Knee Injury Prevention and Recovery 101

By Townsend Benard, December 14, 2016


From walkers to marathoners, and casual gym-goers to CrossFit Games athletes, injuries happen. And there's never a good time for them. They can happen at any time, at any level of activity or fitness, and have no deference for a particular sport. But fear not! With those scary thoughts in mind, we thought we'd put your mind at ease and help you to both prevent injury, and in the case of it, recover faster. 

Jumper’s knee and general knee pain are among the most common complaints we hear at InsideTracker. Both professional and amateur runners and triathletes alike struggle with pain, and many come to InsideTracker to help them get back to training. We combine the athlete’s biomarker results, particularly for Creatine Kinase, hsCRP, and their Testosterone:Cortisol Ratio, with their athletic and injury history, as well as their diet and lifestyle habits to develop highly personalized recommendations to help them combat current, and to prevent future pain and injuries.

While you’re waiting for your next (or first) test, read on for some exercises you can do to help deal with (or prevent) knee injuries. And be on the lookout for an upcoming post with more on the IT band, another common issue many athletes deal with.

Ache in the knees?It's all in the hips

Hey, I thought we were talking about the knee? Sure, but some of the most effective exercises for reducing knee pain focus on the hip. Why does this work? The muscles of the hip control the position of the thighbone, or femur. Limited strength and/or poor control of the femur can lead to poor running and weightlifting form, all of which result in knee pain.

By strengthening the hip muscles, you can better control your knee and leg position under impact, potentially resulting in improved running form. The bottom line: If you have achy knees, work on your hips.

The hip-based exercises that may reduce knee pain primarily target hip abduction, which is moving your leg away from the centerline of your body, and hip external rotation, which is rotating your knee away from your centerline.



Both exercises act to prevent your knees from buckling in, also known as valgus. You can do hip abduction exercises either standing (shown above) or lying down.

As you get stronger, you can add resistance with therabands, cable machines or ankle weights. When you are doing hip abduction exercises, focus on engaging the hip and glute, and allowing these muscles to move/raise the leg laterally rather than simply focusing on the movement pattern. Using good form for the exercises is much more important than increasing resistance or adding repetitions.

Knee-banded full squats

Knee-banded full squats can also be utilized to help train hip abduction, though this exercise is better for warm-ups. For more advanced athletes, Bret Contreras highlights two hip abduction exercises that work the hip through a large range of motion. Remember, proper technique and control are essential when you’re doing any hip abduction exercises.

Along with hip abduction, exercises for externally rotating the hip can help to reduce knee pain. The hip external rotators are a group of small muscles deep within the glute (shown below).

Screen Shot 2016-12-14 at 11.12.07 AM.png

Strengthening these muscles will give you more control over your knees as you run, preventing your knees from buckling and keeping your joints aligned while you run. As your strength increases, you can improve your running form, modifying the impact of your stride, and thus reducing the impact forces and the risk of shin, ankle and knee injury.

The clamshell exercise

A commonly used exercise to train the external rotators is the clamshell exercise, shown below.


For this exercise, the key is to engage/contract the external rotators deep within the glute and to let this contraction drive the movement. If you just mimic the movement pattern without paying attention to contracting the external rotators, the large muscles in the hip compensate, significantly reducing the benefit to the external rotators. Instead of the clamshell, you can also do hip exercises in a prone position using a resistance band, as shown below.


The goal here is to progress, over a relatively short period of time, from these remedial exercises back into more complicated movements such as squats with adequate external rotation. EliteFTS has a great article highlighting external rotation in the context of a squat and movement cues to help you remember to maintain external rotation.

Knee-based exercises

Knee-based exercises to reduce knee pain include squats, lunges, and step-ups. These exercises increase strength and improve control and coordination of the lower legs during movement. Improving strength, control, and coordination can pay large dividends in preventing injury.

Squats, lunges, and step-ups are quite versatile and make it easy for you to increase the difficulty as your strength increases.

For example, a recent multicenter trial progressively increased squat difficulty from ¼ Depth Double Leg squats to ½ Depth Single Leg squats over a 6 week period, as shown below.


Athletes in this study who did these exercises reported significantly less pain. Forward lunges and both forward and lateral step downs were also integrated into the program, increasing in depth (or range of motion) as participants became stronger.

Focus on form

Remember: when you are doing resistance training with knee pain, start with a restricted range of motion/knee bend (flexion) and progressively increase movement depth/knee flexion so long as these increases do not cause more knee pain.  

Just as in the hip exercises, maintaining proper technique and staying in control throughout the exercise are far more important than increasing weight and depth or making changes in exercise. One of the most important cues to remember when completing these exercises is to keep your knee tracking over your second/third toe. Making these exercises the cornerstone to your program may significantly reduce knee pain and start you on the track toward pain-free exercise.

Setting your exercise program

While one specific program will not fit every athlete, studies have shown that if you want to reduce general knee pain, try high rep ranges. Start with 2-4 sets of 10-15 repetitions of each exercise with 2-3 workouts per week. While resistance training should be an established component of every running or triathlon program, programs strictly focusing on reducing knee pain are often fairly short, lasting from 4-8 weeks.

After that, athletes are usually ready to transition to a program focused more on performance than injury prevention.

Exercise therapy is one of the most effective and well-established interventions for general knee pain. Programs that focus on strengthening both the hip muscles and quadriceps appear to be more effective than programs that focus on just the hip or quadriceps alone (25603546, 26175019). While these exercises provide a great starting point, an injury prevention program integrating exercise, injury history, diet and lifestyle provides a much more holistic, individualized and tailored series of interventions customized specifically to you.

InsideTracker’s extensive blood biomarker analysis takes into account all of these factors and recommends changes just for you. 

Ache in the knees?

Wondering what ALL of your biomarkers mean? We've created this handy biomarker e-book for reference—it's FREE & it's yours to download!

New Call-to-action


Some other blog posts we think you'll love:



8 Ways to Biohack Your Health

Free eBook


New call-to-action