Best Movements for Accelerated Knee Health

The ‘Use It or Lose It’ principle no longer seems to apply much in traditional strength training. Using the body and its joints to their full potential can be seen as ‘dangerous training’ and something saved for the advanced athlete or trainee.

In fact, full-range training is an essential component that will optimize mobility and function, and set the stage for peak performance. In this article, I will highlight the importance of the, often feared, full flexion of the knee and provide progressions for training it safely.

The following are incredibly beneficial exercises that, with some physical awareness and modifications on your end, can bring about strength and appropriate stability and mobility in the knee for trainees of just about all backgrounds. These exercises can be modified down to an entry level corrective movement or all the way up to a high level feat of strength and coordination to show off to the other bros in the gym. These movements challenge old paradigms that have been barked out and passed down for generations by personal trainers, physios, and strength coaches who haven’t looked (or thought) passed the regurgitated rhetoric of “Don’t let your knees go passed the toes” and “Only squat to 90 degrees.”

The reality is, if you want healthy knees, you need to be able to safely move your knees over the toes. Make sure to start at the beginning with highly intentional, controlled, and focused movement. Progressive volume will be key to building tissue resiliency.

#1: VMO/Quad Dominant Movements

Poliquin Step-Up

This movement is done on a lower angled step (4-8” depending on your leg length) in order to target the VMO which is the prime mover in the last few degrees of knee extension. Because of the short range of motion, you will be working at a higher volume, typically 20-25 reps.

Set up a step with an incline, or a step with a plate on it to raise the heel. Begin the step-up and touch the non-working leg’s heel to the floor lightly. Make sure to keep the hips square and not to “reach” with them. The goal is control and not to bounce the heel off the floor or push off with the toe.

Cyclist Squat

Start in a slightly narrower than hip-width stance, feet pitched out about 20-30 degrees, heels 6” apart, toes 10” apart. Come up to the balls of your feet. Begin to lower yourself down into a squat with the knees leading the movement (not the hips). The torso stays as vertical as possible. Control the movement all the way to full flexion of the knee - where the hamstrings and calves touch.

#2: Quad Dominant Movements

Split Squat

With feet hip-width apart, step out into a split stance long enough that the knee can travel over the toe without the heel raising up, but not too long that it limits the movement. With the torso upright and back leg as straight as possible, bend and shift the front knee forward with an end goal of touching the calf to the hamstring - full flexion.

Regression - Front Foot Elevated Low Pulley Split Squat

If you can’t get full flexion because of limited ankle mobility, then you will want to elevate the front foot (4-6”), while you work on that ankle’s mobility separately. Set up your box in front of the cable machine with the pulley on a low setting. Grab the handle and set up your body the same way as the regular split squat. Follow the line of force forward; the pulley will be a great movement cue, as this is the direction you should be moving.

Lunge

Not many people know the difference between a split squat and a lunge, and while the movement of the lunge has the ability to vary greatly, the general difference is one has a dynamic base (Lunge) and one has a fixed base (Split Squat).

To perform a lunge you will start in a standing position and step out in a similar position to the split squat. Now this is where the variables come in. Your stance means a lot. If you step out far, the focus goes to the hamstrings, if you step close, then it moves to the quads. You can then continue to go forward in a walking lunge or step back and stay in one location. If you want to add intensity, you can add load with dumbbells, kettlebells, a barbell, and so on.

Lunges are an incredible unilateral movement for strength and stability of the knee, but be aware of how your knee tracks during the movement as repetitive misalignment can cause injury over time.

#3: Hamstring Dominant Movements

Hamstring Curls

Start this movement with a neutral foot position. For hamstring focused movement, plantarflex the foot to lessen the involvement of the gastrocnemius and focus the movement more on the hamstrings. You can also then do a mechanical drop set by dorsiflexing at fatigue as this will help handle more load. If your hamstrings cramp up in the beginning while plantarflexed, then start just plantarflexed on the concentric portion of the movement and dorsiflexing on the eccentric.

Change the angle of the feet to hit more of the hamstring complex. Try all three angles: feet internally rotated, neutral, and externally rotated. This will help to find any areas of weakness and create a priority.

Reverse Nordic Curl

This movement is amazing because it can easily be controlled and very safe, but it can also be extremely difficult. Begin in the kneeling position. Activate the glutes to lock the torso in place; no bend at the hips during the movement. To start, extend the arms in front of you to increase the lever arm and make it easier (progress by crossing arms, progress again by putting them behind the head).

Every time you start this movement, begin with micro-movements. Get the body and central nervous system prepared for what it’s about to do. Lower yourself down as far as possible, pause briefly, and come back up controlled.

Another option in the beginning is to place a bench or something behind you at a height close to or slightly beyond your maximum controlled distance. This gives you peace of mind and a goal to reach. Use this movement to build strength safely at maximum knee flexion.

Final Words: Ultimately, if you want healthy, functional, strong knees, do not avoid the movements they were designed to do. If you limit the movement, then they become weak in the areas you’ve limited. This makes you even more prone to injury and pain in those exact positions. Listen to your body, find your own range of motion, increase it, and enjoy each degree of potential strength and pain-free movement you’ve just unlocked.