Knees don’t discriminate. Whether you run, climb, ski, bike, or hike, nagging knee pain may be just around the corner. Outdoor athletes are used to pushing through discomfort, but when aches and twinges turn into persistent irritation, the situation may call for more than ibuprofen. Below, Nicole Haas, a board-certified orthopedic clinical specialist with a doctorate in physical therapy, and Jared Vagy, who holds the same credentials and is also a certified strength and conditioning specialist, explain the mechanisms behind nagging knee pain—and how to work through it.
What Causes Knee Pain?
If you’re not dealing with a specific injury—say, a torn ACL—sorting out knee pain can seem complicated. The knee is composed of two joints: the tibiofemoral joint, between the femur (thigh bone) and tibia (shin bone), and the patellofemoral joint, between the femur and patella (knee cap). Each is an anchor point for multiple tendons, fascia, and other structures, including the IT band. If you have bad biomechanics, typically caused by a muscle imbalance, especially weak glutes, repetitive movement can irritate structures in the knee and lead to what is broadly known as anterior knee pain—a catchall category for general pain in the front of the knee.
The stabilizer muscles for the knee, counterintuitively, are in the hips. When those muscles are weak or imbalanced, they can’t keep your knee properly aligned. “If you’re not able to control the position of your leg as your foot makes contact with the ground, pedal, or rock, it can result in increased stress to the structures of the knee. To further complicate the issue, once the pain signals your brain that there’s a problem, this can lead to further compensations in response to the irritation, which can shut off key muscles and tighten up other structures,” Haas says.
Can You Train Your Way Out of Knee Pain?
If your knee pain came on gradually over time and you have no excessive swelling, these moves might help increase the functional strength and mobility of the muscles that support your knee and improve your biomechanics. According to Haas, there’s a simple test to check: Stand on one leg and quickly do a couple squats while watching how your leg moves. If this provokes pain, and if your knee wobbles back and forth or dives inward, that’s a sign that these corrective exercises could help—but they are by no means one-size-fits-all.
If you can trace your knee pain to an acute injury or a single moment—say, you wrecked your mountain bike, tweaked it climbing, or heard a loud pop while skiing—these exercises aren’t for you. Excessive swelling or pain in the back of the knee are also signs of a more serious injury. “These exercises do not replace the need for a proper evaluation by a physical therapist or other qualified practitioner if pain persists or gets worse,” Haas says.
Try these exercises three to five times per week, and make sure you’re not sore from the previous session when you start again. “It’s important to start gradually and to avoid overdoing it,” Haas says. “If they are right for you, they are targeting muscles that are not normally getting used. If you can’t hold the proper form during the exercises due to soreness, then you’ll likely start using other muscle groups to compensate, and that’s not the point.”
Haas and Vagy both say it’s still okay to get outside, even if you’re in recovery mode. “I encourage outdoor athletes to continue to do everything they love, but you may have to modify the intensity or the quantity early on,” Vagy says. “Pain should always be your guide. Keep active, but do not do anything that generates more pain.”
Tools You’ll Need
- Resistance band
- Massage stick or foam roller
- Tennis ball or massage ball
- Dyna-Disc or pillow
Side Steps (With a Resistance Band)
What It Does: Strengthens the hips and glutes.
How to Do It: With a resistance band around your ankles, stand with your feet together and a slight bend in your hip and knees. Keep your toes pointed straight ahead and your pelvis level as you take hip-width steps to one side. Control your knees and do not allow them to collapse inward or touch. “If you step too wide, you’ll likely lean forward in your torso or cave in your knees, and that will feed the faulty mechanics and knee-pain cycle,” Haas says. Pay close attention to proper form.
Start with a five-foot distance (roughly eight to ten steps) from left to right; repeat in the opposite direction. To progress this exercise in the following weeks, increase the number of steps and not the width of the steps.
Backward Skates (With a Resistance Band)
What It Does: Strengthens the hips and glutes.
How to Do It: Follow the same process as the side-step exercise above, but instead of stepping sideways, take diagonal (45-degree angle) steps backward. Between each step, bring your feet back together. For example, step backward with your right foot, bring your left foot in, step backward with your left foot, bring your right foot in, etc. With each step, make sure you land on a flat foot versus on your toes. Like the previous exercise, keep your toes pointed straight ahead, and focus on correct form.
Start with a five-foot distance (backward), and build up the overall distance, not the width of a step, as you gain strength.
What It Does: Targets eccentric hamstring control.
How to Do It: Stand on one leg with your knee slightly bent. Without rounding your back, reach forward and down toward the ground as you lift your other leg behind you in the same plane as your trunk. Reach as far as you can without losing good form or knee control, then stand back up. Remember to keep your hips level and back straight, and focus on leg control.
Start with five reps on each leg, and increase the number in the following weeks.
Dynamic and Static Fire Hydrant
What It Does: Strengthens the glutes and improves balance.
How to Do It: While holding onto a wall for balance, stand on one leg and move your free leg out and back at a 45-degree angle as high as you can without losing form. Immediately return to the starting position for one dynamic rep. Repeat these dynamic hydrants five times. On the sixth rep, let go of the wall and hold the leg up for 15 seconds while working on balance. Focus on the form of your stance leg (the one on the ground), and do not allow your knee to collapse inward. Also remember to keep your hips level.
Start with five dynamic reps followed by a 15-second hold per leg. Up the challenge by adding more sets.
Massage Stick or Foam Roller
What It Does: Loosens leg muscles to increase mobility.
How to Do It: Using a myofascial stick—like the Rad Rod (Haas’s favorite) or foam roller—roll out your quads, hamstrings, IT band, and calf for one to two minutes per leg. Use a tennis ball or massage ball to roll out the sole of your foot as well.
Calf Stretch and Ankle Mobility
What It Does: Increases ankle and lower-leg mobility.
How to Do It: One leg at a time, place the ball of your foot on the edge of a step and lower your heel to gently sink into a calf stretch without pain. Hold the tension for 30 seconds on each leg. “Most people need this,” Haas says. “Ankle stiffness greatly impacts the rest of your movement all the way up the [leg].”
Single-Leg Balance Reach (Multiplane)
What It Does: Trains balance and correct movement pattern (stable knee with no inward dip).
How to Do It: With your hands on your hips and toes pointed forward, stand on one leg with a slight bend in your knee. Proper form looks like a level pelvis, level shoulders, and your standing knee in line with your second toe.
Reach your other leg out in front of you, toward 12:00 on the ground, then return to the starting position without touching the ground. Now reach your leg to the side, to either 9:00 or 6:00 (depending on the leg), and return to the starting position. Finally, reach your leg behind you to either 7:00 or 5:00 (again, depending on the leg), and return to the starting position. Switch legs and repeat. Remember to maintain correct knee alignment throughout the exercise.
“The goal is not to increase your strength. It’s to train a movement pattern and work on stability,” Vagy says. “As long as it’s pain-free, you can do this as often as possible and in as many environments as possible to have the greatest carryover to your sport.”
You can make the exercise more difficult by standing on an uneven or soft surface, such as a Dyna-Disc or pillow. “The key is to focus on the correct form and avoid moving with the faulty pattern you’re likely already good at,” Haas adds.