Do you have knee pain? Do movements like the squat or even walking down stairs bring out symptoms? If so, you’ve come to the right place. Today I want to share the exact method I use to help the best athletes in the world fix their knee pain. I use a simple science-based protocol that’s worked for thousands of people. There’s 3 simple yet extremely effective steps to this process – and doing each correctly is crucial – so pay attention.
Step 1 is Mobility. Before we start any corrective exercises we need to first screen for mobility imbalances at the joints above and below the site of symptoms – as restrictions in either can negatively impact how the knee joint moves and handles the forces placed upon it.
Today I’m going to show you 4 tests you can perform to see if you have problems in these areas. If you test positive in any of these tests, I’ll then give you a home exercise program that focuses on mobilizing tight structures to restore balance to your body.
The first is the FABER test which assesses both external rotation and extension. Lay on your back and place one foot on top of your opposite side knee. Then let your leg relax and drop as far to the ground as possible. Make sure to keep your pelvis level as rotating your hips will throw off the results of the test. If you have less range of motion on your painful side that would indicate a positive test.
For test number two we’re going to look at hip internal rotation. This test is best done with a friend so you can relax as the friend assesses how much you can rotate. However, if your by yourself – sit over the edge of a table or bed and rotate your foot out to the side as far as possible without your pelvis moving or torso shifting side to side. If you have less range of motion on your painful side that would indicate a positive test.
Now that we’ve assessed your hip, we need to turn our attention to the ankle. The first ankle test looks at how far your knee can pass your toe – the motion of dorsiflexion. Find a wall and position your foot a fist + a thumbs length away (or roughly 5 inches). While keeping your foot firmly planted, push your knee directly over your toes as far as possible.
While the goal for most should be to get close to touching the wall with your knee – a positive test in the context of evaluating knee pain is only if you had significantly less motion on your painful side.
The last screen is a lesser known but very important motion of tibial rotation. As you squat, your knee not only moves forward over your toes but your shin bone also internally rotates and tips to the side. To screen for this, take a seat and align your feet with your toes pointed straight forward. While keeping your knees in place and your feet flat on the ground, rotate one foot in at a time as far as possible. Don’t let your foot roll on its side or you’ll skew the test results. If you have less range of motion on your painful side, that would indicate a positive test.
So now that we’ve run through the tests, it’s time to start your constructing your individualized rehabilitation plan by restoring mobility to restricted areas you found in the prior testing.
Now before we dive into the exercises – if you didn’t find any mobility restrictions, you can definitely skip over this section and move to step 2. But if you did find some tight areas – let’s dive in.
If you were limited in the FABER test, try the kettlebell weight shift. To perform, start in a kneeling position with your restricted hip up. Then open your hip by squeezing your glute before shifting until you feel a groin stretch. Try 5 reps for a 5” hold.
If you were limited with hip internal rotation, try the assisted hip airplane. Find something to hold onto before then assuming a single leg RDL position with your focus hip as the stance leg. Then drop your pelvis until you feel a stretch in the back of your hip in your glutes. Try 5 reps for a 5” hold.
Now if your limited hip internal rotation is also connected with a pinching pain in the front of your hip when you pull your knee to chest – you may want to try a joint mobilization instead. Place a monster band loop across your restricted hip and assume a lunge position. Holding onto a bench can help you get enough tension on the band without being pulled over. Then take a deep breath out and relax your hip while simultaneously pushing your knee across your body into hip internal rotation. At the same time drop your chest towards the ground. If you have enough tension on the band you won’t feel that prior hip pinch. Then open your hip while squeezing your glute and hold for 3”. Then reset and repeat this sequence 4 more times.
If you were limited with ankle mobility, try a calf stretch with your foot placed on a bench or chair. Drive your knee over your toe until you feel the stretch in the back of your leg and hold 5 reps for a 5” hold. If however this brings out a pinch or blocked sensation in the front of your ankle joint – you may need to try a joint mobilization instead. Make sure to get a ton of tension on a band. Make sure the band is positioned over the top of the foot under your ankle bones as opposed to higher on your shin. This will help the band glide your talus bone backwards – effectively assisting the natural motion of the ankle to enhance mobility. If you have enough band tension, you won’t feel the pinch any more when driving knee over toe – Try just 10 reps back and forth.
And last if you found limited tibial rotation on one side, find a resistance band (if you’re a home a towel works great too). Trap the band under the base of your big toe. Then open your hip as far as you can to the side while keeping your foot firmly planted to the ground. Fail to keep your foot stable and the band or towel will snap out! If done correctly you should feel your glute working hard. Try 10 reps for a 5” hold in the open position.
Now before we move onto step 2 – I want to emphasize how important it is to perform testing like this to help fix any injury as there is no “one size fits all” method to rehabilitate any injury. That’s why I wrote my book “Rebuilding Milo” so you can learn and apply this approach for any area of the body and kickstart fixing your nagging injuries – so after this video is done, head on over to Amazon.com or your local bookstore and pick up your copy of “Rebuilding Milo” But for now – let’s continue…
Now that side to side mobility imbalances have been addressed, we’re ready to move on to step 2. “Stability.” This is your ability to control your body and limit the mictro-trauma that develops at the knee. There are two exercises within this section. The side plank clamshell is the first.
Place a resistance band loop around your knees and lay on your side with your elbow propped under your shoulder. Perform a side plank with knee support before then opening the clamshell by externally rotating your hip. Hold this top position for 5” and you should feel your downside glute working hard to help stabilize the body. Perform 10 reps and yes you can perform this on both sides.
As far as the amount of sets and reps to do – at the end of this blog I’ll show you the full routine written out – for now just focus on perfecting the technique of each exercise.
The second stability exercise is a hip airplane. This exercise helps build foot stability and rotation control of your hip. To perform Assume a single leg stance and hinge into an RDL position. Bend your knee slightly before then twisting your pelvis open and closed slowly 10 times. Make sure your knee stays pointed straight forward and your foot rooted to the ground. Each rotation should take about 5 seconds to perform and make sure to hold the end position for 3 seconds.
If this movement is too difficult to perform without falling over – you can use 1 hand for balance, but try not to hold on with both – as doing so will minimize the stability improvements we’re trying to create and turn this drill into a stretch.
The third step in our complete knee pain rehabilitation plan is integration. In order for your new found mobility and stability to stick around – we need to use those two prior steps during weight bearing movement. Today I’m going to show you 2 exercises most can start performing on their first day regardless of how painful their knee is. I’ll then show you how to progress each. Technique will be key for ensuring these are performed pain free so pay attention.
The first is a squat. The next time you squat, look in the mirror or film yourself from the front and back. Ideally we want to see complete symmetry, however many who have knee pain tend to shift one way or the other which loads the knee joint unevenly.
There are 4 steps to a perfect squat I want to share with you today. Start by Setting your feet around shoulder width with your toes relatively forward or at a slight out-toe angle. Firmly secure both feet into the ground, spreading your bodyweight across these three points (called the tri-pod foot).
Next, open your hips slightly. You’ll notice If you open your hips too far, your feet will become unstable and roll on their side. So make sure your feet remain rooted to the ground. Step 3, perform a small hinge by pushing your butt back while you lean your chest forward slightly. Holding your arms out in front can help ensure your torso stays in a good position and doesn’t round over. Step 4 begin your squat and focus on keeping your bodyweight evenly spread across your entire foot. Your heels shouldn’t lift from the ground, nor should your weight be entirely in your heels. If you focus on your hips staying open. your feet firmly planted and your balance spread across your full foot – your knees will remain stable. Squat only as deep as you can without pain. At first this may only be to a chair, but eventually you can go deeper as long as the movement remains pain free.
If you found your hips to be very fatigued with prior hip stability exercises – it would be a good idea to wear a resistance band loop across your legs at this time. Research has shown doing so can enhance glute engagement and coordination – therefore addressing a common weak link in many who develop knee pain. Just make sure the band you wear isn’t too tight or else you wont be able to achieve your same stance width.
As a side note – don’t worry about how far your knee is moving over your toes or not. Just focus on your balance and maintaining the other pillars of a proper squat. Knees over toes isn’t a bad thing despite what your doctor may have told you in the past.
The step 2 progression will be to add load to the movement. At first this can be in the form of a goblet squat. This can be done by simply holding a dumbbell or kettlebell by your chest and eventually adding in barbell squats as well.
The next exercise essential for abolishing knee pain is a touchdown single leg squat. Start by standing on a small box or weighted plate (usually 2-4 inches in height). Before you begin the squat, drive your hip backwards and bring your chest forward. This movement engages the powerhouse to your body (the posterior chain). Your bodyweight should feel completely balanced over the middle of your foot. Once the hip hinge is complete, begin to squat until the heel of your free leg taps the ground. After you have made contact, return to the start position. Make sure your knee stays in direct alignment with your toes during the entire movement. It should not rotate or collapse inwards whatsoever. Even though the distance for a touch down is small, you should still feel your glutes working very hard after 10 reps if done correctly. If not hinge more at the very start before you start your squat.
The step 2 progression will be to increase the difficulty by making the height of the box progressively higher. A good goal for many will be a height of 8-12 inches.
So let’s now talk about how to create a program that’s right for your body.
Start with mobility drills that address your side-to-side imbalances. Then perform stability drills and finally your integration drills of the touchdown single leg squat and then the regular squats. As you can, progress the height of the touchdown and add load to the regular squats. These need to be performed at minimum 4x/week.
It’s also a good idea to periodically retest your mobility with the prior tests every few weeks to see if you’ve made progress. If your pain is decreasing and you notice your mobility is more symmetrical, you can do those corrective stretches less frequently and just use the stability exercises as warmups before your workouts. Keeping these drills in your weekly routine will minimize the risk of those imbalances and your potential for another injury from returning in the future.
Good luck on your knee rehab and give this video a watch next, for what I believe are some of the biggest mistakes when it comes to fixing low back pain and what to do instead!
Until next time,
Dr. Aaron Horschig, PT, DPT, CSCS, USAW
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I completely agree! Regularly retesting mobility is crucial for tracking progress and adjusting your rehabilitation plan. It’s great to hear you’re noticing improvements in pain levels and symmetry. Reducing the frequency of corrective stretches while maintaining stability exercises as warm-ups sounds like a smart approach to prevent imbalances. Consistency is key in rehab slope, so incorporating these drills into your routine will help in the long run. Thanks for sharing the video recommendation.
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Hi, Dr. Horschig. I’m so glad I found your amazing Youtube channel, as it landed me here. Thank you, thank you! I followed your assessment tests and started performing the recommended exercises. One question… In the section regarding the second stability exercise (the hip airplane), I could not find reference to the stance leg. In all other sections you mentioned it clearly. Should the stance leg be the focus/limited mobility leg or the other leg. Thanks in advance and for everything you do for those of us in pain!
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