goals:
- Stretching
- Strengthening
- Restoring mobility
- Breaking up scar tissue
Your physical therapist will design a specific set of exercises based on your injury, your condition, and your long-term goals for therapy.
What types of knee pain is physical therapy best for?
Nearly all types of knee pain benefit from physical therapy. The old myth that you shouldn’t put pressure on a sore knee is just that — a myth. In fact, inactivity can actually make the vast majority of knee pain conditions worse.
For example, all types of arthritis respond well to physical therapy for knee pain — just check with your doctor first, proceed cautiously, and listen to your body.
If you are still in the acute phases of knee injury — the first 48 to 72 hours — the best course of action is usually rest and comfort measures. This includes the time directly after a broken bone is surgically repaired or set.
Likewise, if you experience an increase in pain after exercise (normal) that does not go away by the next day (not normal), stop your exercises and check in with your doctor.
Is walking good for knee pain?
Walking is good for knee pain, as long as your doctor approves. Walking on an even surface improves overall health, always a bonus, and begins to strengthen the body gradually. It is a low-impact exercise with benefits that are both physical and mental.
It’s a great complement to targeted physical therapy for knee pain.
The best physical therapy exercises for knee pain
It’s crucial that you start your physical therapy for knee pain with a doctor. They will refer you to a specialist who will make sure your form is correct and tailor a set of exercises to directly address your particular concern (and your anatomy).
Once you’ve gotten the okay from your doctor and therapist, you can also try these general knee strengthening exercises at home. Start with the first five stretches for knee pain before moving on to the last five strengthening moves.
1. Quadriceps stretch
If you experience knee pain after biking or hiking, tight quads and hip flexors might be to blame. These next two exercises help release those areas.
Start with the quad stretch. Stand next to a wall or use a chair for support. Bring your weight into the right foot. Bend your left knee, bringing your foot up toward the back of your thigh. Reach back and grab your foot. If you cannot reach your foot, loop a towel or a strap around it and use that to make contact.
Stand tall with a long spine. Engage the muscles of your core and be firm in the foot on the ground. Hold here and breathe for 30 seconds. As you relax, you might be able to move your foot closer to your buttocks, but don’t force it.
Release and repeat on the other side.
2. Stretching through the heel and calf
Tight calves and heels can bind the back of the knee and cause knee pain. This simple exercise begins to gently release this area of the lower leg.
Stand facing a wall and extend your arms in front of you, placing both hands flat on the wall at shoulder height. Slowly slide your right foot back as far as is comfortable (keep both feet facing the wall with the left foot staying in place). Begin to stretch the calf and heel by bending the right knee. Hold for 30 seconds, then step forward and switch.
Do this exercise at least twice on each side.
3. Hip flexor stretch
The hip flexor can be tight from tight quads and too much sitting. This puts extraordinary pressure on the front of your knee.
To stretch your hip flexors, come to all fours, with padding under your knees if you need it. Step the right foot between your hands and pause. If this is enough stretch in the left hip flexor, stay here.
To deepen the stretch, walk the left knee back. You can bring your hands up to blocks on either side of your right knee, or you can bring them to your right thigh. Make sure your right knee is directly over your right ankle. Breathe here for 30 seconds, then switch sides. You can also move directly into the next exercise before switching sides.
4. Hamstring stretch
Come to all fours, with knees padded if you need to. Bring your right foot up between your hands into a lunge.
Take a deep breath in, then begin to sink your hips back toward your left heel, pulling your right toes off the ground. Keep a slight bend in your right knee and only fold until you feel sensation in your hamstring. Avoid sudden movements, and back off if you feel a sharp or stabbing pain. You can use blocks for stability if you feel wobbly
Breathe here for 30 seconds, then inhale to come back into a lunge and switch sides.
5. Reclined figure four stretch
This knee physical therapy exercise is especially good for those who experience knee pain at night. When accompanied by deep, even breathing, this stretch releases tight hips and glutes, both of which can cause overworked upper thighs and tightness in the calves.
Lie on your back (in bed is fine), with knees bent and feet hips-width distance apart. Place your right ankle on your left knee. This might give you enough sensation — press your right knee away gently and relax and breathe.
If you’d like to go deeper, pick the left knee up and lace your hands behind your left thigh, pulling toward you with your right knee relaxed. Breathe here for at least 90 seconds (or for as long as five minutes), then release and move to the other side.
6. Chair pose
Build up strength in the quads and glutes with this classic yoga posture.
Stand with your feet hip’s width apart. Make sure your spine is tall, with the crown of the head reaching towards the sky and the tailbone reaching towards the ground. Your hands can rest comfortably on your hips.
Take a deep breath in, then slowly sink your hips back like you’re coming to sit in a chair. Keep your lower belly engaged to support your lower back. Continue to hold your tailbone under slightly. Look down and make sure you can see your toes — if you cannot, reach your hips back further without going lower.
Take five to ten deep even breaths before pressing into your feet to come back to standing.
7. Calf raises
These can be done on the ground (easiest) or on a stair or ledge (more advanced).
Stand with your feet hip’s width apart. If balance is challenging, hold onto the back of a chair (or railing if you’re on the stairs). Take a deep breath in, then lift both heels off the ground. Slowly lower on the exhale. The slower you go, the more benefit this exercise can provide.
Repeat three sets of up to ten repetitions each.
8. Side leg raises
These can help increase stability along the outside of your knee.
Lie on one side, legs extended, with your bottom elbow bent and upper arm resting on the ground, and your head resting in that hand. Your other hand can rest in front of you for balance. On an inhale, slowly lift the top leg. Make sure your toes face the direction you are looking. Pause at the top, then slowly lower on an exhale. Like the calf raises, the slower you go, the more benefit you may get.
Repeat three sets of up to ten repetitions each on each side.
9. Inner thigh lift
We often ignore the muscles on the inside of the legs, but they are crucial in supporting the knees.
Lie on your side. Come to one elbow, making sure your elbow is directly under your shoulder, and bend the knee of your top leg, bringing your foot to cross over and settle in front of you, toes pointing in the direction you are facing.
Following a pattern of inhales and exhales that work for you, lift and lower the bottom leg, keeping that foot flexed. Move slowly and use an engaged core to support the movement.
Switch to the other leg. Repeat three sets of up to ten repetitions on each side, adding weights or repetitions as you get stronger.
10. Face down leg raises
This works the hip extensors underneath your glutes (and the hamstrings and glutes, too).
Lie face down on a firm surface, with your elbows bent and hands in line with your face (you can also place one hand on top of the other and rest your forehead on them). Just as when you were standing, make sure your spine is long.
Keeping your hips stable and rooted firmly down, inhale and lift your left leg as high as you can. Exhale and release slowly down.
If this is not challenging, add ankle weights or repetitions (but not both at once). Repeat three sets of up to ten repetitions on each side.
Knee pain exercises to avoid
At a minimum, avoid knee pain exercises that make your pain worse. Your pain should not increase dramatically or be sharp and shooting while you stretch and strengthen the muscles surrounding the knee.
In general, other specific activities to avoid include:
- Deep lunges
- High impact exercise (e.g. running)
- Deep squats
- Too many repetitions
- Running up stairs
It can be tempting to push yourself during rehabilitation, but resist that urge. You might worsen your condition or do additional damage.
Other knee pain treatments
Physical therapy for knee pain works best when offered in conjunction with other treatments. These may include the following.
Braces
Braces are often recommended both right after injury and during rehabilitation. Ask your doctor for the best brace for your form of knee pain.
Comfort measures
Comfort measure such as hot/cold therapy can provide relief for acute knee pain. You might also use ibuprofen or naproxen sodium for pain and inflammation.
Acupuncture
The traditional Chinese medical practice of acupuncture provokes a healing response in the brain. These treatments can be deeply relaxing and effective, especially when combined with physical therapy for knee pain.
Chiropractic care
For knee pain that is caused by skeletal misalignment, chiropractic care can help snap you back in place. These treatments are non-invasive and generally side effect–free — an excellent integrative therapy choice.
TENS unit therapy
Transcutaneous electrical nerve stimulation (TENS) is another non-invasive treatment that reduces pain signals with a simple electrical pulse from pads placed at specific points across the body.
These are over-the-counter devices you can buy to manage your pain. Always talk to your doctor about the best approach, pad placement, and more.
Knee injections
For knee pain that is unmanageable and prevents you from starting physical therapy, your doctor might suggest a joint injection to begin. Joint injections use an anesthetic and a corticosteroid to control pain and inflammation that might be slowing down your recovery.
Surgery
If conservative treatments are ineffective, surgery might be another option. There are different knee surgeries that range from minor repairs to major knee replacement. After surgery, physical therapy for knee pain is par for the course, too.
Find help for your knee pain
No matter the cause, knee pain can have a big impact on your life.
When you’re ready to get your life back, the pain specialists at Arizona Pain can help. We specialize in comprehensive treatment plans designed for you (including physical therapy for knee pain).
Get in touch to schedule an appointment today.