Effective Strategies for Managing Exercise and Knee Pain.

Functional Training vs. Exercise Machines and Knee Pain

Functional training has become the most popular method rehabilitation and fitness professionals use to return clients to sports, improve performance, and reduce injury risk. This is because exercises that mimic sports skills promise to be significantly better at restoring movement than strengthening using machines that focus only on a single muscle or muscle group.

The advantage of functional exercises is that they incorporate your bodyweight, balance, and body awareness in each exercise. This helps you improve your confidence when moving while simultaneously strengthening your muscles. Unfortunately, they do not address all factors that are important for strengthening for injury prevention or rehabilitation. For instance, functional exercises almost always involve many body parts moving at the same time, making it nearly impossible to emphasize strengthening one muscle group more than others. Additionally, these movements often do not allow you to move through a large enough range of motion to optimally strengthen any individual area of your body.

In contrast, exercise machines are widely used in gyms for their ease of use and targeting of specific muscle groups. As the “other side of the coin” to functional training, they are excellent at strengthening one specific muscle or group at a time.

However, there is still a lot of confusion as to whether machines or functional exercises place more strain on the knees. Although we know that knee strain can be much higher when using machines than in functional exercises like squats or lunges, this is highly unlikely for more competitive athletes. Bounding, jumping, and landing create knee stresses that are often multiple times greater than bodyweight, and would be impossible for anyone to match in a seated exercise machine of any type. Therefore, knowing your level is very important. Exposing your knees too early to repetitive high forces may lead to progressive damage, resulting in arthritis and persistent pain. This can have a significant impact on your ultimate activity level in the long term, especially for anyone who has had a knee injury in the past.

Tips for Safe Use of Exercise Machines to Avoid Knee Pain

Many people may be training their thighs at the expense of their knees because gyms continue to fill their spaces with these machines due to their popularity. Here are some guidelines to help you use exercise machines safely and effectively:

1. Proper Equipment Setup:

Ensure your knee lines up with the point of rotation of the machine.

Instead of placing the pad just above the ankle joint, adjust it to about mid-shin level to help decrease stresses on the knee ligaments.

If you have knee pain or a previous injury, use a machine that allows you to adjust the starting angle and total range of motion to a safe amount, or stay within your pain-free range of motion.

2. Change Your Tempo to Increase Effort instead of Load:

There is increasing awareness that high forces are not necessary to grow muscle, so why risk the possibility of knee pain? Instead of your normal up/down tempo, try going down to a 5 count in each direction, or experiment with holding the weight for a 5 count at full extension, or reduce your rest period between sets to between 30 and 60 seconds. Aim for moderate resistance that allows you to perform around 10-15 repetitions with perfect technique. This increases both muscle activity and fatigue, which is highly associated with muscle growth, and has no effect on increasing joint loading.

3. Monitor Your Knee Health:

Pay close attention to how your knees feel during and after your workout, and never let your knee pain increase during any set of an exercise. Signs of swelling, redness, or heat may indicate an irritation to the joint that could turn into bigger problems in the future. If pain or swelling does not return to normal within the same day of your workout, consider seeing a musculoskeletal health professional for help.

Conclusion

Exercise machines often focus on a single muscle, or localized area of the body. However, many experts believe that lower body strengthening exercises should condition more muscles than just the quads, such as the muscles of the hips, which are used in many sports movements. A balance of functional and machine exercises can provide the best results.

People trying to prevent knee pain or those who are back playing sports pain-free will likely benefit from including exercise machines for the legs because the forces are not likely to be greater than when doing squatting or lunging movements. This also includes people with mild knee osteoarthritis. However, those following a knee rehab program should focus on bodyweight exercises that restore normal movement in the knees, hips, and ankles. Knowing how much of each type of exercise to use depends on your stage of recovery, medical and activity history, individual physical characteristics, and goals. It pays in the long term to have a therapist assess your needs and work with you to plan a return to the activities you love the most.

The advice in this article is not meant to replace professional advice from your therapist. If you would like to find out how you can safely prevent or manage knee pain, or to schedule an appointment, please contact John Gray at jgray@orthophysio.com, or call us at The Orthopaedic Therapy Clinic at 416-925-4687.