How to Get Rid of Knee Pain in 5 Steps:
The Minimalist Path to Unbreakable Legs

What are the most time-effective exercises to get rid of knee pain? How can you ensure fast training progress by staying injury-free? For this article, I turned to academic research to find the answer.

First, I investigated biomechanical causes of the most common leg injuries: knee pain, ankle sprains, and plantar fasciitis. Then I took an exhaustive list of corrective exercises to improve these biomechanical factors and distilled it down to the most potent drills.

Here’s what you will find on this page:

  1. The Infographic: Everything you need to know compressed into one image
  2. The Science: A short explanation of the risk factors and the exercises
  3. The Training Plan: A minimalist corrective routine for your workouts


Let’s get started!

The Infographic: How to Make Leg Injuries History

“Everything should be made as simple as possible, but no simpler.” – Einstein[1]

I compressed everything you need to know into the following infographic. It offers a minimalist approach to preventing leg injuries and many of my readers have used these exercises to get rid of knee pain.

For your safety, I strongly recommend you work with a qualified medical expert if you are injured, or suspect that you have an injury. The following exercises only form the foundation of a good rehab program, but depending on your individual situation, you may need additional (or different) exercises.

Become Unbreakable: 5 Steps to Make Leg Injuries History (Infographic)

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Using Better Science to Build Healthy Legs (And Get Rid of Knee Pain)

The most common leg injuries are knee pain (10.4 Million per year[2]), ankle injuries (2 Million per year[3]), and plantar fasciitis (1 Million per year[4]). Behind these statistics are men, women, and children that suffer great emotional pain and financial pressure.

In 2011, Fix-Knee-Pain.com was born from my desire to help people with knee pain get back to enjoying their lives, by providing a comprehensible and applicable system of what science and the smartest physicians of our time have discovered about injury prevention and rehab.

After all, what’s the point of having 2.5 Million research papers published each year[5], if almost nothing of it finds practical application?

To determine the exercises best suited for preventing leg injuries, we have to examine their most common risk factors. Let’s start with knee pain.

Knee Pain Risk Factors

Many smart thinkers have written about why these risk factors cause or contribute to knee pain, so if you want to learn details about individual items on these lists, I highly recommend you read the linked articles or check out the references at the bottom of this page.

I intentionally selected the exercises in the 5-step plan of the infographic based on how well they can help you fix these knee pain causes. Here’s the first risk factor.

 
1) Previous Knee Injury [6],[7],[8],[9],[10],[11]

Statistically, having suffered a knee injury in the past dramatically increases your odds of getting knee pain again in the future. However, based on my experience, I’m convinced this has a lot to do with insufficient work on the actual causes of pain in favor of a treatment approach focused on eliminating pain itself quickly (i.e., symptom treatment).

In other words, even if you had pain in the past you can still get better if you work on the following knee pain causes.

 
2) Low Mobility or Stability at the Hip or Ankle [12],[13],[14],[15],[16],[17],[18],[19],[20]

The knee is a slave to what happens at the ankle and the hip. This topic actually deserves a much closer examination, but we’ll focus on two key aspects for the sake of brevity: mobility and stability.

Mobility is about what a joint system can do without external force. Stability is the ability of a joint system to maintain its position in the presence of an external force. Put simply, mobility allows for movement, whereas stability controls movement.

Each major joint system requires one aspect’s dominance, as illustrated by the following picture.

The joint-by-joint approach explains how low ankle mobility can cause knee pain.

Here’s why this matters.

If you lack mobility at the hip or the ankle, the body will make up for it by increasing mobility demands on the neighboring joints – the knee and the lower back – forcing them to “work overtime”. Eventually, the knee and the lower back become overused and painful.

However, problems also arise if you lack stability at the hip or in other words, if you cannot control hip position in the presence of an external force (see cause #4 below). This external force could just be gravity, but it could also be much higher, for example during the acceleration and deceleration when running and jumping.

Academic research has confirmed how important strong and flexible hips, as well healthy ankles are for preventing knee pain. If you want to learn more about this fascinating topic, check out the Joint-by-Joint Approach by Dr. Gray Cook and Michael Boyle, as well as their expanded version.

 
3) Tightness in the Quads, Hip Flexors, Hamstrings, or Calves [21],[22],[23]

Tightness in any of these four muscles can contribute to knee pain, mostly because they introduce excessive tension to the knee. They’re also indicative of a movement dysfunction.

The most common movement dysfunction of our time is the result of too much sitting. This leads to certain muscles getting weak, like the gluteal muscles on the side and back of your hip, with others getting “tight”, like the hip flexors on the front of your hip.

Hip Flexors and Hip Extensors

Movement dysfunction eventually overworks certain body parts. The result may just be a tight muscle, like a tight hamstring, but it could also be an injury, like knee pain, plantar fasciitis, or a torn hamstring.

The dysfunction will spread from one place in your body to another, which is why examining the body as a whole is so critically important. Conservative medicine falls short by only looking at the site of pain and while that’s great for treating acute injuries like a fracture, it won’t help you with chronic issues.

 
4) Low Skill at Single-Leg Exercises & Bad Leg Alignment [24],[25],[26],[27],[28],[29],[30]

How well you can keep your legs aligned when you’re moving on one foot determines how much excessive stress you’re placing on certain tissues of your knee.

For example, if your knee collapses towards the midline of your body, you’re putting your patellar tendon, your ACL, and your Achilles tendon under abnormal load. That’s why alignment problems contribute to overuse injuries in those tissues.

Pictured is an exaggerated example of bad leg alignment. If you do this fast enough on one leg, your ACL may need surgery.

Pictured is an exaggerated example of bad leg alignment.
If you do this fast enough on one leg, your ACL may need surgery.

To prevent bad alignment, you first have to strengthen and mobilize your hips. Then you need to “update” your motor control center by paying attention to correct alignment during your day and as you’re doing sports.

Single-leg exercises, like the hip hinge progression in step 4 of the infographic, will help you become aware of problems in this area. Additionally, they will make the strength you built with isolated hip strengthening exercises (step 3) carry over into real-world applications by improving your hip stability.

 
5) Wait, there’s more! Other Knee Pain Risk Factors

Other knee pain risk factors include doing sports that require strong quads for optimal performance[31], a high training volume[32], over-pronation[33], being overweight[34], and having inflammation in your body[35]. Weak quadriceps muscles also put you at risk[36].

A lot more could be written about each of these topics, but I want to be respectful of your time, so let me finish with this surprising fact.

I was fascinated when I discovered that in patellar tendonitis (“Jumper’s Knee”), tissue damage occurs before you feel pain[37] and I suspect the same applies to other types of knee injuries as well.

In other words, once you feel something in your knee, the damage has already been done. At that point, you’re left with two options.

You could continue your regular training and watch your rehab efforts fail[38] or you could make healing your priority and get well. Most people only prioritize rehab once their pain leaves them no other choice and that’s unfortunate, because the longer you ignore pain, the worse it becomes and the longer it will ultimately take to heal.

Plantar Fasciitis Risk Factors

As you’ll see in a moment, the risk factors for knee pain and for plantar fasciitis share some similarities. That’s why the exercises in the infographic can help you with both problems at the same time.

Each year, around 300 Million dollars are spent on physician visits and treatments for plantar fasciitis[39]. In one study, 70% of people with plantar fasciitis were found to be obese[40] and other studies confirmed obesity as a risk factor[41], but there’s more to it.

Obesity was only associated with higher risk in non-athletic patients! More interesting yet, while obesity elevated risk overall 2.4-times, tight hamstrings lead to an impressive 8.7-times increase[42]. Tight calves and ankles also put you at risk[43],[44] with low ankle dorsiflexion being present in 53% of patients[45].

Over-pronation occurred in 81% of patients[46] and flat feet are another risk factor[47]. However, using orthotics only provided a very small benefit at the 3-month follow-up, with no long-term benefit at the 12-month interval[48].

The challenge with plantar fasciitis is that walking and standing on hard surfaces also increases risk[49], but we can’t just sit around all day.

 
One Shoe Problem That Contributes to Pain

Some people with plantar fasciitis found that wearing healthier shoes also helped them get better. For example, one potentially problematic shoe feature is the toe spring or toe lift.

infographic_article_toe_spring

This toe lift places the plantar fascia under permanent tension by lifting the toes up. I only had a dress shoe to illustrate it, but the toe lift can be much higher in sport’s shoes, thereby causing more tension in the plantar fascia.

infographic_article_plantar_fascia

The basic treatment approach for plantar fasciitis is to wear shoes with a flat sole and no toe lift in addition to stretching your calves and your hamstrings.

For a more detailed examination of plantar fasciitis, please read physical therapist James Speck’s articles on the real cause of plantar fasciitis, why conventional treatments are prone to failure, and his ultimate guide on plantar fasciitis.

More Surprises: Here’s What Really Causes Ankle Injuries

One study on ankle injuries found that athletes with a BMI higher than 23.1 had 8-fold greater odds of suffering an ankle sprain[50] (calculate your BMI here).

For comparison, if you’ve suffered an ankle injury in the past, you’re at a 4.9-times greater risk[51], but get this, if you wear shoes with air cells in their heels, your risk also increases 4.3-times!

Shoes with air cells put athletes at a significantly greater risk of injuring their ankle[52], even though the protective response in the lower leg muscles also increases when wearing shoes with thick soles[53].

Howard Hillstrom, PhD, director of the Leon Root Motion Analysis Laboratory at the Hospital for Special Surgery in New York City, pointed out that spraining your ankle is difficult if you’re barefoot. He explained that by wearing shoes, you’re reducing the freedom of articulation in your feet and introducing an artificial point of instability “… due to the edge of the shoe under the lateral aspect of the foot.”[54]

My own explanation of the mechanism of injury is that sole thickness increases the lever arm between your ankle joint and the ground, which means your lower leg muscles have to work harder to oppose forces that would otherwise cause a sprain.

 
How Strong Are Your Lower Leg Muscles?

Several studies support the importance of strong lower leg muscles.

A 2012 prospective study on professional soccer players found asymmetries in ankle flexion strength to increase odds of ankle injury 8.88-times[55], which is even more than being overweight! In those that suffered a past ankle injury, a “neuromuscular deficit” could contribute to these asymmetries[56].

Other muscular problems associated with ankle instability are weakness in peroneal muscles, ankle dorsiflexors, and hip abductors[57],[58]. Additionally, weak single-leg balance is a risk factor for leg injuries[59] and it may increase odds for ankle injuries as much as 7-fold[60].

Good News Everyone

A large body of evidence supports the positive therapeutic effects of balance training[61]. For example, a 6-year study on professional basketball players found that proprioceptive training reduced occurrence of ankle sprains by 81%[62].

Beyond balance training, another research team discovered that practicing proper landing technique reduced occurrence of ankle injuries by 45%[63]. Ankle taping can also be very useful when applied properly.

My conclusion on ankle sprains is that we can reduce risk dramatically by doing balance training on solid ground, by improving ankle and hip mobility, by strengthening hip muscles, and by wearing shoes with a thin sole. Unfortunately, the choice of footwear strongly depends on your sport and your body’s preparedness for thin-soled shoes. s

Explaining the 5-Step System to Get Rid of Knee and Build Healthy Legs

So far, you’ve gone through a crash-course on the actual causes of knee pain, plantar fasciitis, and ankle injuries. A lot more could be said about each individual injury, but by now we know enough to come up with a science-based training plan for healthy legs. First, here’s why I prefer training to surgery.

In their article on risk of surgery, the Scientific American writes that anesthesia drugs “… bind to and incapacitate several different proteins on the surface of neurons that are essential for regulating sleep, attention, learning, and memory.”

Call me old-fashioned, but these are things I’d rather leave alone if possible, especially if the mechanism of action is so little understood: “[I]t seems that interrupting the usual activity of neurons may disrupt communication between far-flung regions of the brain, which somehow triggers unconsciousness.”

I’m not comfortable with that level of uncertainty. We should at least expect good rewards taking such high risks, but that may not be the case. In acute injuries (i.e., fractures, bleeding, torn cartilage or ligaments etc.) caused by accidents, surgery is the best option, but what about chronic injuries?

The research I read for my book Beating Patellar Tendonitis concluded that surgery provided inconsistent outcomes[64], while other researchers found that the strongest evidence only existed for physical training[65]. I suspect that a similar situation exists for other chronic leg injuries, making exercise by far the preferable first choice in terms of the risk-reward-ratio.

Let me explain how each of the 5-steps in the training plan addresses the actual causes we discovered earlier.

 
Step 1: Self-Massage

I first discovered self-massage through Mike Robertson and Eric Cressey. Here’s what self-massage will do for you.

  • Help correct muscular imbalances by releasing soft-tissue restrictions.
  • Increase flexibility and hip mobility.
  • Help injuries heal faster by releasing tension from your legs.
  • Improve your posture.
  • Allow better athletic performance.
  • Reduce muscle tightness safely.

Professional treatment from a qualified practitioner can provide faster results, but with regular maintenance through self-massage, this may not become necessary.

 
Step 2: Hip Flexor Stretches

Credit for the couch stretch goes to Dr. Kelly Starrett. These two stretches will counter the negative effects of sitting by releasing tension from your hip flexors, which is required for optimal hip mobility and stability.

The hips are tremendously important for healthy legs and a healthy lower back. That’s what we’re working on them with the following step as well.

 
Step 3: Gluteal Strengthening Exercises

I admit they’re not particularly exciting, but these three drills are crucial for the following reasons.

  • Strengthen hip muscles that stabilize the knee.
  • Reduce risk of ankle injuries and over-pronation.
  • Release tightness from overworked hamstrings, by strengthening their synergists.
  • Make you look better.
  • You will jump higher and run faster, once your body knows how to use these muscles well.

Academic research supports the benefit of hip strengthening exercises, especially when used in conjunction with stretches [66],[67],[68],[69],[70],[71],[72],[73].

 
Step 4: The Hip Hinge Progression

The one-legged deadlift is a true jack-of-all-trades type of exercise. Done correctly, it will give you a myriad of benefits, which is why the return on time invested is spectacular. Here are two caveats.

First, you will be tempted to skip the stick variations because they’re “easy” and because you may be too lazy to go to your broom closet and grab a stick. Don’t make that mistake. Practice technique with the stick for a few hundred repetitions before you move on to using weights.

The second caveat is that it’s tempting to use too much weight too quickly, which erodes exercise technique and puts your back and your legs at risk of injury. As an analogy, you wouldn’t let a teenager drive a 400 Horsepower car on the highway during his very first driving lesson.

Be smart with your body and the one-legged deadlift will give you the following benefits.

  • Strengthen your upper and lower back.
  • Help relieve back pain by teaching good back alignment during weight-bearing exercises.
  • Strengthen your hamstrings, gluteal muscles, and grip.
  • Reduce risk of ankle sprains by strengthening the lower leg muscles.
  • Make you look better.
  • Prevent ACL-tears by teaching you to avoid bad leg alignment.
  • Allows you to use the hip muscles we strengthened in step 3 in real-world scenarios.
  • Improve posture.
  • Allow knee pain to heal faster by reducing forward knee movement and teaching the hip hinge.
  • Improve hip stability.

Practicing this exercise helped me avoid two possibly serious ankle sprains in basketball.

Both times, I landed on another player’s foot, but my lower leg muscles were strong enough to compensate for the uneven ground, thereby preventing the sprain. In one case, I didn’t even notice it until the guy started screaming at me to get off his foot.

 
Step 5: A Pinch of Ankle Mobility

Lack of ankle mobility, specifically dorsiflexion, turned out to be a risk factor for all three injuries, which is why we’re working on it with the dorsiflexion drill. If you have knee pain, you can make this exercise easier on your knee by placing a book under the balls of your feet and doing it standing.

The samurai sit, on the other hand, will stretch your toes and help improve big toe mobility. A restricted big toe can cause knee pain and back pain, because it influences how your whole body moves during gait. Be careful with the samurai sit if you have plantar fasciitis, as it will stretch the plantar fascia, which could increase pain.

Before I end this article, here’s why some people could criticize this approach.

Criticism: Correlation vs. Causation

Most of the research I cited in this article doesn’t talk about “causes,” but rather about odds-ratios, p-values, and other statistical terms. I understand that correlation does not equal causation, but until we have better data, we need to rely on the old scientific approach of making a hypothesis and then testing it.

The exercises I shared above have indeed been shown to be very potent in the work of rehab professionals. My own experience in helping people get rid of knee pain confirms this as well, but as I said in the introduction, they’re only the foundation of a good rehab program, since everyone has slightly different needs that may necessitate additional exercises.

Your Next Steps

Did you find this useful? Let me know by sharing this material on your website, on Facebook, or by sending emails to three friends that could benefit. I depend on your help to reach as many people as possible.

Next, if you have knee pain, I will help you get back to enjoying your life by sharing some of my most effective techniques in my advanced course on getting rid of knee pain. Over 11,000 people have taken the course since I offered the first version in 2011. Click here to have me send it to you.

Finally, download your short training routine to start building unbreakable legs to day.

 

 

References

 

[1] Garson O’Toole, “Everything Should Be Made as Simple as Possible, But Not Simpler,” accessed March 7, 2016, http://quoteinvestigator.com/2011/05/13/einstein-simple/

[2] “Common Knee Injuries,” American Academy of Orthopedic Surgeons, accessed March 8, 2016, http://orthoinfo.aaos.org/topic.cfm?topic=a00325

[3] Douglas Ivins, “Acute Ankle Sprain: An Update,” American Academy of Family Physicians, accessed March 8, 2016, http://www.aafp.org/afp/2006/1115/p1714.html

[4] James D. Goff, “Diagnosis and Treatment of Plantar Fasciitis,” American Academy of Family Physicians, accessed March 8, 2016, http://www.aafp.org/afp/2011/0915/p676.html

[5] Sarah Boon, “21st Century Science Overload,” Canadian Science Publishin, accessed March 8, 2016, http://www.cdnsciencepub.com/blog/21st-century-science-overload.aspx

[6] Behzad Heidari, “Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I,” Caspian journal of internal medicine 2, no. 2 (2011)

[7] V. Silverwood et al., “Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis,” Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 23, no. 4 (2015), doi:10.1016/j.joca.2014.11.019

[8] H. Miranda et al., “A prospective study on knee pain and its risk factors,” Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 10, no. 8 (2002)

[9] C. Cooper et al., “Risk factors for the incidence and progression of radiographic knee osteoarthritis,” Arthritis and rheumatism 43, no. 5 (2000), doi:10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1

[10] Shigeyuki Muraki et al., “Incidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: a longitudinal population-based cohort study,” Arthritis and rheumatism 64, no. 5 (2012), doi:10.1002/art.33508

[11] B. Marti et al., “On the epidemiology of running injuries. The 1984 Bern Grand-Prix study,” The American journal of sports medicine 16, no. 3 (1988)

[12] Mary L. Ireland et al., “Hip strength in females with and without patellofemoral pain,” The Journal of orthopaedic and sports physical therapy 33, no. 11 (2003)

[13] Christopher M. Powers, “The influence of abnormal hip mechanics on knee injury: a biomechanical perspective,” The Journal of orthopaedic and sports physical therapy 40, no. 2 (2010), doi:10.2519/jospt.2010.3337

[14] Ludvig J. Backman and Patrik Danielson, “Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players: a 1-year prospective study,” The American journal of sports medicine 39, no. 12 (2011), doi:10.1177/0363546511420552

[15] Peter Malliaras, Jillianne L. Cook, and Peter Kent, “Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players,” Journal of science and medicine in sport / Sports Medicine Australia 9, no. 4 (2006), doi:10.1016/j.jsams.2006.03.015

[16] Wolf Petersen et al., “Patellofemoral pain syndrome,” Knee surgery, sports traumatology, arthroscopy official journal of the ESSKA 22, no. 10 (2014), doi:10.1007/s00167-013-2759-6

[17] Kerry J. Mann et al., “A lower limb assessment tool for athletes at risk of developing patellar tendinopathy,” Medicine and science in sports and exercise 45, no. 3 (2013), doi:10.1249/MSS.0b013e318275e0f2

[18] Petersen et al.

[19] Jodi Aderem and Quinette A. Louw, “Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review,” BMC musculoskeletal disorders 16 (2015), doi:10.1186/s12891-015-0808-7

[20] Farzin Halabchi, Reza Mazaheri, and Tohid Seif-Barghi, “Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address?,” Asian journal of sports medicine 4, no. 2 (2013)

[21] Ibid.

[22] Mann et al.

[23] E. Witvrouw et al., “Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study,” The American journal of sports medicine 29, no. 2 (2001)

[24] Petersen et al.

[25] R. W. Bisseling et al., “Relationship between landing strategy and patellar tendinopathy in volleyball,” British Journal of Sports Medicine 41, no. 7 (2007), doi:10.1136/bjsm.2006.032565

[26] Petersen et al.

[27] S. Grau et al., “What are causes and treatment strategies for patellar-tendinopathy in female runners?,” Journal of biomechanics 41, no. 9 (2008), doi:10.1016/j.jbiomech.2008.03.005

[28] Kelly Starrett and Glen Cordoza, Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance (Tuttle Publishing, 2013), 86

[29] Ibid., 92f

[30] Seyit Citaker et al., “Static balance in patients with patellofemoral pain syndrome,” Sports health 3, no. 6 (2011), doi:10.1177/1941738111420803

[31] A. Frohm et al., “Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols,” British Journal of Sports Medicine 41, no. 7 (2007), doi:10.1136/bjsm.2006.032599

[32] Martin Hägglund, Johannes Zwerver, and Jan Ekstrand, “Epidemiology of patellar tendinopathy in elite male soccer players,” The American journal of sports medicine 39, no. 9 (2011), doi:10.1177/0363546511408877

[33] Grau et al.

[34] Heidari

[35] Ibid.

[36] Nienke E. Lankhorst, Bierma-Zeinstra, Sita M A, and Marienke van Middelkoop, “Risk factors for patellofemoral pain syndrome: a systematic review,” The Journal of orthopaedic and sports physical therapy 42, no. 2 (2012), doi:10.2519/jospt.2012.3803

[37] K. M. Khan et al., “Patellar tendinopathy: some aspects of basic science and clinical management,” British journal of sports medicine 32, no. 4 (1998): 351

[38] Håvard Visnes and Roald Bahr, “The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes,” British journal of sports medicine 41, no. 4 (2007), doi:10.1136/bjsm.2006.032417

[39] Larry E. Miller and Daniel L. Latt, “Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies,” North American journal of medical sciences 7, no. 1 (2015), doi:10.4103/1947-2714.150080

[40] Mohammad A. Tahririan et al., “Plantar fasciitis,” Journal of research in medical sciences the official journal of Isfahan University of Medical Sciences 17, no. 8 (2012)

[41] Brett D. Owens et al., “Risk Factors for Lower Extremity Tendinopathies in Military Personnel,” Orthopaedic journal of sports medicine 1, no. 1 (2013), doi:10.1177/2325967113492707

[42] Jonathan M. Labovitz, Jenny Yu, and Chul Kim, “The role of hamstring tightness in plantar fasciitis,” Foot & ankle specialist 4, no. 3 (2011), doi:10.1177/1938640010397341

[43] Tahririan et al.

[44] Miller and Latt

[45] Tae Im Yi et al., “Clinical characteristics of the causes of plantar heel pain,” Annals of rehabilitation medicine 35, no. 4 (2011), doi:10.5535/arm.2011.35.4.507

[46] Tahririan et al.

[47] Miller and Latt

[48] Karl B. Landorf, Anne-Maree Keenan, and Robert D. Herbert, “Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial,” Archives of internal medicine 166, no. 12 (2006), doi:10.1001/archinte.166.12.1305

[49] Robert A. Werner et al., “Risk factors for plantar fasciitis among assembly plant workers,” PM & R the journal of injury, function, and rehabilitation 2, no. 2 (2010), doi:10.1016/j.pmrj.2009.11.012

[50] Konstantinos Fousekis, Elias Tsepis, and George Vagenas, “Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players,” The American Journal of Sports Medicine 40, no. 8 (2012), doi:10.1177/0363546512449602

[51] G. D. McKay, “Ankle injuries in basketball: injury rate and risk factors,” British Journal of Sports Medicine 35, no. 2 (2001), doi:10.1136/bjsm.35.2.103

[52] Bruce D. Beynnon, Darlene F. Murphy, and Denise M. Alosa, “Predictive Factors for Lateral Ankle Sprains: A Literature Review,” Journal of athletic training 37, no. 4 (2002)

[53] A. K. Ramanathan et al., “The influence of shoe sole’s varying thickness on lower limb muscle activity,” Foot and ankle surgery official journal of the European Society of Foot and Ankle Surgeons 17, no. 4 (2011), doi:10.1016/j.fas.2010.07.003

[54] Cary Groner, “Ankle sprain prevention revisits shoes as solution,” Lower Extremity Review, accessed March 13, 2016, http://lermagazine.com/article/ankle-sprain-prevention-revisits-shoes-as-solution

[55] Fousekis, Tsepis and Vagenas

[56] Beynnon, Murphy and Alosa

[57] You-Jou Hung, “Neuromuscular control and rehabilitation of the unstable ankle,” World journal of orthopedics 6, no. 5 (2015), doi:10.5312/wjo.v6.i5.434

[58] Tine M. Willems et al., “Intrinsic risk factors for inversion ankle sprains in male subjects: a prospective study,” The American Journal of Sports Medicine 33, no. 3 (2005)

[59] Dario Riva et al., “Proprioceptive Training and Injury Prevention in a Professional Men’s Basketball Team: A Six-Year Prospective Study,” Journal of strength and conditioning research / National Strength & Conditioning Association 30, no. 2 (2016), doi:10.1519/JSC.0000000000001097

[60] Beynnon, Murphy and Alosa

[61] Hung

[62] Riva et al.

[63] R. Bahr, O. Lian, and I. A. Bahr, “A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study,” Scandinavian journal of medicine & science in sports 7, no. 3 (1997)

[64] Brett M. Andres and George A. C. Murrell, “Treatment of tendinopathy: what works, what does not, and what is on the horizon,” Clinical orthopaedics and related research 466, no. 7 (2008), doi:10.1007/s11999-008-0260-1

[65] Maria E. H. Larsson, Ingela Käll, and Katarina Nilsson-Helander, “Treatment of patellar tendinopathy—a systematic review of randomized controlled trials,” Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 8 (2012): 1645, doi:10.1007/s00167-011-1825-1

[66] Reed Ferber, Karen D. Kendall, and Lindsay Farr, “Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome,” Journal of athletic training 46, no. 2 (2011), doi:10.4085/1062-6050-46.2.142

[67] Thiago Y. Fukuda et al., “Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up,” The Journal of orthopaedic and sports physical therapy 42, no. 10 (2012), doi:10.2519/jospt.2012.4184

[68] Nienke E. Lankhorst, Sita M. A. Bierma-Zeinstra, and Marienke van Middelkoop, “Factors associated with patellofemoral pain syndrome: a systematic review,” British journal of sports medicine, 2012, doi:10.1136/bjsports-2011-090369

[69] Eduardo Magalhães et al., “ISOMETRIC STRENGTH RATIOS OF THE HIP MUSCULATURE IN FEMALES WITH PATELLOFEMORAL PAIN: A COMPARISON TO PAINFREE CONTROLS,” Journal of strength and conditioning research / National Strength & Conditioning Association, 2012, doi:10.1519/JSC.0b013e318279793d

[70] Erik P. Meira and Jason Brumitt, “Influence of the hip on patients with patellofemoral pain syndrome: a systematic review,” Sports health 3, no. 5 (2011), doi:10.1177/1941738111415006

[71] Hossein Negahban et al., “The effects of muscle fatigue on dynamic standing balance in people with and without patellofemoral pain syndrome,” Gait & posture, 2012, doi:10.1016/j.gaitpost.2012.07.025

[72] Christian J. Barton et al., “Gluteal muscle activity and patellofemoral pain syndrome: a systematic review,” British journal of sports medicine, 2012, doi:10.1136/bjsports-2012-090953

[73] Petersen et al.

Comments

  1. Harold Johnson says

    Martin, I can’t thank you enough for the help your advice has provided me. I am athletic and tend to recover quickly, but it is the preventive knowledge that helps me the best, to maintain my health, quality of life and outlook.

    What you have to teach is important. Keep it up.

    Yours truly,

    Harold Johnson

    • Martin Koban says

      Hello Harold,

      Thank you very much :-)

      You know what they say, an ounce of prevention is worth a pound of cure.

  2. Frank Russo says

    Hello Martin,

    Thanks for the infographic on knee injury risk however I saw two risk factors that I don’t understand why you included them.
    1) balancing on one leg easily for 30 seconds
    2) raising toe up 2 inches

    You stated if the answer is yes, then they are risk factors. Aren’t these beneficial? If not, why?

    Thanks,
    Frank

    • Martin Koban says

      Hey Frank,

      I plan on explaining this in another article at some point. In short: restricted big toe mobility (= not being able to lift the big toe up) can lead to altered foot mechanics which can be a contributing factor to plantar fasciitis and knee pain.

      Ability to balance with eyes closed is a strong indicator of body awareness (proprioception). Better body awareness will help you prevent ankle sprains and it can also help maintain better leg alignment during movement.

      – Martin

  3. Daniel Paredes says

    Hi Martin,

    I couldn’t find the explanation of the risk factors listed above. I couldn’t figure out why standing with closed eyes and being able to rise the big toe are risk factors.

    I hope you can explain the risk factors.

    • Martin Koban says

      Dear Daniel,

      I plan on explaining this in another article at some point. In short: restricted big toe mobility (= not being able to lift the big toe up) can lead to altered foot mechanics which can be a contributing factor to plantar fasciitis and knee pain.

      Ability to balance with eyes closed is a strong indicator of body awareness (proprioception). Better body awareness will help you prevent ankle sprains and it can also help maintain better leg alignment during movement.

      – Martin

    • Martin Koban says

      For best results, daily during the first 2 weeks. After that you can do it two or three times per week.

      You’ll notice which exercises you find most difficult. Concentrate on those.

  4. RICHARD W RINCK says

    Outstanding Martin !!
    I am 54 and an avid marathon runner. Its clear to me that these exercises will keep me functioning at top speed.
    I already feel the benefits.
    Thank you !!

    • Martin Koban says

      Thank you Richard.

      I’m very confident that you’ll benefit tremendously from these drills. These are the most important exercises for healthy legs.

      Spread the word about this method :-)

      • Cal says

        Martin:
        Thanks for this excellent info. Many more thanks for the “did you miss” email.

        Can you explained why the head tilted up can cause injuries?

  5. Ron says

    Martin – I have arthritis in my big toe knuckle and it won’t bend at all… any additional training I should try? I have already had surgery on the Toe knuckle.

    Thanks,
    Ron

    • Martin Koban says

      Hey Ron,

      Look into a supplement called MoveFree (it’s on Amazon).

      Be sure to move your toe as much as possible without causing pain. You can use the muscles in your foot or your hands.

      For arthritis pain, I’ve had great success with acupuncture, so that’s something you may want to look into as well.

      Much love,

      Martin

  6. Chris says

    Hi Martin, your website helps me but I still suffer from pt. I have had pt formalmost 1 year now. I’m 13 yrs old. I stretch, exercise, I do parkour, I run, I eat healthy, I’m not overweight And I’m very strong for my age. I jumped down a flight of stairs akkt of feet high I’ve done it before nbu this time I landed on a stair and sprained my ankle bu my knee went hard. That is where my problems came from. Please help me!

    • Martin Koban says

      Hey Chris,

      First thing you must do is give your knees a break from stressful activities like running and especially parkour. Parkour is an extreme sport and there’s a reason why most health insurances don’t cover injuries caused by it.

      I realize that’s not the answer you were looking for, but since you’re a minor, you really do need to work with doctors and your parents. Find a good physical therapist and do rehab until you’re 100% pain-free. Then return to running slowly.

      I hope you get well soon.

  7. Jon Lucas says

    Dear Martin,
    I have been meaning to contact you earlier but the death of my father and a discussion and some therapy with a great osteopath/Dr. of Chinese acupuncture and two young kids meant I have been time poor of late. Thank you for your passion and knowledge.
    I am a 56 year old male who just before I signed up to your site was given this info from a MRI scan – 1) Displaced flap tear medial meniscus, 2) Grade 4 chondral defect posterior aspect lateral femoral condyle, 3)Grade 2/3 chondromalacia patella.
    I have been practicing martial arts (Taekwondo and Karate) for 6 years. My knee issue started from an ice skating incident ( I used to be able to speed skate 30 years ago) but alas have lost my muscle memory trying to ‘show off’ to my kids -silly i know!
    Good news is my osteopath is pretty sure I can recover without an operation and I spoke to a Doctor friend who specialises in knee injuries for professional football players and he concurred. So my question is – Should I take up this training regime you have created or pick and choose from it. I can do full weightless squats (5x5times p/day)now. I am back doing light training no sparing. Any suggestions to help me recover please?

    Jon

  8. Danilo Vujovic says

    Hallo Martin

    Ich habe schon fast 2 Jahre nicht mehr Basketball spielen können. Ich werde jetzt bald wieder anfangen, im Moment trainiere ich nur die Beine und werfe ab und zu. Schmerzen habe dabei keine, nur morgens und selten beim Laufen ganz kurz. In letzter Zeit ist mir aber aufgefallen, dass meine Knie gerötet sind. Den ganzen Tag über. Vorallem an der Kniescheibenspitze und etwas weiter unten am Tibiakopf. Meine Knie sind auch minimal geschwollen (seit ich vor ca. 1 Monat einen nicht sehr schlimmen, kleinen Rückfall hatte als ich zum ersten mal wieder joggen ging). Jetzt bin ich aber etwa wieder an diesem Punkt an dem ich war bevor ich diesen kleinen Rückfall hatte. Meine Frage: Was bedeutet diese Rötung und soll ich etwas dagegen tun? Kühlen/wärmen?

    Danke & Freundliche Grüsse

    Danilo

    • Martin Koban says

      Hallo Danilo,

      Ich würde spontan verstärkte Durchblutung vermuten, bin aber kein Arzt. Ich würde Dir empfehlen, damit mal zum Arzt zu gehen, falls es Dir Sorgen bereitet.

      Kühlen/wärmen kannst Du ja mal ausprobieren, aber ich bezweifle, dass das an der Rötung etwas ändern wird. Vielleicht ist es aber für Dich angenehm.

  9. Tommy Dhondt says

    Hi Martin,

    I think that Frank & Daniel understood why (not) balancing on one leg easily for 30 seconds & raising toe up 2 inches are risk factors, but that the infographic is incorrect: those two risk factors/questions should be reversed (e.g. change “can” into “can’t”) to avoid that BEING able to do all that would result in Yes (more risk).

    Kind regards,
    Tommy Dhondt

  10. Prateek Munikuntla says

    Thanks alot for the this awesome fix knee pain guide. Ive already started implementing some of the things and I see some results so far. Id like to do something for you in return! Where do I buy your book?

  11. Fernanda Attia says

    Hello Martin
    Hope you are having a great day, I just wanted to tell you that the last email that I received was this one “Become Unbreakable: 5 Steps to Make Leg Injuries History” about a month ago, I want to know if there are more emails coming (I really want to know more about this),
    or if I´m not receiving the rest. :(

    Thank you !!!

  12. Mayank says

    Hello, Martin. Im suffering from patellar tendonitis and i have each and every problem you have stated yet( in my emails) im over weight and i know thats the main reason, but i cannot think of a way to lose weight without playing. My knees are caved in as you mentioned in the weak hip muscle mail. From where should i start my treatment and how should i go about it after starting.
    Thanks :)

  13. Prateek says

    Hi Martin!
    Thank you for taking the time to make this very creative & informative graphic. Ive already started to incorporate alot of this material into my routine .

    Youve helped me out alot for free. What can I do in return?

  14. Ian Baxter says

    Hi Martin. I developed patellar tendonitis about five months ago. It was originally diagnosed as bursitis, which I suspect is not an uncommon mistake made by doctors. I run ultramarathons, and interestingly this started two or three weeks after running a hilly 64 mile event. After trying repeatedly to return to training (I was entered in a 100 mile race later this year) and repeatedly hurting my tendon, I came across your website, and the message has finally sunk in – whatever physios like to tell you, there is no quick fix! I’ve cancelled all my entries now and ordered your book. This year is going to be about rehab, and strengthening. Its interesting that it takes an injury like this before we seriously appraise our fitness, strengths and weaknesses. My glutes, hamstrings and core are all pathetic bystanders and all need strengthening, and after reading your articles I’m sure this is the root cause of my problem. So many sports like trail running and cycling become “quad dependent”. With your help I’ve turned my negative emotions of being injured into positive ones of “rest, rebuild and come back stronger”. I cant thank you enough!
    Ian

  15. keith stock says

    Dear Martin

    i signed up and am still doing your last video course. do i need to do anything to access the videos now that it seems you will be starting a new course? will there be any changes??

    thanks Martin

  16. Kelvin says

    Hi Martin,

    Firstly, I am so happy to have found your site. Thank you so much for all the information and time spent on researching it. Seriously, THANK YOU!

    Secondly, after reading through much of your research I can confidently diagnose that I have patellar tendonosis. The problem is that I had tendonitis from Sept 2014 – June 2015….I never really took care of it at that point, or treated it seriously, but rather treated it more like a pain that will “pass away at some point”.

    I have had tendonosis since June 2015 (movie-goers knee, jumpers knee, & runners knee symptoms) which has rendered me unable to participate in sports without pain.

    I’ve decided 2016 is the year to change that, and this info graphic is the perfect starting point. My question is, with so much time within my condition, how often should I do these exercises?

  17. Preston Villadoz says

    Hello Martin, I really need help. I’m doing everything that I can for my patellar tendinitis but it’s not working. I am a volleyball player, and it’s our off season. We have practice about two times a week, and I can barely take it. The next day walking up and down the stairs is a challenge. When I jump there is a unbearable pain. I try my best, but I want to keep playing. I am really scared because I don’t want to ruin my chances into joining the military. I’ve done a lot of stretches, they help temporarily but I just can’t seem to make this go away. I’ve had this for about 7 months. Please help, thank you.

  18. Rob A says

    Thank you for a truly helpful site. I previously recovered from a 2.5-year episode of patellar tendonosis using a program similar to the one you outline (including the gradual and methodical incorporation of increasing eccentric loading). It worked!!! After 2.5 years of no activity other than swimming and some moderate walking, I was finally able to return to normal activity, including riding centuries and running marathons, both at an elite amateur level.

    Unfortunately, I became over confident and started adding in new activities too quickly, including leg extensions with large amounts of weight. The tendonitis/osis has returned, which is what helped me find this site, and your book, which I just purchased. I hope people realize the value of the information you are providing – thanks!

    • Sean Robertson says

      Hi Martin, great website. I’ve got a scenario for you. Being an avid cyclist riding 10-15 hours a week last season(I live in Alberta Canada) I developed a pain around the top of my kneecap at the end of the season (October)which made a pedal stroke quite painful. My job as a machinist requires that I stand all day for 7 hours. I’ve been foam rolling, stretching, and body weight exercises for a little more than a year. Now being April and the start of the season the pain is still there. What is going on? The pain only happens when I’m riding, I can snowboard on it all day without any pain, and do squats without pain. I’ve seen a physio therapist and gotten a bike fit and pain comes on after an hour(was 20 minutes before bike fit). Any information would be great. Thanks.

      • Martin Koban says

        Hey Sean,

        Sounds like it’s an overuse injury that only gets triggered when you cycle, likely based on how your body moves. So some tissues inside the knee still haven’t healed 100% yet and when you’re cycling, they get aggravated.

        I’d stay withing the pain-free riding time and maybe take up other sports that you can do without pain.

  19. Mickael says

    Dear Martin,

    a big Thank You for all your time and energy devoted to learn about patellar tendinitis and for sharing with us all what you learned and experimented…
    I benefited a lot about it, slowly incorporating the stretches and exercises you shared with all of us…
    I just made myself a slant board.
    I had all the tools and materials available to me, it just took 40 minutes to make it!!
    I am also very appreciative for making all your materials available for free otherwise it would be difficult for me to have access to it.
    I am projecting to buy your book in order to learn more about the principles under the healing of “jumper knee”. It will be also a way to give you a little bit back for all I received.

    I got patellar tendinitis after running a bit too much the last year and also by lack of understanding of the mechanism behind the knee…
    It is all good for now, I am on my way to recovery for my knees…

    I also have a tendinitis in my right wrist from too much stress doing aikido ( wrists’ locks ) and bad habits when carrying heavy things with one hand…

    So my question is :
    would you know any exercises for healing tendinitis in the wrists or any links where I could get some?

    Thank you again for your wonderful offering, you are bringing a lot of happiness and relief to people as many sharings in your website are expressed….

    With deep gratitude,

    Mickael

  20. Steve Faller says

    Hi Martin,

    First of all, I want to thank you for your great book. I got peronial Tendonitis in my good knee compensating for a knee that underwent ACL surgery. I am feeling much better and looking to return to competitive martial arts. I wanted to know if there were any advanced exercises you recommend to further my progress? Also, my father is experiencing great knee pain and is looking at possible knee replacement surgery. He had an acl tear back before arthroscopic methods and also has cartilage damage that is very painful. Are there any exercises you would recommend to him? Thank you in advance for all your good work! You are doing great things in an under researched field.

    Best,
    Steve

  21. Richard says

    I bought the book. I must say it is more than an eyeopener. I wish I only got it earlier before my knees are out of commission for the past three months.

    To strengthen the leg muscle, would you recommend regular deadlift or romanian deadlift exercise? Or should I stick just one leg only? I could not find any info during my research. And I asked because it seems that little knees movement is involved with the deadlift in general.

    Any thoughts?

    Richard

    • Martin Koban says

      Hi Richard,

      Thank you for supporting my work.

      The single-leg variation will train your balance more and is somewhat easier on the back. It’s also great for correcting strength differences between sides. If you don’t have back issues, the regular deadlift will work fine. Try trapbar deadlifts too, if you can do them without discomfort.

      In general, as long as it doesn’t cause pain, what type of deadlift you do depends on your goals. If it’s just leg strength and rehab, the single-leg variation is a good choice.

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