Take control of your knee pain

If you've got sore knees, exercise might seem like the hardest thing you can do — but it's also one of the best.

"Exercise is one of the most important things you can do for knee pain," says Dr. Lauren Elson, an instructor in physical medicine and rehabilitation at Harvard Medical School.

The right combination of strengthening and stretching exercises can relieve pain by helping to improve the way the joint moves and functions.

"The knee is often an innocent bystander between the hip and the foot. Knee pain is often caused by problems occurring above or below," says Dr. Elson.

For example, weak hip muscles may cause more strain on the knee, intensifying your pain. Strengthening the muscles around the hip joint can help relieve it, says Dr. Elson.

In addition, knee pain is sometimes caused or aggravated by tight muscles around the knee, a problem that is often successfully addressed by stretching. If the muscles aren't flexible, the knee joint sometimes won't move properly, says Dr. Elson.

What conditions can exercise help?

Knee exercises and stretches can help relieve knee pain caused by many conditions, including these three that commonly affect older women:

Patellofemoral pain. This condition typically causes a dull, aching pain in the front of the knee that's made worse by daily activities, such as squatting, going up or down stairs, or standing up after sitting for a long period of time. The pain is caused by irritation of the cartilage underneath the kneecap when it does not glide or sit properly. Exercise can help to eliminate problems that lead to this irritation. Stretches can loosen tight muscles on the side of the knee that may be pulling the kneecap out of its groove as it moves. Strengthening weak hip muscles or stretching tight muscles in the front or back of the legs can also reduce discomfort.

Chronic degenerative meniscal tears. When one or both pads of cartilage that cushion each of your knee joints deteriorates or tears, you may feel pain and a sticking or locking sensation. While surgery is sometimes necessary, doctors usually first recommend physical therapy to help build up the muscles around the knee to take the pressure off the joint and reduce discomfort.

Osteoarthritis. If you're over age 50 and you have stiffness, pain, or swelling, it may be osteoarthritis. Years of wear and tear can break down the cartilage in the knees, leading to chronic joint inflammation. A past injury may also lead to arthritis. While nothing can reverse these physical changes, you can reduce pain by building up the muscles around the knee as well as in the pelvis and core. Strong muscles act like scaffolding, taking some of the pressure off the joints. Stretching to increase flexibility can help the joint function properly.

Exercises to try

To ease knee pain, you'll want to perform exercises that work a number of different muscles, from the hip abductors to the hamstrings and quadriceps, says Dr. Elson.

Two to add to your routine are the side-leg raise, and the single-leg lift. Do this workout at least two days a week to start and ideally work up to every other day.

How many exercises you do in each session is your choice. But keep in mind that rushing through exercises can be counterproductive.

"It's more important to have good form than it is to have volume," says Dr. Elson. Start slowly with fewer repetitions to ensure you get your form right. Then add more as it becomes easier.

Side-leg raise

Starting position: Lie on your right side, with your legs straight. Bend your right forearm upward and rest your head on your hand.

Movement: Keep your legs straight and slowly lift your left leg up toward the ceiling. Pause, then slowly return to the starting position. Finish all repetitions, then repeat on the left side.

Tips and techniques:

• Throughout the movement, keep your hips straight and still as if you were lying with your back against a wall.
• Contract your abdominal muscles and keep your pelvis still (no rocking) throughout.
• Lift your leg up as high as possible without letting your hip move and while maintaining good form.

Make it easier: Lift your top leg a shorter distance, or lean your back against a wall for support.

Make it harder: Tie resistance tubing around your upper thighs, or increase the number of repetitions.

Single-leg lift

Starting position: Lie on your back with your legs straight. Extend one leg, foot slightly flexed. Rest your hands at your sides on the floor.

Movement: Tighten your thigh muscles and slowly lift the leg in the air until your knees are aligned. Pause, then slowly lower your leg to rest on the floor. Finish all repetitions, then repeat with the other leg.

Tips and techniques:

• Keep your abdominal muscles contracted.
• Keep your hips on the floor as you lift one leg.
• Exhale as you lift.

Make it easier: Lift your leg a shorter distance.

Make it harder: At a slow, controlled pace, try tracing the letter T with your leg in the air. Lift up one leg four inches, move the leg four inches to the left, return to center, move the leg four inches to the right, return to center, then lower your leg to the floor. Finish all repetitions, then repeat with the other leg.

Stretching

You should also incorporate daily stretching into your routine. Try using a foam roller to work out the kinks in your muscles. The roller targets tight, rigid, and painful areas in both the muscles and the myofascial tissue (a layer of connective tissue around the muscles). This process, called myofascial release, which can also be performed through a hands-on massage, is designed to relax this tissue to reduce pain. It does this by releasing tension in muscles that are pulling abnormally on the knee joint, says Dr. Elson.

Below are two stretches to try. Ideally, you should aim to do three or four repetitions of each, holding for 10 to 30 seconds each time.

Hamstring stretch

Starting position: Lie on your back with your legs straight and your arms by your side.

Movement: Grasp your right leg with both hands behind the thigh. Extend your leg to lift your right foot toward the ceiling, foot flexed. Straighten the leg as much as possible without locking the knee to feel a stretch along the back of the right thigh. Hold. Return to the starting position and repeat with the left leg.

Tips and techniques:

• Stretch the leg extended toward the ceiling to the point of mild tension without any pressure behind the knee or any pain.
• Relax your shoulders down and back into the floor.

Make it easier: Don't lift your leg as high, or use a strap instead of your hands to support your leg.

Make it harder: Pull your leg closer to your chest.

Quadriceps stretch

Starting position: Stand on the floor with your feet spaced shoulder-width apart.

Movement: Bend your right knee and bring the heel toward your right buttock. Reach back with your right hand and take hold of your foot. Hold the stretch, then slowly lower your foot to the floor. Repeat the stretch with your left leg.

Tips and techniques:

• Stand straight.
• Keep your bent knee aligned with the hip, not pointing out to the side.

Make it easier: Lie on your stomach to do the same stretch. Place a yoga strap around your foot and hold on to both ends as you get into the starting position. Then use the strap to assist with the stretch.

Make it harder: Doing the stretch on your stomach, lift your knee off  the floor slightly, without pulling your foot, to increase the stretch.

Image: Jan-Otto/Getty Images; exercise illustrations: © solar22/Getty Images