What makes any exercise “the best” for something? For many, they assume the biggest weight that can be lifted means the most productive exercise. That MIGHT be true, but it has to be in the proper context of other variables. Just having the most weight without knowing any other aspect the exercise can make what we are discussing pretty limited.
Nowadays, you see that all the time and hearing the “best” exercise for anything can make you pretty numb because everyone claims they have all the answers. I’ll be honest, when it comes to something like knee pain, we are going to discuss this as though you have been having chronic knee pain for a while. Not that you just came out of surgery, or that you got into an accident of sorts that caused specific trauma to your knee. It is important to be clear what we mean when we are discussing knee pain specifically.
So, with that said, what IS the “best” exercise for knee pain in my opinion? It won’t be glamorous, but I will give A LOT of rationale for it. That would be the step-up. What? Not squats, not lunges with knees over toes, or whatever? Yup you got it and it is my opinion based on A LOT of research. Like what? Let’s explore below…
Open vs. Closed Chain Exercises
When people get into arguments about what muscles to train, this implies that it really doesn’t matter HOW we train these muscles as long as we hit them. Meaning, if we want to “work the quads” because we think this has an element to help knee pain, it doesn’t ‘t matter if we squat (a closed chain exercise) or do a leg extension machine (an open chain exercise) right? If we are talking post surgery there is a discussion to be had because how well someone can use the leg is something to consider, but in general, a great deal of research highlights that closed chain exercises (those we typically think of like squats, deadlifts, lunges, and step-ups) are better for knee pain. Why? As this 1992 study explains..
“since the closed chain kinetic exercises include weight transfer and are similar to functional daily activities such as sitting and stair climbing, they can be superior for knee issues like osteoarthritis.”
Other studies have pointed to the importance of the chain functioning well to help knee pain like the image below explains…
Okay, step-ups allow for all that, but why would they be better than other exercises for knee pain?
Lateral Strength & Foot Stability
While so many social media influencers love to talk about this or that muscle being essential for knee pain (oddly a lot of quad talk) the truth is that most of the research shows that lack of the ability to have the knee resist lateral or frontal plane forces is the reason for A LOT of knee injuries. Why don’t people just say that? Well, it is a lot easier to talk about individual muscles than more sophisticated concepts like how the chains of the body resist frontal plane movement (since most don’t even know what the frontal plane is) and probably not surprising, step-ups are a great way to progressively build frontal plane stability.
One reason is that the step-up is also a TRUE single leg exercise. Split squats and lunges are great, but there are still two legs on the ground. The step-up can be progressed very easily (using a lower step, direction of our step, and how we use load on the step-up) and is a true single leg exercise. This means greater frontal plane stability and foot strengthening too! We know foot issues can have a significant impact on the knee as does chronic ankle instability. Guess what does a great job of strengthening both?! If you said step-ups you are right!
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Better Glute & Hip Muscle Training
This isn’t about which glute muscle you are hitting or isolating more of, knee pain requires ALL the gluteal muscles to be working at a high level to be both helping us move through space (where we are often on one leg like walking) as well as stabilizing us in that frontal plane we were talking about.
What is shocking to so many people is that step-ups have been shown in MANY studies to be the BEST at getting the gluteal muscles MOST active. They also do wonders for the whole hip complex that can help stabilize our knee and allow us to address the true root causes of a lot of knee pain.
What we do in DVRT that is unique for the step-up that changes how we can impact knee pain is that we are also very adamant about integrating the core by HOW we use the Ultimate Sandbag. Integrating the Ultimate Sandbag with Press Out and Front Loaded positions like physical therapist Jessica Bento shows above is how we can start, but then I show some more advanced progressions below. Using the core with the lower body enhances the stability and strength of the lower body that will help knee pain and make us more resilient.
Understanding the principles behind knee pain should help us see why an exercise like the step-up can be so effective in addressing the real issues people face. The best part is how progressive we can make the step-up as well. If you want to find out more, you can check out our physical therapist, Jessica Bento’s DVRT Rx Knee courses 30% off HERE with code “education”
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