Sumiko at 62: Four simple exercises from a physiotherapist for stronger knees

In The Physio Fix, a physiotherapist from the Singapore General Hospital shares practical exercises to improve mobility and ease aches and pains.

My husband has a ritual whenever he comes home. He goes to the freezer and scoops up ice to fill a large ice bag, then wraps it over his right knee where it stays for the next hour.

When he was 20, he pulled his right hamstring while running in a triathlon, and didn’t allow it to heal properly. At the time, he was doing his national service in the commandos. The following week, he snapped his right anterior cruciate ligament (ACL) while jumping off the Ramp, the final station of the Standard Obstacle Course.

His knee swelled with blood. The pain was intense but eventually subsided. (He was physically downgraded and spent the rest of his NS as a librarian.)

In his 30s, he underwent ACL reconstruction surgery. It gave him two more decades of a functional knee. He could play tennis but couldn’t run or walk for long. In recent years, osteoarthritis has set in. Despite stretching, physiotherapy and even a platelet-rich plasma therapy session, his knee still swells and aches if he is on his feet for too long – hence the daily ice ritual to reduce the swelling.

As many in their 60s discover, the injuries of youth can resurface years later in the form of chronic knee pain.

The knee is one of the largest and most complex joints in the body, says Clinical Assistant Professor Moo Ing How, a consultant at the department of orthopaedic surgery at Changi General Hospital. It functions primarily as a hinge, supporting body weight and enabling you to walk, run and bend.

The joint is formed by the femur (thigh bone), tibia (shin bone) and patella (kneecap). The ends of these bones are covered with articular cartilage, a smooth, slippery tissue that cushions and protects the bones during movement.

Then there are the menisci – two tough, C-shaped, rubbery “shock absorbers” between the femur and tibia – that help distribute load and stabilise the joint.

Four main ligaments – the ACL, posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL) – connect the femur to the tibia and fibula (calf bone), holding the bones together and stabilising the knee against unusual or excessive movement.

As complex as the knee is, it does not function in isolation. It sits between two highly mobile joints – the hip and the ankle – which also affect it, says Dr Moo.

The hips control rotation and movement of the entire leg. When the hip is tight or weak, the knee is forced to handle rotational forces it cannot manage, leading to pain. Sometimes, the pain felt in the knee is actually referred pain from the hip.

The ankles provide the foundation for movement. If they lack mobility or stability, the knee must compensate. Limited ankle motion or foot problems such as flat feet can alter gait and force distribution, which may lead to knee pain.

The knee is particularly prone to injury compared with many other joints because it bears large loads, undergoes repetitive stress and must balance both stability and mobility. It is also exposed to twisting and high-impact forces during sports. Age-related wear, excess body weight and previous injuries make it even more vulnerable.

Dr Moo says that most of his older knee patients suffer from osteoarthritis, a degenerative condition where the cartilage gradually wears down, causing pain, stiffness and reduced mobility. In younger, more active patients, knee pain is often related to sports injuries such as ACL tears.

Less commonly, it may be caused by inflammatory conditions such as rheumatoid arthritis, infections or previous trauma like fractures. “Overall, knee pain is not a one-size-fits-all condition,” he adds.

Treatment depends on the cause, severity and duration of the pain. For recent injuries, the aim is to settle the pain and swelling with rest, ice, compression, simple pain relief and physiotherapy to get movement and strength back.

Long-term issues like osteoarthritis require regular care such as maintaining a healthy weight, doing the right exercises to strengthen muscles and sometimes medication or injections to ease symptoms. For more serious damage, surgery may be an option, from keyhole procedures to knee replacement.

Dr Moo says some knee problems are preventable. Maintaining a good weight and keeping leg muscles strong can reduce the stress on the knees. Early physiotherapy after an injury is important to support recovery.

He warns that persistent or worsening pain, sudden swelling with warmth or redness, fever, unexplained weight loss or night pain that interrupts sleep may signal a serious problem. A knee that feels unstable or locked or cannot bear weight after an injury could mean a major ligament tear or fracture and should be checked by a doctor promptly.

The Physio Fix

Where your knee hurts and the type of pain can offer useful clues about what’s going on, says Dr Philip Cheong, senior principal physiotherapist (clinical) at the Singapore General Hospital.

Pain at the front of the knee points to kneecap-related issues. This is typically a dull, aching pain that worsens with stair climbing, squatting or prolonged sitting.

Pain in the inner side of the knee is linked to ligament strain or irritation of the medial meniscus (the inner shock absorber). Pain here is often sharp or localised, especially with twisting, turning or sudden directional changes.

If the outer side of the knee hurts, this could be due to overuse and irritation of the iliotibial band, a thick, fibrous band running from the hip to the shin. The pain is sharp or burning and rears its head when you are running or walking downhill.

If the pain is in the back of the knee, it could be caused by swelling, cysts or muscle/tendon issues. You may feel a tightness, pulling sensation or fullness when bending or straightening the knee, says Dr Cheong.

A deep ache that feels as if it is inside the joint rather than at a specific spot could indicate joint irritation, cartilage changes or inflammation, and this could worsen after activity or with prolonged weight-bearing.

Dr Cheong stresses these are general patterns. “Knee pain is often influenced by how the entire lower limb – hips, knees, ankles and feet – functions and overall physical activity levels, rather than a single structure in isolation.”

Knee pain caused by overexerting weak, unused muscles usually improves with physiotherapy and exercise. But longstanding pain, worn-out joints or pain from multiple causes takes longer and needs a more thorough approach.

Physiotherapy helps the knee and nearby joints move better and handle weight and pressure. This involves strengthening muscles, correcting movement and gradually returning to normal activities. “The goal is not just pain relief but restoring movement confidence and function,” he says.

As for what harms the knee, Dr Cheong says this is less about specific activities and more about how much and how often you do them, and how prepared your body is. Sudden spikes in activity, doing too much too soon, staying inactive for long periods and repetitive loading without enough rest take a toll.

Physiotherapy can help most people improve symptoms and function, but not all pain can be fully eliminated, especially in advanced conditions. “The focus is often on helping you move better, stay active and manage symptoms effectively,” he says.

My husband knows this all too well. Knee replacement surgery is something he has considered. For now, he sticks to his daily ice routine.

Wall slide

Instructions

1. Stand with your back flat against the wall. Move your feet forward about one foot-length from the wall (roughly 20-30cm). Keep your feet shoulder-width apart.

2. Slowly slide your back down the wall by bending your knees. Keep your knees facing the same direction as your toes. Do not let the knees extend past your toes. Remember to start with a ¼ squat (45 degrees) or ⅓ squat (60 degrees) so you don’t stress your knees. Don’t force a 90-degree or deep squat. Hold for 5 seconds.

3. Slowly slide back up. This counts as one repetition.

This exercise strengthens the quadriceps that support the knees. It also engages the glutes and hamstrings, reducing knee stress. It improves knee stability and joint control, helping prevent injuries.

To do

10 repetitions / 3 sets / Daily

Safety tips

Keep knees facing the toes and don’t extend them beyond the toes.
Only bend to a pain-free range.
Keep your back flat against the wall; don’t arch.
Move slowly and with control.
Stop if you feel sharp or pinching pain in the knee.

Sit to stand

Instructions

1. Sit at the edge of a sturdy chair with your back straight. Place your feet flat on the floor, shoulder-width apart. You can place your hands at your hips.

2. Lean slightly forward at your hips, keeping your chest up. Press through your heels and stand up slowly.

3. Pause for 1-2 seconds at the top.

4. Sticking your bottom out slightly, slowly sit back down in a controlled motion.

5. This counts as one repetition.

This exercise strengthens the quadriceps, glutes and hamstrings and improves knee and hip stability. It helps with everyday movements like getting up from a chair safely. It also builds balance and control, reducing the risk of falls.

To do

10 repetitions / 3 sets / Daily

Safety tips

Use a sturdy chair of normal height. A chair that is too low will overload the knees and cause pain.
Sit and stand slowly and with control.
Avoid leaning too far back or forward.
Stop if you feel sharp pain in the knees or hips.

Knee extension with resistance band

Instructions

1. Sit on a sturdy chair with your back straight. Loop a resistance band around your ankles. Place your feet flat on the floor, shoulder-width apart. There should be some resistance in the band.

2. Slowly straighten the left knee, pressing against the band’s resistance until the knee is fully extended. Keep the rest of your body relaxed. Hold for 1-2 seconds at the top.

3. Slowly return to the starting position. This is one repetition for the left leg. Do 3 sets of 10 repetitions.

4. Repeat on the right leg, doing 3 sets of 10 repetitions.

This exercise strengthens the quadriceps, improves knee stability and supports proper knee alignment. This helps with everyday movements like standing up, walking or climbing stairs.

To do

10 repetitions per leg / 3 sets / Daily

Safety tips

Keep movements slow and controlled.
Don’t lock your knee when it’s at full extension.
Choose a band that feels challenging but allows you to complete the exercise without pain.
The final few repetitions should feel challenging and require effort, but should not cause pain.

Lunge

Instructions

1. Stand tall with your feet hip-width apart and hands on your hips or by your sides.

2. Step forward with your right foot so that both knees can comfortably bend to about 90 degrees when you lower your body vertically.

3. Slowly bend both knees, lowering your back knee straight towards the floor while making sure your front knee does not extend beyond the second toe. Keep your back straight. Pause briefly at the bottom.

Push through the front heel to return to the standing position. This counts as one repetition for one leg. Repeat on the other leg.

This exercise strengthens the quadriceps, glutes and hamstrings. It improves knee and hip stability, enhances balance and helps with everyday movements like climbing stairs.

To do

Start with 5 repetitions per leg / 3 sets / Daily

Safety tips

When bending, don’t let the front knee extend past the second toe.
Your back knee should be lowered vertically.
Move slowly and with control.
Stop if you feel sharp or pinching pain in the knee.

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.