Using Pilates to solve knee problems

by pilates32 on May 2, 2011

[dropcap1]P[/dropcap1]ilates is used to aid in the recovery from sports injuries and the rehabilitation process, making it popular amongst physiotherapists and sports therapists. I have found from my own experience Pilates to be a key contributor to my recovery from various injuries I have had in the past and also as a tool to diagnosis the underlying cause of the problem and as the method to solve it.

My Story

I discovered the depth of Pilates and corrective exercise following the many problems I had with my right knee several years ago. At the time of injury, I was training hard; lifting weights, cycling several times a week, playing sport and neglecting stretching and any type of core or corrective exercise. The result was that one weekend; I completely ruptured my ACL (anterior cruciate ligament) in my right knee during a basketball game. Although this is a common injury in many sports, the consequences of it resulted in a three year long process of trying to get my knee right again. The ACL is a ligament that runs through the knee and is responsible for a lot of the knee’s stability when twisting and turning. Because of its highly elastic properties; the ACL will not heal itself and the options are then to live without it or have reconstructive surgery. My first attempt at surgery failed following one year of rehabilitation. The tendon did not graft properly in place and consequently I had surgery again 18 months later to try again.  This journey for many would be annoying and frustrated and for me it was no different. But I also recognise the good that comes out of it, what it has taught me and all the learning I received from it in regards to Pilates, corrective exercise, muscle imbalances and the importance of posture and stretching.

The source of the problem

Having this experience made me seek out the source of the problem as well as the best methods to solve it. As I said before, at the time of injury I had no interest in protecting myself from injury and would train as hard as I could with no real regard for recovery, stretching or posture. The result of this was bad posture, muscle imbalances and tight agonist to antagonist ratios (muscles that oppose each other). Here was my diagnosis:

Firstly, I was too tight. My quadriceps were tight and tired a lot of the time from cycling and squatting and my hamstrings were also tight, but neglected in comparison. At no time did I take time to stretch and condition my legs and I neglected a lot of single leg movements that would have helped improve coordination and stability.

Secondly, my posture was poor. I had a slight anterior (forward) tilt of the pelvis which generated problems through the body’s kinetic chain. My femurs (the thigh bones) rotated inwards causing unequally force to pass through my knee. This I found out much after my injury; is a common cause of ACL problems.

Lastly, my feet rotated outwards slightly, again cause unequal force to travel into my knee. These issues are small and easily missed but all contribute to making me more injury prone in the long run later on down the road. The direction of rotation known as eversion is caused also by muscle imbalance between the medial and lateral muscles running down the leg (the inside and outside muscles).

The Solution

Pilates became a big contributing factor to my recovery and my future training. My objectives following surgery were to rebuild strength in the quadriceps, hamstrings and gluteals without putting any stress on the knee joint. Once full range of motion was returned I am to increase flexibility in the hamstrings and quadriceps, improve the gait (tread) of my feet and to bring my posture back into neutral alignment as much as possible, reducing that dreaded forward tilt.

As well as rebuilding strength in many ways such as cycling, gentle squats and so forth, I primarily used the following Pilates exercises for the following reasons.

The shoulder bridge

The Shoulder Bridge was a primary move for recovery and also future training. It allowed me to rebuild the strength of the glutes and quadriceps without putting any stress on the knees. [blockquote align="right"]shoulderbridge Using Pilates to solve knee problems[/blockquote]Ensuring three points of contact between the floor and the soles of the feet would help eradicate the rotation of my feet and bring that back into correct balance. The many progressions of the move meant I could raise the difficulty when strength improved. Examples of progressions would include; a one leg shoulder bridge, using a foam roller or stability ball as the foot platform and also the option of turning the feet outwards to focus on the outer muscles of the leg.

Swimming/Glute Leg Raise

Lying prone on the mat, the one leg progressing to two leg glute raise would allow me to rebuild strength in the glutes and hamstrings without putting any stress on the knees. This exercise is also effective in teaching one to maintain neutral spine as the leg lifts, preventing extension of the spine. If done properly the lift is initiated by muscle contraction, not the tilt of the pelvis.

Leg Pull/Plank

I favoured this move as improved core stability as a whole and trained me to keep engage my core properly to prevent my pelvis from tilting out of place. If done incorrectly the user will have a bowl shaped dip in the lower back where the core is not activated enough to hold you stable.The image below is an example of the full plank/leg pull progressed on from performing on the elbows to the hands.[blockquote]full plank Using Pilates to solve knee problems[/blockquote]


This exercise would help to improve hip flexor strength as well as maintaining extension in the leg at the knee and increasing flexibility of the hamstring. This would only be used once I had regained a certain amount of range of motion following surgery and it is also excellent at training core stability and preventing the pelvis from tilting forward and lifting the lumbar spine from the floor. See April’s exercise of the month.

Birddogs/Swimming on Knees

Once I could place a certain amount of weight on the knees in contact with the floor, swimming on the knees is ideal for improving hamstring and glute strength and core stability. The various progressions such as adding in the opposing arm lift would make this move even more effective in improving core stability and overall posture.[blockquote]swimmingknees Using Pilates to solve knee problems[/blockquote]

Hamstring stretches

My hamstrings were tight, so in the later phases of recovery and as a stable move used now in most Pilates classes, hamstring stretches were essential.

There you have it; a touch on the surface of a huge topic. There is much more to knee rehabilitation than just these few exercises and I strongly recommend consulting a medical professional before starting any rehabilitation. This article was just a small insight into my own experiences.

If you feel you have any problems with posture or would like to begin using Pilates to improve your overall health then please feel free to check out our tutorials section. Feel free to email us at Pilates 32 with any questions you may have.

All the best


Author: Ian Harris

{ 1 comment… read it below or add one }

Mary April 25, 2012 at 3:34 am

Since taking Pilates with a trainer fo 30 1-hour sessions the right side of my right leg aches. Do you know why this is? My right hip muscles are tighter than left. Stretching the right hip w/a tennis ball helps a bit. Please advise. Thank you.


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