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The Best Investment for Knee or Hip Pain

[ read time ~ 5 minutes ]

Note: I'm sharing this with you in case you're frustrated by knee or hip pain.

I have no financial incentive in the recommendation below.

Common medical advice for knee and hip joint pain is typically two-fold:

(1) strengthen nearby muscles, &

(2) avoid squats.

While these recommendations are provided by people with good intentions, they both frequently fail to provide long-lasting improvement.

In this article, I'll describe a better approach to this mainstream advice.

Part 1:

Strong muscles are important. But when someone with knee or hip pain performs exercises to gain muscle strength, it often causes more knee or hip pain. (Before working with me, many of my clients were doing these types of exercises. To hear their stories, click here or here.)

An increase in knee or hip pain happens after muscle strengthening exercises when the inside of the knee or hip is weak.

Cartilage is a substance (inside knees and hips) that covers and protects the bones and provides a smooth, slick surface for motion to occur. When cartilage is strong, it is a very firm surface. But when cartilage weakens, it softens. Softer cartilage can't withstand the type of challenging exercises that make muscles stronger.

An approach called Joint-First Strengthening helps my clients gain strength throughout their legs and achieve long-term success. They get stronger without getting more knee or hip pain by starting with exercises that make the inside of their knees and hips stronger, and gradually working up to also strengthening muscles.

(My colleague Doug Kelsey has published tips on improving joints here and here. He has also written books on this topic including The 90 Day Knee Arthritis Remedy, The Runner's Knee Bible, and Better Hips, Better Life.)

Part 2:

When someone has knee or hip pain, they are often told to stop squatting.

And if they avoid squatting, they usually stop getting the pain.

But avoiding squats isn’t a sustainable solution for most people.

Squatting -- at various depths -- is required for activities like sitting down on a chair, getting out of a car, going up and down stairs, as well as for running, jumping, and sports such as basketball and tennis.

So when someone with knee or hip pain avoids squatting they feel better, but when they try a squatting activity again, their joint pain returns.

Sometimes my clients tell me they avoid (or significantly reduce) knee and hip pain when squatting to sit down on a chair by placing their hands on the arm rests. Pressing through their arms supports a portion of their body weight and decreases the amount of body weight that their knees and hips must support.

When using their arms decreases or eliminates pain as they sit down, it indicates the Load Tolerance of their legs is less than all of the person's body weight. (Load Tolerance, a term developed by my colleague Doug Kelsey, indicates "the amount of pain-free force that you can produce or absorb for a specific movement....")

In this example, the specific movement is squatting. But the exact Load Tolerance is unclear when watching someone sit down with arm support.

Sometimes you can get stronger by guessing at the right amount. This often works when strengthening muscles. Muscles are resilient and don't require a very specific amount of weight. You may not need an exact recipe for success. It is kind of like cooking a medley of vegetables: the green beans are important, but the exact amount is not critical.

But the cartilage inside knees and hips are not as resilient as muscles. This is when knowing the exact amount, the Load Tolerance, is critical.

If you use too much weight, you'll cause pain and get even weaker. But if you use too little weight, you won't get any stronger and the pain won't get better. This is similar to baking. If you were baking a cake and you had all the ingredients, but you didn't have measuring cups and spoons, you would need to guess how much of each ingredient to use. And it would probably take multiple attempts at producing an edible dessert, if it ever actually happened.

A Variable Incline Plane allows you to measure out just the right amount of squatting exercise for your knee or hip, so that you can get stronger and eliminate pain.

Having a Variable Incline Plane is like having measuring cups and spoons for your knee and hip joints. It prevents a lot of wasted time spent guessing how hard the squatting exercises need to be.

If you try to get stronger joints without a Variable Incline Plane, sometimes the exercises you choose will be too hard for your joint and cause more pain. Other times, they will be too easy. In both cases, you won't be getting better. And thwarted attempts at developing a better, stronger joint leads to a lot of frustration.

Most of my online clients hesitate initially about getting a Variable Incline Plane. After all, most Variable Incline Planes cost at least a few hundred dollars, and they require some space within your home.

There are countless ways to spend money to counteract knee and hip pain-- injections, acupuncture, medication, supplements, braces. (This list is far from exhaustive.) However, these options typically provide only partial or temporary relief because they do not strengthen inside the knees and hips.

I recommend using a Variable Incline Plane to understand how much each knee or hip tolerates and then to perform the right amount of Joint-First Strengthening exercises.

(Note: there are multiple companies that sell Variable Incline Planes. My colleague Doug Kelsey and I do not have any financial interest in recommending them.)

Once my clients successfully overcome their joint pain-- Keith* avoided joint replacement surgery; Amanda* returned to CrossFit; Andrew* resumed cycling and taking the stairs without pain-- they frequently tell me how grateful they are for investing in a Variable Incline Plane.

My clients use a Variable Incline Plane to exercise in ways that strengthen their joints from the inside out, allowing them to eliminate pain and return to their active lives.


My colleague, Doug Kelsey, PT, PhD, and I have developed Better Knees for Life, a program for people with tolerable knee pain. Better Knees for Life offers step-by-step instructions that can be performed at home with very little equipment.

What people are saying about Better Knees for Life :

"...well thought out, easy to understand and implement."

"It is almost like a computer algorithm. (That's how clear it is!)"

"BKL (Better Knees for Life) is an outstanding program -- with graded exercise programs and guidelines for advancing, and outstanding support with the Zoom sessions."

"I've already recommended BKL to 2-3 friends because of the noticeable difference in reducing pain in my left knee."

Better Knees for Life helps you get stronger, feel better and maybe best of all, feel more in control of your life.

To determine if working with me is a good fit for you to overcome knee pain, schedule a Strategy Session by clicking here.

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