If Strengthening Quads Was Really the Answer to Beating Knee Pain, I Wouldn't Exist

How's that for a provocative title?

On a number of occasions, I've weighed in against the "strengthen the quad(ricep)s" mantra for overcoming knee pain (realizing the wrongheadedness of this approach is my big epiphany in Saving My Knees). I'm not against strong leg muscles. I just think physical therapists have it bass ackwards, if you will.

Strengthen your joints, THEN strengthen your quads. It's very, very, very important to get this sequence right. Sort of like if you decided to start putting on your shoes, and then your socks, before going to work each day. After a while, you might wonder why your feet always hurt and why you were wearing out socks so fast.

Today I'm going to prove the weakness of the "strengthen your quads" school of thought, using my own story as an example. If "strengthen your quads" is correct -- if it's impossible to heal damaged knee joints and your only hope lies in bulking up your leg muscles, to prevent further injury -- then I guess I don't exist.

Why? Because my knees healed while my quads got weaker.

I'm a numbers and logic kind of guy, so I'm going to do some numerical simplification. When the chronic pain began in my knees, my legs were quite strong. I had been powering up steep hills and low mountains on my titanium Litespeed bicycle for months. So I'm going to guess that my quads were at roughly 95% of their maximum strength.

So here's the situation: My knees start burning. I have "patellofemoral pain syndrome," I am told. What's the solution for this condition? Strengthen the quads! (according to the old school physical therapists). So if my quads are at 95%, my only salvation (it appears) would be to get them even stronger -- to say 97% or 98%.

I should've been on a one-way rocket sled ride to the land of endless pain. That's because I had to curtail my cycling for a while, to give my knees a rest. But they didn't heal. Then I tried doing less-intense cycling. They still didn't get better. Meanwhile, my quads were steadily weakening.

After floundering around for more than a year -- seeing a handful of doctors, trying standard physical therapy, trying ANYTHING I could find that promised the least bit of relief -- I quit my job to try to recover on my own. If my quads had been 95% of maximum strength when knee pain set in, they were probably no more than 60% at this point.

But the type of exercise I chose to do during my recovery wasn't quad strengthening at all -- not at first. I was just slowly walking around. I was moving my joints, trying to strengthen them. I had knee pain symptoms whenever I tried quad strengthening, so I focused first on rehabbing the joints themselves.

And I made progress. I started feeling a little better, by degrees. Meanwhile, my quad strength was still declining.

But this can't be, if you believe in "strengthen the quads to escape knee pain." How could I be getting better while my quads were getting progressively weaker? That would make me, by the standard thinking in physical therapy circles, a living contradiction. Therefore, I don't exist. :)

Or there's the alternative explanation, if you prefer common sense:

When your knee joints are in bad-enough shape, you CAN'T exercise vigorously enough to build up your quads. You get caught in a cycle of frustration. But when you focus on strengthening the joints first -- then you can make real progress, to the point where you can then strengthen the quads.

(For the right approach, listen to physical therapist Doug Kelsey at Sports Center on the topic of "patellofemoral pain syndrome." For example, he notes, "Almost every exercise program that you find for PFS targets muscle (quadriceps strengthening, stretching of the hamstrings, etc.) and having stronger muscles is helpful but weak muscles are not the primary problem.")