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Preventing Knee Pain


Updated February 13, 2008

Knee pain occurs for a variety of reasons, but the following tips generally help prevent or reduce pain. Check with you physician for specific recommendations for your situation:

Increase Training Gradually
Doing too much too soon, is one of the major causes of sports injury. Knee pain is particularly common in runners who increase training mileage quickly. The best way to avoid this is to follow the 10 percent rule. This simply means that you should limit your training increases to a maximum of 10 percent each week. That cane be time, load, mileage or any other parameter.

Strengthening Exercises
Muscle weakness or imbalance is one of the first things physical therapists check for when evaluating knee pain. Such an imbalance can be the source of pain. In addition to specific muscle strengthening of the muscles that support the knee (quads, hamstrings, calf), building core strength improves overall stability which may reduce the risk of injury.

The balance of quadriceps to hamstring strength is not 1:1; but closer to 3:2. In general healthy hamstrings can lift 60 - 80% of what healthy quads can do.
More about Conditioning Exercises.

Athletes who are less flexible than average may benefit from flexibility exercises. This is more critical in athletes involved in stop and go sports or those that require quick cuts and turns. Improving flexibility in the quadriceps, and the hamstrings are helpful. For specific stretching information, also see Flexibility Links.

Skills Training
Coordination drills and proprioceptive training have also been found to be helpful in protecting the knee from injuries. More about Proprioception.

One of the best programs for preventing knee injuries, particularly ACL injuries, has been seen in the Santa Monica ACL Injury Prevention Project (PEP). This program, designed based upon the results of a research project, involves a specific routine of exercises and skills training. While designed to address the increase ACL injury rates in female soccer players, the exercises can be used successfully by anyone who wants to avoid knee injuries, as the core concepts are the same for all knee injuries.

Appropriate Footwear
Finally, using the correct footwear is helpful to control excess ankle motion (pronation and supination). Prescribed orthotics may also help with this. More about Foot and Ankle Pain and injuries.

Also Read: 10 Tips for Safe Workouts


Hole CD, Smit GH, Hammond J, Kumar A, Saxton J, Cochrane T. Dynamic control and conventional strength ratios of the quadriceps and hamstrings in subjects with anterior cruciate ligament deficiency. Ergonomics. 2000 Oct.

Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM. Hamstring muscle strain recurrence and strength performance disorders. American Journal of Sports Medicine. 2002 Mar-Apr

Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects. Clinical Journal of Sports Medicine, Sept 2004

Aagaard P, Simonsen EB, Magnusson SP, Larsson B, Dyhre-Poulsen P. A new concept for isokinetic hamstring: quadriceps muscle strength ratio. American Journal of Sports Medicine. 1998 Mar-Apr.

American Academy of Orthopaedic Surgeons Public Information

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