All too often we hear positive feedback about the exercises and lessons on this site, but when we ask if people are actually doing the exercises they reply “There’s nothing wrong with my knees.” These people insist that their other regular exercises, whatever they may be, are enough to keep them fit – without thinking about form of movement. Unless you’ve mastered perfect posture, and a perfect strength balance, however, whether you’ve got knee pain or not, there is likely something imperfect with the mechanics of your knees. Those who claim otherwise just don’t know it yet. Here is a little story we wrote to illustrate this point. Please read it, and consider the message carefully, because resolving knee pain through strength training is not just for today: it could affect all of your tomorrows.
On their 60th birthday, identical twins Brian and David decided it was time for them to start focussing on getting fitter. Brian had always marvelled at how runners can complete marathons and so he set out to become a runner. David didn’t much like the idea of running; he just wanted to do some exercise that would help him move around a bit better and make him stronger, so looked instead to strength training.
Both men were very determined and consistent. Two months in, Brian was running for 30 minutes, 5 times a week, and David had grasped the basics of squat and overhead press technique through a personal trainer. David did two training sessions per week with his trainer, each lasting about 30 minutes. David was only performing bodyweight movements and lifting light weights at this point, focusing on improving his technique before moving up to lift more.
After these first two months had passed, the twins sat down to discuss how they were getting on. Brian expressed that he felt he was working a lot harder at this exercise business, pushing himself to new running limits, but David explained that he had faith in his trainer, and was confident that the techniques he was learning were filtering into his daily life. Brian could run faster, and further, during each session, while David was simply squatting to a chair with minimal weights – and minimal pain. No, David did not seem to be pushing himself very hard, but – it seemed – his knees were moving a lot smoother than before.
Brian scoffed at this idea. He said that the guys at the running club insisted injuries in fitness had a lot to do with the equipment you used, such as good running shoes. They were super fit, after all, they knew what they were talking about. They ran marathons. Brian lamented that David was doing nothing for his heart, that without getting his heart rate up for 30 minutes, 5 times a week, he was bound to have problems in the future.
David was not easily swayed from his weight training though. He knew that what he was doing was hard work, requiring focus and effort. He was also satisfied that he was learning about the joints of the body, proper positioning and proper combinations – whether or not he knew about the latest shoes.
“But what are you doing for your heart?” Brian asked again.
“It gets exercised, I can feel it beating when I lift weights,” David told him, “What are you doing for your leg strength?”
“Ha!” said Brian,“I’m running five times a week! My legs are as strong as you like!”
Over the next ten years, Brian built up to an average of four hours of running per week. He achieved his goal of completing the London Marathon. He became a regular on the 10k circuit and was always happy if he could snap up a new PB. Everybody was so proud of Brian’s achievements and how fit he had become. “Brian runs marathons, you know” people would say.
David got to the point where he could parallel squat a barbell that weighed nearly as much as he did, with perfect technique, and overhead press about two-thirds of that. Once he had got to this level of strength he didn’t really feel it was necessary to get any stronger, so he just maintained his strength around there. David didn’t really talk much about his training but people did notice how he stood better and became a handy man to have around when anybody was moving house. Even at 70 years old he could handle heavy cabinets up awkward staircases.
Another ten years passed, and at eighty years old, things had changed for Brian. He was having hip problems that were affecting his running. The doctor advised him to take pain killers, which allowed him to jog a few times a week, but his running had becomeslow and uncomfortable. He no longer competed in 10k races.
David, on the other hand, was still doing his weight training exercises. He used lighter weights but he was still able to move through the full ranges of motion without pain. If ever anything did hurt a little, David knew enough about anatomical positions and movements to analyse what movement imperfections he was making, and could make the necessary corrections. The pain he felt subsided within a few sessions, or sometimes within the session itself. David tried to convince Brian that his personal trainer, and strength training, could help with his hip. They could identify his movement problems and resolve them, he said. But Brian would not listen. He said he had seen a doctor who had formerly specialised in joint reconstruction: he knew what he was doing, and was not interested in the under-qualified opinions of some weight trainers.
Five years on, at eighty-five years of age, Brian was happy to be getting replacement hip surgery. David met with him in the hospital after the operation.
“I’ll be able to walk around again, it’s going to be marvellous,” Brian told David. The two then chatted about the football season, which was coming to an interesting close. Brian turned to his bedside table to pick up a newspaper to show David an article on the pundit’s predictions for the final few games. As he picked up the newspaper, a pen sitting on top of it slipped off and fell on the floor. Without hesitation, David stood up off his chair, lunged to the ground with a deep bend of his knees and hips, swept up the pen, stood back up and sat back down on his chair. The movement took only a moment, but Brian had taken it all in with amazement. As David waited eagerly for Brian’s analysis from the paper, Brian sat there dumbfounded.
“I can’t do that anymore,” he said.
“Do what?” David had no idea what his brother was talking about.
“The way you picked up that pen” answered Brian. “I’ll never be able to move like that again. Not even with this new hip, not like that. You know everyone used to say about how healthy my heart was. All those 10ks, half-marathons, marathons… ‘You’re super fit, Bri!’ they would say. ‘I hope I’m as fit as you when I’m a granddad!’ But the sad truth is that all the marathons in the world don’t mean a damn to my heart now, because those days are past. I can barely walk fast enough to get my heart rate up. I’m lucky if I can get up stairs one step every ten seconds. And there’s you, David. You never had any interest in keeping your heart healthy and you can belt up a flight of stairs. I struggle to get out the chair to make a cup of tea.”
“I did everything right: exercised just like the doctors said so. I’ve just been so unlucky with this damned hip. I can’t believe how lucky you’ve been with your joints. Why do you get all the luck!?”
“Brian,” David answered, “ Luck’s got nothing to do with it. You want to know why your hip startedhurting?Because there were minor imperfections in the way you moved. For example, if every time you stood up one of your knees moved slightly to the inside of your foot. Done once, that wouldn’t cause any problems, but when you do that every time you stand up it strains one lot of muscles more than they were meant to be strained.The muscles which were supposed to be helping, if the kneewas in the correct position, do nothing, and get weaker.
“This process of tightening and weakening exacerbates the already impaired movement, making the problem even more pronounced. The weakened muscles start to waste away, such that moving properly becomes extremely difficult. Then, to make matters worse, in an attempt to protect the overworked tight muscles from being damaged by the overuse, the body’s natural defence mechanism comes into play and nervous impulses are sent to parts of that muscle in an attempt to shorten it by creating knots. The space in the joint served by the muscle is decreased, leading to rubbing of the surfaces and pain. This pain stops you from wanting to put movement through that joint. Without knowing how to deactivate these knots, and without knowing what movement imperfection took place to start off the process and how to correct it, the joint continues to hurt. The surfaces continue to rub on each other improperly and the joint cartilage will break down, leading to even more pain. You have hip pain because you didn’t move correctly, so many times, for so long. It wasn’t luck, Brian. It could have been avoided.”
“I’m sorry,” Brian shook his head, “I’ve got no idea what you’re talking about.”