Everything you need to know and do for knee health

Author: Nikolai Borisov - coach, champion of Russia in powerlifting.
2018-05-13

Table of contents:

1. Possible causes of discomfort. And is squatting to blame?
2. More about the warm-up
3. Pharmacy assistance. This section is for all joints
4. Which exercises to do
5. Which cyclical activities to combine with squatting for knee benefits?
6. More about cycling

We will discuss situations when the knees just start to ache or feel slightly uncomfortable. If your knee has already suffered a ligament tear, cartilage damage, or a meniscus tear, you will need to see a doctor and take a break from training for an extended period.

Possible causes of discomfort. And is squatting to blame?

If you experience unpleasant sensations in your knees, it's essential to analyze possible causes and take corrective measures. We will consider the situation assuming there are no complaints regarding your squatting technique.

1. Most often, knees cannot handle the load for those trying to combine squats with running or jumping, including jump rope. This combination usually goes painlessly at a junior age and almost always leads to injuries at a veteran level. The age at which you'll have to give up jumping and running depends on your weight, genetics, and lifestyle. If your knees already hurt - it means it's time.

2. Many athletes save time on warm-up. Beginners can do this with no consequences and often get used to skipping warm-ups. As training weights increase over the years and the athlete ages, this bad habit eventually leads to injuries. To prevent them, the warm-up should be enhanced with training experience.

3. Sometimes, cold hinders knee recovery between workouts. A decrease in body temperature by 1 degree slows metabolic processes in tissues by 13-18%, and cooling by 3 degrees - by one and a half times! This is very significant. Those who do not load their knees can walk in the cold in ripped jeans or tights. If you want to squat a lot, you'll need to keep your knees warm. Sometimes wearing warm underwear or knee pads under your pants outdoors alleviates aching pain within a few days. This works even at temperatures close to freezing. Just because you don’t feel cold doesn’t mean your knees maintain an optimal temperature for recovery processes.

4. Deterioration of blood circulation can hinder recovery. For instance, if you spend your workday sitting with your legs bent under the chair, or you have to work in uncomfortable static positions, standing on a stepladder, etc. In these cases, regular breaks with position changes and warm-ups, as well as self-massage, will help. The bad habit of sitting cross-legged leads to blood stagnation not only in the legs but also in the pelvic area. This can provoke varicose veins, knee pain, and many other issues.

5. Chronic dehydration reduces the amount of synovial fluid. For athletes, dehydration most often occurs during weight cutting. It can also arise from excessive use of certain medications, saunas, alcohol...

6. Pressure on the knees from the floor. Repairs, floor washing, playing with children - some people do this while kneeling. However, knees are not designed for this. Comfortable protective knee pads from IKEA can be bought for less than a tube of ointment or pills needed for treatment.

More about the warm-up

The warm-up should correspond to the exercise you are about to perform. Running will not prepare you for squats or bench pressing. Running warms up the body, but warming up and a warm-up are not synonymous! Various types of squats will prepare you for squats:

Before squatting, it's essential to warm up the lower back; for this, the following are great:

It is advisable to use all the listed exercises. Veterans should do more than one set.

The recommended duration of warm-ups according to physical education textbooks is 30-40 minutes, which is not practiced in gyms. Only when staying in a sports camp can a person afford such luxury. To achieve the desired effect in a shorter time, before the warm-up, apply warming ointment on the knees and wear knee pads (medical, not too tight) to maintain warmth. Between warm-up sets, perform self-massage of the knees, as this is perhaps the simplest type of self-massage. Combining these actions will prepare even old knees for squatting in about 20 minutes.

Pharmacy Assistance. This Section Applies to All Joints.

1. Ointments.

They will speed up the warming process. You are unlikely to find a remedy more effective than Finalgon. For sensitive individuals, Apizatron is suitable. Capsicam has a milder effect. There are other options; good ointments can be brought from Thailand. Mild ointments are suitable for nighttime rubbing. An athlete sleeps - rehabilitation is in progress.

2. Chondroprotectors.

Reading about the mechanism of action on Wikipedia makes it clear why they don't help everyone. Chondroitin sulfate and glucosamine control aspects of synovial inflammation. However, knees can hurt for other reasons. The number of positive reviews I know of is within the placebo effect. They won’t cause harm; the composition closely resembles sports nutrition: Amino acid composition of hydrolysate: proline / hydroxyproline - 25%; Glycine - 20%; glutamic acid - 11%; arginine - 8%; alanine - 8%; other essential amino acids - 16%; other non-essential amino acids - 12%.

3. Anti-inflammatory agents.

The list is extensive https://ru.wikipedia.org, but only a smaller portion is used in sports. Let’s focus on a few.

Naprozen. Starts working on the 3rd-5th day of intake, stops working 5-7 days after discontinuation. A mild agent. It can be used for prevention when nothing hurts, but the joints are at their limit. 10 days before competitions, take 2 tablets a day (for 70-100 kg). As a result of such preparation, when stepping onto the platform, you feel "freshness" in your ligaments.

Diclofenac. From the same group, works stronger. It can manage "moderate conditions". It’s a shame that there’s a substantial list of side effects.

Reopirin. Should be injected intramuscularly, as it works better this way and causes fewer gastrointestinal issues. It handles severe pain.

Injection of hyaluronic acid into the knee. If it hurts a lot, and competitions are approaching, you are in good shape, fees are paid, the hotel is booked... The best solution is to inject the necessary medication into the knee. It begins working within 1-3 days and resolves the issue with one injection for up to 3 years. Since various athletes have received different hyaluronic acid-based products and all have benefited, choosing the specific medication should be left to a good doctor.

Which Exercises to Do

The knees are most at risk when descending, and the faster the descent, the greater the traumatic load on your ligaments. The rebound is necessary to achieve results in squatting, especially during "wrap work". However, if your knees start to "act up", it’s advisable to temporarily refrain from using the rebound until unpleasant symptoms disappear. Definitely exclude hack squats and sissy squats, as they apply increased load on the knees at any descent speed. To maintain muscle tone, you can use exercises that eliminate rapid descent. Once your knees return to normal, you can return to your usual exercises with minimal loss of working weights.

1. Squat on a Block

Set the block at a height that allows for a depth appropriate for powerlifting standards. Descend smoothly! Try to touch the block with your glutes as far from your feet as possible. Ideally, pause at the lowest point for 1-2 seconds. This exercise is very beneficial for teaching technique to beginners.

2. Squat with a Pause at the Bottom

Everything is as in the previous exercise, but you will need to determine the depth of the squat based on your feelings, not by relying on a mirror. Even experienced athletes will occasionally need depth control from a third party. If there is no experienced judge in the gym, you can use video feedback.

You can make the exercise more challenging. If you take 5 seconds to lower yourself, you'll need lower working weights, thereby reducing the load on your knees, while still effectively working the muscles, possibly even more so.

3. Box Squat

If knee pain increases at sharp angles, you can squat only within the range that does not cause discomfort. Choose a box of appropriate height. Perform it like a squat on a block; working weights will be significantly heavier. This exercise cannot be done without safety assistants. Dropping the bar onto the box will damage the equipment at best and cause injury at worst.

4. Rack Pulls

You can perform this alone in the gym. Set the bar at a height from which your knees can work relatively pain-free today. To successfully lift, it’s crucial to assume the correct starting position. The vertical projection of the bar should pass through the centers of your ankle joints. The centers of gravity for both the equipment and the athlete must be aligned vertically. The skill of achieving this starting position comes with experience.

After lifting, lower the bar smoothly, avoiding any bouncing. Perform each subsequent lift after relaxing in the lower position.

Which Cyclical Activities to Combine Squats for Joint Benefits?

Many athletes rightfully believe their bodies should receive not only strength training. Some need aerobic load for fat burning, while others have different goals. Today, it is common to use the term "cardio," but it distorts the meaning, creating the impression that only the heart is being trained. Aerobic activities train not only the cardiovascular system but also pulmonary function and skeletal muscles, providing a comprehensive impact on the body. To achieve this, one should choose one (or several) cyclical sports. Strength results in squats will suffer from any aerobic activity, except swimming.

1. Long-Distance Running will negatively affect your squats and knees with 100% certainty. Short sprints up to 100 meters, preferably on sand or deep snow, and uphill are less harmful. However, sprinting is not aerobic; it is an anaerobic load. Swimming clearly does not harm the knees and can actually benefit squat performance.

1. All types of rowing are practically safe for the knees, but there is a risk of overloading the back when combined with heavy pulling.

2. Combining with speed skating is relatively safe. However, you won't be able to move too fast on ice rinks, as they are usually crowded with hockey players and casual skaters. Moving on frozen rivers and canals is not always possible everywhere or at all times.

3. Brisk Walking is significantly better than running and is accessible to anyone with legs, anytime. It’s still best to avoid hard surfaces. Walk on dirt, sand, or snow, preferably with inclines. Nordic walking is likely even more beneficial for the body as a whole, but if your knees are already hurting, walking may make things worse.

4. Skiing. Classic and skating styles are essentially different sports. The first is unlikely to harm your knees and will provide excellent aerobic load to your body. The second is also good in terms of aerobics, but it stresses the outer collateral ligament in an unnatural way; the human leg is designed for walking, not for repeated lateral push-offs.

5. Cycling. Under certain conditions, it can benefit your knees. The repeated movements from pedaling stimulate the production of synovial fluid, which protects your knees from wear. By "repeated movements," we mean thousands of pedal rotations; doing 20 squats in this context is negligible. Considering the balance of benefits and accessibility, cycling is the best aerobic activity for athletes, and it will be discussed in more detail.

6. Scooter. Adults have become actively interested in scooters in recent years. There are currently no observations on knee effects. Presumably, it will not be harmful and won't have therapeutic effects either. With regular use, it’s essential to periodically switch the pushing and supporting legs for balanced development. Scooters are quite convenient for getting aerobic exercise while commuting to work or other places. They are inferior to bikes in terms of speed and carrying capacity, as there is no place to hang bags, a frame bag, or a child’s seat. However, they are convenient for transport on the subway and surface transport, which is a significant advantage in urban environments.

More About Cycling

Athletes should not blindly follow the advice given by racers to racers. Our goals and speeds differ. Additionally, your pedals will likely be standard, while racers often use clipless ones. Since many bicycle sellers are former or current racers, they will recommend exactly the model on which they became prize winners in nationwide competitions. However, your bicycle should meet your requirements.

Seating position: Athletes should not hunch their backs. Air resistance increases approximately proportionally to the square of speed. The average speed in professional races is about 45 km/h, while the average for tourists is 20 km/h. All else being equal, racers experience five times more air resistance. You can comfortably disregard resistance in favor of a straight back and comfort. Use all possibilities to raise the handlebars; if necessary, change the stem and install a "V"-shaped BMX handlebar. https://www.instagram.com/p/BJUc7UfgCoS/?taken-by=nikolai_coach.

Weight: An extra dozen kilograms is actually beneficial; it increases the training effect. Carbon frames are unnecessary; aluminum works just fine. But a true athlete should have a robust steel bike with large wheels and a stock of food on the rack. It’s tough climbing hills – dismount and push the bike, preferably running, for more variety in your workout. If the elevator breaks, dragging it up 14 flights will give you a workout with crossfit elements.

Shock absorbers are for show-offs. Your strong legs are the best shock absorbers. By frequently rising from the saddle, you also reduce blood stagnation. Standing uphill is beneficial too. Your core works excellently when you pull the handlebars toward you while riding upright. Ideally, you should spend up to a third of the time standing for health benefits during your ride.

Saddle position: The differences from racing standards aren’t significant. While sitting on the saddle, you should be able to reach the pedal with your heel. You can lift the saddle a few centimeters higher to ensure proper foot engagement. The larger the angles in your knees while pedaling, the better it is for them. It's advisable to move the saddle as far back as possible for maximum comfort of the knees.

Practice shows that to maintain healthy knees, one should accumulate at least 3000 km of road cycling or a bit over 2000 km on dirt per year, equating to approximately 150 hours of pedaling. For producing synovial fluid, it's the time, not the distance, that matters. Not everyone can find 150 hours for a second sport. However, cycling and scootering can be advantageous because they can replace other activities like skiing, skating, rowing, or swimming – you can use them on your way to work, the gym, or the store... Often, this results in a time gain.

In winter, it is safer to ride on public roads with studded tires; for rural roads (with compacted snow, not ice), cross-country tires are sufficient. Replacing a bike with an exercise bike in a gym will rob you of fresh air, elevation changes, beautiful views, and in many cases, personal adjustments.