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Pilates is associated with the integration of body, mind, biomechanics, motor learning and core stability[i] – however, it can provide a useful tool when helping us deal with knee pain.
Like many, knee pain is a pain in more ways than one – we know that persistent knee pain, and impaired mobility/function of the knee has an impact on our quality of life[ii]. Knee pain stops us being able to bend down easily, sit with our legs crossed, or just have general aches and pains throughout the day. This tends to mean we avoid exercise because maybe we think that doing mor exercise will make this work - which is understandable, but it does not help us when what we really need to do is strengthen the muscles and ligaments around the joint plus help improve our core stability and support the structure of the skeleton.
There is a way to help this though – and I want to share with you some of my thoughts and ideas about how Pilates can be of great assistance.
People often accept that knee pain is an inevitable part of ageing, and that it is something that we have to endure or manage.
The knee is a complex structure, and it is designed to allows us to take stress and strain in various load positions – both downward loading force, but also the ability to take shear force strain both laterally, and frontal.
The knee is a key movement coordinator and transfer of power when we contact the floor – working with both the ankle and the hip to ensure our gait is efficient and effective. Any damage to the knee makes us change the way that we move – this a frustrating element to our daily life. In a study of over 9,000 people, a quarter of all over 55 report persistent knee pain[iii] - with half of this group in severe pain or severe difficultly in function – so you are not alone. A study by Mazloum[iv] found that Pilates provided a more effective training method than conventional therapeutic exercise to improve knee pain. Whilst we know that conventional training, such as going to the gym or doing aerobic exercise are effective, there is now emerging evidence that Pilates can improve knee pain and also improve mental and physical aspect of quality of life.
So how does this work?
First, many of the Pilates’s exercises require us to statically contract the quadricep muscle (main front of thigh). We know that strengthening the quadriceps[v] plays an important role in the prevention and improvement of osteoarthritis. This large muscle that starts at the hip and runs down the front of the thigh before it attaches to the shin bone is the main player for knee stability and provides us with “shock absorption” as we run, jog, or walk. We also need to work on increasing hamstring strength and flexibility, plus the internal and external muscles that run on the outside of the leg which all work together to keep the knee functioning freely.
I have been teaching Pilates for many years now, and what I find is that although people think the doing of “exercise” that does help, I believe its more about how you do that exercise. You may have seen that many people talk about the concentrating and precision of Pilates – and this comes about from contracting the muscle throughout the exercise - controlling both the eccentric (lowering against gravity) and concentric (lifting away from gravity) phases of the movement. This is really key to helping us work on stabilising joints – and especially the knee joint.
Like all joints, the knee is two bones joined together with a slight gap between them. The end of the joint has cartilage which aids the smooth movement and cushioning of the joint, and is then held together with a complex series of ligaments to stabilise movement and external muscles and tendons to “bind” the joint, much like a knee brace. Unlike other joints though, the knee has an additional free bone that sits outside the two inside bones to provide further protection - this is your knee cap, or patella. The patella sits inside the quadricep tendon (end part of muscle, made up of fibrous connective tissue), and slides within this depending on how far you bend your knee to increase the power that the quad tendon exerts . We want the patella to be able to move freely, without grinding, pulling, or stressing the ligament - the “Jumper’s knee” or patella tendinopathy, is a common cause of knee pain, even if you don’t jump or run.
When performing your Pilates moves, you need to focus and concentrate on contracting the quad muscle when performing your leg lifts – for example, Side Lying works more effectively when you “lengthen” the leg away from your body, allowing the quadricep to contract and stabilise the knee – this action is done without loading the knee with weight, and is a great starting point for those of you who want to get stronger knees, but find that conventional exercises such as squats etc cause more irritation. Think about your position of your “table top” before doing single leg stretch. Keep the knee placed directly under the hip to load the weight through the femur, and then tense the leg all the way from the hip to the ankle to help stabilise around the knee. There is a short video available that leads you through these exercises – this is a part of my Café sessions where we do weekly workouts and workshops to help increase your strength and conditioning, with supporting information on how to do this – please note that that this is part of a class, so ignore the part that say see you tomorrow!
Posture – or being able to stand up without strain, helps your knees, and many of the Pilates’s exercises will be able to strengthen the muscles that support your core to allow suitable distribution of weight throughout your body.
Try to include standing work to help balance, alongside the bridge, leg kicks, torpedo, and swimming exercises. Don’t forget to elongate and tighten as you do the exercise, and follow up with some specific stretching to elongate lengthen the muscle. Finally, think about following a diet that includes anti-inflammatory foods (see Arthritis web pages for suggestions) and reduce food that increase inflammation, to support the health repair of your tissue.
Whilst some knee problems may be down to direct injury, there is evidence that even a total knee replacement, recovery from an ACL[vi], and osteoarthritis. So, if you have knee pain and it is causing you misery, why not think about doing some Pilates to help? Contact me for more details about programmes to help.
[i] C. Wells, G.S. Kolt, et al. Defining Pilates exercise: a systematic review. Complement Ther. Med., 20.4 (2012), pp. 253-262 [ii] Briggs, A. M., Cross, M. J., Hoy, D., et.al. (2016). Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. The Gerontologist, Volume 56, Issue Suppl_2, April 2016, Pages S243–S255 [iii] Jinks C, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain.2002;100:55–64 [iv] Mazloum, V., Rabei, P., Rahnama, N., Sabzehparvar, E. (2017). The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis. Complementary Therapies in Clinical Practice. Vol. 31, May 2018 [v] Najafabadi, M.T., Mahdavinejab, R., Ghasemi, G. (2014). Comparison of isometric and Pilates’s exercise on Knee pain and quality of life in women with Knee Osteoarthritis. Asian Journal of Multidisciplinary Studies. Vol. 2 Issue 3. [vi] Celik, D., Turkel, N. (2015). The effectiveness of Pilates for partial anterior cruciate ligament injury. Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages2357–2364 (2017)
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