In a recent blog, we posed the (slightly rhetorical) question: Could just two hours of exercise a week transform knee pain?
The answer, according to a major new study of patients with persistent joint pain, was an emphatic yes. The researchers found that people who stuck with an expert-led gym programme for 12 weeks experienced a 35% improvement in pain, on average. That’s a very impressive result.
But classic cardio work wasn’t the sole focus of the Joint Pain Programme, which involved 40,000 people and is now being touted for a wider rollout across the NHS. It also encouraged patients to work on their “mobility, stability and strength” – three things that are critical for giving painful knees the best chance of improvement.
And if there’s one muscle that provides all three of those things, it’s the quadriceps. In this article, we’ll examine why the “quads” are so closely linked to knee-joint health – and break down five simple, low-impact quad exercises that are often recommended to patients with long-term knee pain.
What are the quadricep muscles?
The quads are at the front of your thigh, covering an area from just below the hip to just above your knee. There are actually five muscles in the set, not four: the rectus femoris, vastus intermedius, tensor of the vastus intermedius, vastus lateralis and vastus medialis. But, together, they provide some very important functions:
- enable you to straighten your leg (AKA “knee extension”)
- help you maintain balance
- help you to flex your hips
- absorb shock when your heel strikes the ground during movement
- keep your kneecap stable and properly aligned with your leg
How does quad strengthening help your knees?
The key thing about strong quads is that they offload pressure from the knees. Your knees have to bear a lot of impact when you move – the equivalent of 2-3 times your bodyweight when walking on the flat and up to 6 times on stairs. If your quads are weak, more of that force travels through your knee joint. This can degrade the smooth cartilage covering on bone endings more quickly, leading to pain and, eventually, osteoarthritis. You can think of strong quads as a bit like good scaffolding – they provide a support structure that relieves the stress factors on a painful joint.
Does the science back this up?
Yes. There are some good studies that support the link between stronger quads and healthier knees. One randomised clinical trial with osteoarthritis patients, for example, found that targeted quad exercises led to a significant reduction in knee pain intensity. Another study involving a 12-week quad-strengthening programme showed patients’ shock-absorbing capacity increase by 36% and a significant improvement in pain and function.
5 quad exercises
With those things in mind, here are five common routines that knee specialists often recommend for quad strengthening. A quick note before you plunge into them, though: it’s essential to consult your doctor or physiotherapist before trying any new exercise programme. If you’re experiencing chronic joint issues or osteoarthritis symptoms, always ask a specialist first so they can tailor them to your own knees. A second rule of thumb: if any exercise causes sharp or worsening pain, don’t persist with it!
Quad exercise with towel
Sit down on the floor or your bed with your back straight and legs stretched out in front of you. Place a rolled-up towel under one knee. Gently bring your toes and foot of that leg towards you, while pushing the back of your knee downwards and letting your heel rise from the floor as you do so. Keep this position for five seconds, then relax. Repeat 10 times.
Straight-leg raise (lying)
This is a straightforward exercise that’s often recommended to patients who are recovering from knee replacement surgery. Lying on your back, move one leg up into a bent position. Then simply raise your other leg, keeping it straight as you do so. Raise it to about 25cm (10”) if it feels comfortable, hold for five seconds, then gently lower it again. Repeat five times.
Long arc quad exercise (sitting)
This exercise is very similar to the last one, but you’ll be seated rather than lying back. Take a straight-backed chair and sit down with both feet flat on the floor. Slowly raise one of your legs upwards until it’s straight (if you can move it comfortably that far). Hold this position for 3-5 seconds, then relax. Repeat 10 times.
Quad strength with squats
Squats are simple exercises that help to strengthen your hamstrings and glutes as well as your quads. To give yourself the best support, get a kitchen chair and stand behind it, holding on to the top of the chair. Then gently squat downwards, feeling the weight go into your heels. You could hold this pose for 5-10 seconds before returning to your starting position.
Quad stretch from kneeling
Just slightly more advanced, this exercise starts in a kneeling position. Make sure you’re on a comfortable surface, like a yoga mat, with your back straight. Now move one leg out in front of you, until it forms a right angle. Next, tuck in your bottom so you can feel your kneeling leg being gently stretched. If you’re able to, you can improve the stretch by holding on to the ankle behind you and pulling it slowly towards your bottom.
And 5 more articles on exercise and knee pain…
If you’re interested in finding out more about targeted exercise and how it can improve knee health and reduce long-term pain, you may find these other blogs helpful…
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Can exercising more often increase your risk of knee arthritis?
3 common exercises for knee replacement patients
