Sunday, May 8, 2011

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.")


  1. Brilliant post, I too have the same problems with knee joints. My legs are very strong and I have been told the same by a doctor 'strengthen the quads' ............. really , all he had to do was open his eyes and see the muscles do not need strengthening, I am going to try this method instead ,ill post back some time

  2. Did you strengthen your joints just by walking, or were there other things you did, too? I don't have very strong quad muscles, but I do have knee pain, and walking just hurts them more.

    1. Me, I mainly did walking. But -- as I have emphasized before -- my high-repetition key to recovery may not be your high-repetition key to recovery. I'd first try to find something your knees tolerate fairly well, that you can do for a while. Movement in a swimming pool while wearing a flotation belt? Cycling very slowly (or even backwards)? Doing "unloaded" exercises (as when you're in some kind of harness) that lessen the forces acting on your bad knee? And of course -- are you overweight? If so, I'd lose the excess weight too.

  3. Jesus this is painful to read, you can not build the strength of your joints because your joints are not muscle. There are a lot of things going on besides the quads that all go into how your joint feels but I assure you, you didn't strengthen your joints.

    1. Of course I don't mean "strengthen" in the same way you "strengthen" a muscle. But you sound like a native English speaker, so I'm sure you're aware: "strengthen" is a word that is used broadly to apply to everything from "strengthening" one's resolve to (and more relevantly) "strengthening" various body tissues (not all of which are muscles).

      Do you believe that you can strengthen tendons? Strengthen ligaments? Strengthen cartilage? If so, say you have weak cartilage in your knee joint. You then strengthen that cartilage (make it tougher and more resilient, and better able to perform its essential functions). By doing so, I'd say you have strengthened that knee joint.

      This doesn't strike me as an unreasonable usage of "strengthen". Just do a Google search on "strengthen cartilage" or "strengthen knee joint," and you'll see plenty of others using these terms.

  4. Strengthening quads is idiotic PT dogma. It makes no sense.

  5. Interesting article. I have patellofemoral pain on my left knee, and coincidentally my left quad is way stronger, and even visibly larger, than my right, uninjured leg's, quad. So I am baffled every time I hear "strengthen your VMO." Though for me, walking makes the pain much worse. I am not sure what to do to strengthen the joint.