Strengthening the muscles around the knee is important for functional movements.
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Key Takeaways

Sit-to-stands are a simple functional exercise that strengthens the hips, quads, and hamstrings and improves balance.
Side-lying clamshells target hip and glute strength, which helps prevent inward knee collapse and reduces stress on the knee joint.
Stretching the calves with a standing calf stretch improves ankle flexibility, reducing knee stress caused by limited ankle dorsiflexion.

Knee pain is an incredibly common complaint as people age, affecting approximately 25% of adults. But movement can help strengthen your muscles, improve your flexibility, and lessen the burden on this vulnerable joint.

We asked Joe Hribick, DPT, a clinical assistant professor of physical therapy at Lebanon Valley College, in Annville, Pennsylvania, for the safe, simple exercises he recommends to keep your knees healthy as you age.

*This interview has been edited and condensed for clarity and length.

Question: I want to protect my knees as I age. What’s the first simple exercise you would recommend?

Hribick: First, I want to clarify that when you think of knee health, you want to make sure you’re addressing not only the muscles directly around the knee, but also muscles and joints above and below the knee. The knee is often the victim when there’s an issue above or below it, so you also need to look at the hip and ankle and make sure there’s enough strength and mobility there.

The first exercise that I recommend to most patients is sit-to-stands. Cross your arms, then go from sitting to standing without using your arms. If you can’t do it with your arms crossed and need a little assistance, that’s fine. Start with one set of 10.

If that becomes easy, you can do three sets of 10. You can progress this by holding a dumbbell or medicine ball while you do the reps, or even put on a weighted vest to add resistance as you get stronger.

With this exercise, you’re working your hip musculature, your quads, your hamstrings, and you’re also working on balance and power. You go from sitting to standing as a functional movement all day long, whether you’re getting off the toilet, a chair, or the couch. So not only is it exercise, but it’s something patients can do functionally.

Q: What hip-specific exercise should I try?

Hribick: The next exercise I would do, which is more specifically for the hip, is called side-lying clamshells. You tend to lose strength in your hips over time unless you’re working on them directly. This is an exercise that targets hip strength, specifically glute strength.

Start by lying on your side, with your knees and hips flexed and your feet together, one foot on top of the other. If you’re lying on your left side, then your right leg would be on top and your left leg on the bottom. Keep your feet together and raise your top leg up toward the ceiling. The key is to keep your feet together while you do this. Hold for about five seconds, and come back down.

I typically recommend starting with 10 reps, then progressing to 3 sets of 10 over time. After 10 reps, switch sides to ensure you work both sides of the body. A simple way to progress is to use an elastic resistance band and wrap it around your knees.

Often, when you lose strength in your hips, your femur—which is the bone that the knee is a part of—tends to collapse slightly inward. Your knees also tend to collapse inward during weight-bearing activities, such as squatting, climbing stairs, and pushing off with your knees. When you have weakness in your hips, that collapsing starts to happen, and that puts more stress on the front and inside of the knee. You can counterbalance that by strengthening your hip muscles.

Q: What about an exercise that focuses on flexibility?

Hribick: From a flexibility standpoint, stretching the calves is really important. If you lose ankle dorsiflexion range of motion, which is the ability to flex your toes toward your nose, more stress is then placed on the knee. That’s an indirect cause of knee pain. When you step, and you land, and you don’t have adequate ankle dorsiflexion, the force gets translated up into your knee.

A standing calf stretch, where you’re standing one foot in front of the other, holding onto the wall, keeping your back leg straight, front leg bent, and leaning into the wall, is a really helpful stretch for your calves. I usually recommend a 30-second hold three times on each leg. That will help prevent knee issues or address them in patients who already have pain.

Q: Why is movement important to help keep your knees healthy as you age?

Hribick: Biomechanically, the knee tends to be an area that takes a lot of wear and tear. It’s a weight-bearing joint, and you use it for a lot of different motions, whether you’re kneeling, squatting, or going up and down stairs. As you age, natural muscle strength loss tends to occur in the hips, and tightness can develop in the hips and ankles. The knee is left in the middle as the thing that tries to compensate for those losses. It’s the universal compensator for the lower extremity.

Also, to get your joint fluid—synovial fluid—back into the joint space and lubricate the surfaces, you need movement. That can be through exercise, walking, or stretching. Movement will help maintain your strength, aerobic capacity, and mobility.

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We Asked a Physical Therapist for 3 Exercises to Keep Your Knees Healthy as You Age