Joint Ventures: Specialized Exercise Programming for Less-Than-Perfect Knees and Hips

By CarolAnn, MS, CPT, NPCT

The knees and hips are two of the most critical joints in the body, bearing the weight of our movements and enabling us to perform everyday activities with ease. However, they are also among the most susceptible to injury, especially as we age or engage in physically demanding activities that create wear and tear. Proper exercise is essential not only for maintaining the strength and flexibility of these joints but also for preventing pain and injury. Here’s a comprehensive guide to programming exercises for knees and hips safely and effectively.

Structure of the Knee and Hip

Knee: The knee is a hinge joint, primarily allowing for flexion and extension. The knee joint is made up of two parts. The part of the knee between the end of the thigh bone (femur) and the top of the shin bone (tibia) is called the tibiofemoral joint. The patellofemoral joint is between the end of the thigh bone (femur) and the kneecap (patella). 

Hip: The hip is made up of five bones and several other structures that form a ball-and-socket joint where the thigh bone (femur) meets the pelvis (acetabulum, ilium, ischium, and pubis). The hip also contains other structures, including bursa, tendons, and supporting muscles such as the gluteals, adductor muscles, iliopsoas, quadriceps, and hamstrings. The hip is a ball-and-socket joint, enabling a greater range of motion, including flexion, extension, abduction, adduction, and rotation. 

Most Common Injuries

Both joints are supported by a complex network of muscles, tendons, ligaments, and cartilage that work together to facilitate movement and absorb shock. When these supporting structures are weak or imbalanced, it can lead to problems such as osteoarthritis, bursitis, tendonitis, and even more severe injuries like ligament tears or fractures. Therefore, it’s crucial to focus on exercises that strengthen and stabilize the muscles around the knees and hips.

Key Principles of Knee and Hip Exercise

1. Warm-Up Thoroughly:
   A proper warm-up increases blood flow to the muscles and prepares the joints for exercise, reducing the risk of injury. Focus on dynamic stretches and light aerobic activities that target the lower body, such as walking, cycling, or leg swings.

2. Strengthen Supporting Muscles:
   The quadriceps, hamstrings, glutes, and hip abductors play vital roles in supporting the knees and hips. Incorporate exercises that target these muscles to ensure they are strong and balanced.

• Quadriceps: Exercises like squats, lunges, and leg presses help strengthen the quadriceps, providing stability to the knee joint.  Keep in mind that one should perform shallow squats or lunges if pain is present.

• Hamstrings: Deadlifts, bridges, and hamstring curls are effective for building hamstring strength, which is essential for knee health.

• Glutes: Strong glutes stabilize the hips and pelvis, reducing stress on the knees. Try exercises like hip thrusts, step-ups, and lateral band walks. The height of the step will be determined by one’s range of motion or if pain is present. 

• Hip Abductors: Strengthening the muscles on the outer thigh with exercises like clamshells, side leg raises, and monster walks can improve hip stability.

3. Focus on Flexibility:

Flexibility is crucial for maintaining a full range of motion in the knees and hips. Regular stretching of the quadriceps, hamstrings, hip flexors, and glutes can prevent tightness and imbalances.

• Hip Flexor Stretch: Kneel on one knee with the other foot in front, push your hips forward gently to stretch the hip flexors. If one has knee pain, then this can be performed standing.

• Hamstring Stretch: Sit on the floor with one leg extended and the other bent, reach towards the toes of the extended leg to stretch the hamstrings.

• Glute Stretch: Lie on your back, cross one ankle over the opposite knee, and gently pull the supporting leg towards your chest.

4. Incorporate Low-Impact Aerobic Exercises: 

Low-impact activities like swimming, cycling, and elliptical training reduce stress on the knees and hips while promoting cardiovascular health. These exercises are especially beneficial for individuals with existing joint pain or those recovering from injury or surgery.

5. Avoid High-Impact and Overuse Activities:

High-impact activities, such as running on hard surfaces or jumping, can put excessive strain on the knees and hips, especially if done without proper conditioning. If one enjoys these activities, ensure they have a strong foundation of strength and flexibility and consider cross-training to reduce the risk of overuse injuries. In addition, avoid kneeling or laying on the injured or problematic area.  For example, avoid kneeling on the knees in a modified plank or push-up. Instead, position the body on the toes, wall, or ballet barre. Another example would be to avoid laying on the hip in side-lying leg lifts. Instead, perform standing leg lifts with a thigh band.

6. Program Balance and Proprioception:

Improving balance and proprioception (the body’s ability to sense its position in space) helps prevent falls and injuries. Incorporate exercises like single-leg stands, heel-to-toe walking, and stability ball exercises into the programming.

7. Listen to Your Body:

Pain is a signal that something is wrong. If your client experiences pain in the knees or hips during exercise, stop immediately and assess the cause. It’s important to differentiate between muscle soreness, which is normal, and joint pain, which could indicate an injury.

Sample Exercise Program to Improve Knee and Hip Health

Here’s a sample program that combines strength, flexibility, and balance exercises for optimal knee and hip health.

Warm-Up:
5-10 minutes of light cardio (e.g., walking or cycling)
Dynamic stretches (e.g., leg swings, hip circles)

Strength Training:
Squats: 3 sets of 12-15 reps
Glute Bridges: 3 sets of 15-20 reps
Lateral Band Walks: 3 sets of 10-12 steps each direction
Hamstring Curls (using a stability ball): 3 sets of 12-15 reps
Step-Ups: 3 sets of 10-12 reps per leg (The height of the step will depend on the knee/hip issue.)

Flexibility Exercises:
Hip Flexor Stretch: Hold for 30 seconds each side
Hamstring Stretch: Hold for 30 seconds each leg
Glute Stretch: Hold for 30 seconds each side
Quadriceps Stretch: Hold for 30 seconds each leg

Balance Training:
Single-Leg Stands: Hold for 30 seconds each leg
Heel-to-Toe Walking: 2 sets of 20 steps

Cool Down:
5-10 minutes of stretching and deep breathing

Final Thoughts

Proper exercise for the knees and hips is essential for maintaining joint health and preventing injury. By focusing on strengthening the supporting muscles, improving flexibility, incorporating low-impact aerobic activities, and practicing balance, one can keep his/her knees and hips strong and functional for years to come. 

FiTOUR® offers several Primary and Advanced courses that provide tools necessary to create safe and effective programming for knees and hips including Yoga, Pilates, Aqua, and Indoor Cycling. With the growing needs of your clients, specialty education is imperative to service those needs. 

CarolAnn has been a certified fitness professional with a master’s degree in Exercise Science and Health Promotion for over 30 years, has been a FiTOUR® ProTrainer for over 25 years, and has authored 18 FiTOUR® courses including the Yoga, Pilates, Aqua, and Indoor Cycling Primary and Advanced courses.  CarolAnn is a Club Pilates Corporate Master Trainer and Lead Instructor for the Club Pilates studio in Athens, GA where CarolAnn specializes in movement for everyBODY.