Fix your knee pain

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Every year, millions of people take up a New Year’s resolution to start exercising and get in shape, and each year, most of them quit within a few weeks. There are lots of reasons, but two that I hear over and over again from people are either:

My knees hurt too much to exercise.

or

The workouts hurt my knees and I had to stop.

The problem is that knee pain doesn’t just keep people from exercising, it keeps people from doing anything. Your legs are your life, and most people with knee pain slowly and steadily start avoiding all kinds of simple daily activities in order to limit their discomfort. I’m not saying fixing your knees will suddenly get you in the best shape of your life, but it is an important step in improving the overall quality of your life.

For years, I’ve helped people strengthen their legs and rehab their knees with one simple exercise, but new research is highlighting some additional ways to speed up your recovery and improve the overall health of your joints. Since this article is about knee rehab, I’ll focus there, but these tips can also be applied to other joint injuries.

1. Build up supporting muscles

Probably the number one cause of knee pain is weak leg muscles. People never believe the two are related because they can feel where the pain is and it’s far away from any muscle. While it is true that the source of the pain (and damage) is in the connective tissue inside of the knee, the cause of the pain actually begins in the muscles.

As your muscles get weaker, you tend to push your knees out past your toes when bending your legs. This improper form directs excessive force down your thighs and into the connective tissues holding your knees together. Pain is just the first sign that your ligaments (the tissue that holds the joint together) and cartilage (the shock absorbers around the bones) are getting overstressed, but doing this too often will eventually start to injure the tissue. Cartilage, ligaments and tendons (the connective tissue that holds your muscles to your bones) aren’t well vascularized (not a lot of blood vessels) so when they do get hurt, it can take a long time to heal. Plus once people believe they have “knee problems” they stop working their legs at all and their muscles continue to get weaker, which only makes the stress on their knees worse.

Working your knees with an exercise called assisted squats not only strengthens the supporting muscles, but it increases blood flow to the joint which can help heal any actual ligament damage. I’ve taught people this move for years and everyone is always shocked not only by how easy it is to do, but by how it actually makes their knees feel better while they do it. The key to a proper, pain-free assisted squat is to make sure your knees never go out past your toes. That’s what caused the problem in the first place, so all your focus should be on preventing that.

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To do assisted squats, hold onto a sturdy object with both hands and then squat down as far as you can. The extra support allows you to lean back deep as you squat down without fear of tipping over. This helps you focus on proper form which builds good supporting strength for your knees. Then you can use your arms to help pull yourself back up. People think the up portion of the move is what builds strength, but studies have shown that high load eccentric training (the down part) can lead to greater overall strength and muscle mass gains than concentric training alone (the up part). This type of advanced training is typically done by athletes because it requires massive weights and a training partner, but in this case, the weight the person typically can’t handle is his own body weight, and the training partner that helps pull the weight back up is his arms.

Since we’re starting with atrophied muscles, your body weight should be plenty. You also want to work up to higher reps because increased reps will cause increased blood flow (and healing) to your injured cartilage and ligaments. I typically start people doing sets of 20 and then work them up to sets of 60. The goal is 3 sets of 60, 3 days a week, but don’t push too hard in the beginning. A single set of 20 or even 10 is fine the first day. Build up to it and your body will build itself up along the way.

It’s important to point out that you should stop if you feel those old pains in your joints. It is still a sign that something is wrong and your body is warning you to stop. The first thing you should notice when you’re doing assisted squats, is that you shouldn’t feel any of your old knee pain. The people that I’ve recommended assisted squats to in the past report that even after a few reps, the typical pain in their knees quickly feels better. This is because they’re finally doing the movement with proper form and the strain is placed in their muscles rather than in their joints. This will be true of any eccentric exercise, so if you’re still feeling stabbing pain in your joints, it either means your form is still incorrect or there is damage in your joint that might require medical attention.

2. Clear out the inflammation

Exercise will help, but you can improve your recovery with a few extra steps. Plus this tip will improve your overall health and can contribute to weight loss.

We live in a stressful environment that inflicts all kinds of biological damage to our cells. Sometimes when a cell becomes too stressed, it loses it’s ability to replicate and it becomes senescent. These cells then send out signals that attract immune cells and cause localized inflammation. The point is to signal the body to break down these senescent cells and recycle them to make new cells, a process known as autophagy. Unfortunately, this system only activates when food is scarce. When food is plentiful, your body doesn’t need to rely on autophagy for new building materials since you’re readily supplying them in frequent meals.

These senescent cells then just sit there causing constant inflammation which has been shown to lead to osteoarthritis and heart disease. You don’t need to starve yourself to activate autophagy, but you do need to go through a slight period of fasting. The easiest way to kickstart autophagy, clear out senescent cells, and reduce inflammation is to simply stop eating after 7 PM and then have your first meal at 8 AM the next day. You can read about other health benefits from this intermittent fasting strategy here.

3. Rebuild connective tissue

As I mentioned above, tendons, cartilage and ligaments don’t get a lot of blood flow, so they are notoriously difficult to heal. Many people have used glucosamine and chondroitin over the years to repair their cartilage and reduce osteoarthritis knee pain, but studies looking at the effectiveness of these treatments have been mixed. Intermittent fasting and strengthening the supporting muscles will help reduce pain and inflammation but there is a supplement that has been shown to replace and repair damaged connective tissue.

Cartilage, ligaments and tendons are made out of collagen. Researchers have wondered if consumed collagen (also known as gelatin) can make it all the way to the connective tissue intact or if it is simply broken down into amino acids. One mouse study used radio-labeled collagen so they could trace it’s post-consumption path. While some of it was broken down into its base amino acids, they found that intact collagen actually accumulated in the cartilage. That’s impressive in and of itself, but the collagen that was broken down into amino acids was still useful for connective tissue healing. Collagen is primarily composed of the amino acids glycine, proline, and arginine, so even if the collagen supplement gets broken down into it’s component parts, they happen to be just what your body needs to rebuild the collagen in your connective tissues. Another study found that 10 days after a connective tissue injury, proline levels around the wound are 50 percent higher than in the rest of the bloodstream, which shows that this amino acid is an important precursor of wound healing. Other studies in humans have found that supplementing with hydrolyzed collagen (a more easily absorbed from of gelatin) does reduce osteoarthritic knee and hip pain.

Of course, connective tissue injuries aren’t just for seniors. Many athletes and frequent exercisers have also experienced these types of injuries. A new study found that supplementing with vitamin C-enriched gelatin 1 hour before completing an intense 6-minute rope skipping workout improved biomarkers for collagen synthesis which can help prevent or repair connective tissue.

Jumping rope is a great exercise, but you can combine a hydrolyzed collagen supplement one hour before your assisted squats workout to help deliver the necessary building blocks to the damaged area. If you’re not sure what one to get, I like the Perfect Hydrolyzed Collagen Peptides Powder. You can find it on Amazon here.

Try one or combine all three

Whether you try tips 2 and 3 is up to you, but unless you’ve experienced a serious knee injury, your knee pain is likely caused by atrophied leg muscles. It won’t take much effort to rebuild your support structure and regain your mobility, but take it slow. If you’ve been avoiding moving your legs, your muscles are going to be really sore the next day when you start using them again. Even though the first few days will feel easy, give your muscles time to adapt so you’re not torturing yourself with excessive post-exercise soreness.

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