The Simple Exercise Plan That Helps Avoid Knee Surgery

Will Harlow, the over-50s specialist physio, shows us how to stay out of hospital:

Making sure it all works how it’s supposed to

First, understand that most knee pain is mechanical: more than 80% of knee pain cases* not primarily caused by injury or arthritis, but by abnormal forces from stiffness, tightness, or weakness affecting the hip, knee, or ankle. Correcting these mechanical problems often resolves the pain and may help people avoid surgery.

^{*In Will Harlow’s clinic, anyway. So while there is a data bias here, the data bias is “people over 50”, which makes it actually more useful to most of our readers rather than less.}

So, the most likely problems and how to fix them:

• Weak glutes: weak glute muscles allow your knee to collapse inwards during movement, increasing stress on the front and inside of your knee. Even without obvious knee collapse, weaker glutes are associated with greater knee pain risk.
  • You can strengthen your gluteus medius and minimus with side-lying hip abductions, by lifting your straight top leg slightly backwards while keeping your body rolled slightly forwards.
• Hip stiffness: reduced hip internal rotation forces your knee to compensate for movements it is not well-adapted to perform, increasing knee stress.
  • You can improve hip internal rotation using a resistance band around your ankle, actively rotating your leg inward while gently assisting it the final few millimetres with your hand. The movement should feel stiff, not painful, and is most effective when done several times daily.
• Weak quadriceps: weak quadriceps more than double the risk of knee pain. Strong quadriceps protect rather than damage your knees.
  • If you can comfortably do squats, they are an excellent option. If not, do straight-leg raises while keeping your knee locked straight, your toes pulled towards you, and your lower back pressed into the bed. Resistance bands or shallow single-leg dips can be used as progressions.
• Knee stiffness: stiffness often develops before pain, gradually altering movement and leading to a variety of adverse symptoms.
  • It is usually possible to restore full knee movement by repeatedly bending your knee into stiffness (not pain), then fully straightening it and pressing it into the bed. This is especially helpful first thing in the morning, to reduce morning stiffness.
• Tight or weak calves: calf muscles play an essential role in walking mechanics, and so should not be neglected either.
  • In this case, the answer is slow heel raises done from the edge of a step both stretch tight calves and strengthen weak ones. Lower your heels below the step, rise onto your toes, then lower yourself back down slowly. Increase the challenge with added weight or by progressing to one leg if needed.
• Restricted ankle mobility: limited ankle dorsiflexion prevents your knee from moving naturally over your toes during activities such as squatting, climbing stairs, and walking uphill, which shifts excessive stress onto your knee.
  • You can improve dorsiflexion by putting your foot flat on a chair, keeping your heel down, and repeatedly driving your knee forwards over your toes using gentle pressure from your hands.
• Weak foot muscles: each foot contains around 20 muscles that help maintain its structure, and weak foot muscles reduce support, transferring stress upwards to your knees.
  • You can strengthen them with towel scrunches by keeping your heel on the floor while using your toes to pull a towel underneath your foot until it is fully gathered.

For more on all of this plus visual demonstrations, enjoy:

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Want to learn more?

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The Secret To Better Squats: Foot, Knee, & Ankle Mobility

Take care!