7 Reasons Why Stronger Thigh Muscles Make Knee Arthritis Worse

Getting stronger thigh muscles is often one of the first recommendations given to people suffering from knee osteoarthritis on all of our knee arthritis videos here on this channel, I often recommend people don’t strengthen their quads and instead strengthen their glute muscles.

This has become controversial because most health care professionals will disagree with me on avoiding strengthening the quad muscles and the hamstring muscles and instead, focusing on strengthening the glute muscles don’t want to talk to these healthcare professionals in person, I find out that they don’t understand the reason why I tell people to do glute exercises instead of Thigh Exercises.

So I wanted to bring this to you. In this video, I’m going to explain the seven reasons why strengthening your thigh muscles actually makes your knee arthritis worse. Now just a disclaimer, this video is going to be more technical in wording. And some of the concepts are definitely advanced specialist concepts. So don’t be worried. If you can’t follow I’ll try to make it as simple as possible.

But this video is really intended for that person that is going into a deep dive about why you need to strengthen your glutes and why not to strengthen your quads. So let’s get into it. Reason number one, stronger quad muscles on the front of your thigh over pressurize the kneecap when the quad muscles here on the front of the thigh are getting stronger and stronger, it causes the kneecap to be pressed harder against the thigh bone right here.

Because the quad muscles come in and attach to the kneecap when the knees bent or even straight, it’s pushing the kneecap against the thigh bone more than it needs to now this bone and the joint itself is designed for the kneecap to fit in there and to slide in their butt joints are designed to take certain amounts of pressure in certain directions.

And the way that this joint is designed to work, it’s a pulley joint, but you can put too much force on it and that force sustained over a long period of time because you keep strengthening your quad muscles inadvertently, it starts to wear down on that joint. Reason number two is that strong quad muscles also pull the shin bone up against the thigh bone.

Let me just grab my other knee model to show you this one. You can see the kneecap better there too. Here’s the tendon from the quads, it’s actually bigger than that because there’s a bunch of quad muscles that are missing here. But those quad muscles attached to the kneecap and then you have this continuation of the tendon that goes down into the shin bone right here.

So that tendon right there, when the quad muscles are very strong, it helps to yank the thigh the shin bone up against the thigh bone. And if your quad muscle is significantly stronger, it’s the strongest muscle in the area, then it’s going to push the shin bone aggressively up against the thigh bone. And it’s just not necessary to have extra force there.

So people make the argument that that’s part of what holds the knee joint together and attaches the thigh bone to the shin bone. But there’s lots of other very strong ligaments that do that for you, you of course, your ACL, MCL, LCL and your PCL, and there’s the whole joint capsule as well that holds the joint together and allows it to move well.

The quad muscle in the patellar tendon, the ligament that runs right there, this one that I was showing you just a moment ago, is not 100% necessary to hold the knee joint together. It’s more involved in the movement and control of the knee joint.

And the reason number three goes along with reason number two, but we’re talking about the hamstrings on the back of the thigh. Now, those hamstrings come from the glute area and they go in the back of the thigh and they split apart and they attach to the sides of the lower leg right here the shin bone and in this little bone right here, the fibula and tibia, and the way that they pull is there, when the knee is straight, they’re pulling the shin bone up into the thigh bone deploying the shin bone against the thigh bone. When the knee bends, they can affect that force.

I’ll talk more about that in just a minute. But at rest, if your hamstrings the muscles in the back of your thigh, are very strong, they’re going to potentially aggressively push the shin up against a thigh bone, which compresses the knee joints. And when these muscles are chronically strong along with the quad muscles, then that extra compression there gives the appearance of a bone on bone joint because it squashes the cartilage there.

Now over time, if that cartilage remains squashed, then you start to wear holes in the cartilage and you have the losses of cartilage that’s more permanent. But of course you can have a picture taken of your knee joint an x ray a picture of the inside of your knee joint. And if that knee joint is overly compressed because of your strong thigh muscles, it’s going to appear like it’s bone on bone.

But it’s possible to alleviate that pressure by not allowing your quads and your head hamstrings are your thigh muscles to get too strong, and allow the joint space to look more normal and not be bone on bone as much.

This is why it’s my strong belief that even patients that have been told that they have bone on bone knee arthritis can get better, because if they can take the pressure off the quads, and the hamstrings, all these thigh muscles, and their knee joint can behave much more normally, the knee joint can be depressurized, and we can make progress and avoid having a knee replacement surgery reasonable for the quad muscles or need the accelerators.

Now this is where it’s going to get a little bit more technical, and the concepts can get a little confusing. And if you’re a physical therapist, or a healthcare professional watching this, you might want to pay close attention. Now, traditional anatomy classes teach that the quad muscles on the front of the thigh here are knee extensors.

In other words, they straighten out your knee, they move your knee into extension, they help you to do this like a kicking type motion with your leg. And it’s very easily confirmed and, and it sticks in people’s brains that way whenever they go through health care classes, because when you’re in class, and you learned the knee, that the quads are a knee extensor everybody does this in class, they straighten out their leg, and then they look at their thigh and they’re seeing their muscle buyer, and they’re feeling it work.

So boom, the knee is the quad muscle is a knee extensor. But that’s not how they work in normal, everyday function. I mean, unless you’re doing a kicking sport, you know, like soccer, football one of those things, you’re, of course going to be extending your leg to kick a ball. But if you’re not doing that on a regular basis, if you if you’re a person that just goes to the gym walks, maybe jogs a bit does chores around the house.

You might be active, but you’re not at forcefully extending your knee to do your normal everyday activities, what you’re doing is you’re on your feet, and you’re moving around, you’re walking from place to place, and you don’t have to forcefully extend your knee. So what’s happening instead is your quad muscle actually has to work to decelerate knee flexion. So deceleration is the opposite of acceleration.

So if you think about the knee here, when you bend your knee, your your muscles back here are helping to do that. Also, momentum can help to do that. But when you’re changing directions and walking around the house, all these little subtle motions that you’re doing, these motions have to be controlled by this muscle slowing down how fast your knee is bending. So it’s kind of a another way to put it is it’s the opposite action.

If the quad muscles action is knee extension, then it’s possible that the quad muscles can also decelerate knee flexion or in other words, it can work ie centrically into knee flexion. If you think about everyday activities as being the majority of your normal, everyday use of your quads, then you don’t really need a train your quad muscles to extend forcefully with resistance. That’s not proper use of your quad muscles.

So if you take it in that context than doing quadricep focused exercises where you’re trying to strain out your knee without the foot on the ground, and you’re making your quad muscles react and tighten up quite a bit. That’s not training the muscle to work the way that it’s intended to work. And it might actually mess things up and it’s going to compress the knee joints.

Now reason number five is the other side of the thigh. Same idea. The hamstrings are also need the celebrators but they decelerate extension. So if the quads decelerate flexion, the hamstrings can help to slow down how fast you extend your knee in those same everyday movements. Because how often do you have to just forcefully bend your knee against resistance?

Now you might say, well, I bend my knee getting in and out of a car and in and out of a chair, in and out of the shower bed, those types of situations. But how often do you have to do it against a lot of resistance where you’re pushing your heel or the back of your leg into something more often it’s just moving through the air, and it doesn’t take a lot of effort.

What’s more important is the control how you do it, the direction you’re moving it that you bet your foot lands safely and appropriately so that you keep your balance. That’s the proper use of hamstrings. So again, most of your everyday motions with your hamstrings are involved in deceleration or slowing down how fast you straighten out your knee in an effort to control your movements properly.

So it doesn’t make sense to do exercises where you forcefully bend your knee against resistance to tighten up and fatigue this muscle. It’s actually going to train you in appropriately and over pressurize your knee joints and feed into a knee arthritis, bone on bone situation. Reason number six is increased resting muscle tension. Now, we’re still kind of technical here, we’ll get out of the weeds in just a bit.

But what think about this, if you train your muscles aggressively in your thighs, like you go do exercises where you get a pump in these thigh muscles, and then the ones back here, and you walk out of the gym, or wherever you’re doing them at home, or at the physical therapy clinic. If you’re doing exercises there, and you feel these thigh muscles very tired, then what happens is they of course, get sore, and the muscles start to adapt. And they’re adapting in response to the forces that you put on them.

So in other words, if you’re making them work harder against resistance that you’re not used to working on, then the muscles responded by saying, hey, let’s get stronger, because you’re putting me through a lot and I have to be stronger in order to take what you’re putting me through successfully without getting hurt. That’s how muscles get bigger over time. But now that thicker, stronger muscle at rest, increases its tone.

What I mean by that is like, you know, you know how, when you don’t work out, you get all flabby in your muscles, and then you go start to exercising, you tone up, your muscles get firmer all over your body, well, in the muscles that you’re working out consistently, if it’s your thighs, they’re going to firm up and tone up. And so they go through a little bit of shortening.

At rest, they’re constantly just a little bit shortened in that low level shortening, that’s just happening while you’re not doing anything, you can even be unconscious asleep, that small amounts of increased muscle resting tension.

Follow those words closely. It causes your kneecap to be subtly pressed against your thigh bone, and it causes your shin bone to be suddenly pulled up against your thigh bone as well, over time, this is why people that have knee arthritis like you might if you’re watching this video have stiffness in the morning when they wake up. And this is why it gets worse over time.

In some cases, even though you’re doing exercises recommended by a physical therapist or some other health care professional. If it’s thigh focused exercises like the quads and the hamstrings, your stiffness might increase afterwards, because you’re increasing that resting muscle tension. And it’s just forcing your shin bone to be butted up further against your thigh bone and your kneecap as well.

And it causes stiffness in the joint because the joint can’t move as freely, it’s being compressed. And you can put this to the test. Of course, you can avoid doing those exercises. That’s what I’m kind of telling you to do here on this video. But in the short term, because that might take a little bit more time to see the effects.

Massage your thigh muscles, if you just massage these muscles out and get them to relax a bit so that they’re they don’t have that increased resting tension as much, you can put this to the test by getting a massage going like this one, and put it on your thigh, where the muscles are stiffest and just go up and down here for a couple of minutes, it doesn’t even take that long get that muscle to relax.

And I’m willing to bet that your knee joint is going to feel much looser, less stiff once you softened up these muscles because you’ve decreased the resting tension in the thigh muscles, which decreases the pressure in your knee joints. The reason number seven is quad muscle dominance.

This is one of the biggest factors that I think about when people have knee arthritis. If you’ve already got strong five muscles, or at least they’re the most dominant muscle of all the muscles in your hip, and thigh, then your nervous system is wired to use the most dominant muscle consistently. And first, whenever you go do any activity, especially activities that require more effort and stability from your body.

Like if you’re going to carry something heavy, or move more quickly, you’re going to use your quads first. And if you’re consistently using your quads, first, they’re the dominant muscle group and your leg and your hip, then you’re going to be consistently putting more pressure through your knee joints. I say joints because I’m talking about the kneecap against the thigh bone and the shin bone up against the thigh bone, they’re technically separate joints.

The concept behind this is called muscle sequencing and the way the body works and this is commonly known in especially in physical therapy, but in healthcare is that you should have a certain sequence of firing of contraction in the muscles in your body whenever you go do something like walking or whenever you do anything, anything that involves motion, you should always fire the muscles that are at the center of your body.

So we’re talking like your core muscles in order to get stability from your spine. And then once that’s stable all this happens in a split second. And when she gets stability there, then you should start firing muscles that are moving away from your spine.

But if your wiring is off, because you’re used to using your quad muscles, your dominant and your quad muscles, what I find very often is that the sequencing is off in somebody’s hips and thighs, they’re using their quad muscles right away for doing simple exercises and simple movements.

And I have to retrain them to not use your quad muscles and use their core muscles, and then their glute muscles. And then after that five muscles, but in somebody who’s become quad dominant, they’re consistently using their quad muscles when they shouldn’t be. And that just feeds in to a knee arthritis, a bone on bone joint problem over time.

This is the problem that sets up the muscle imbalance where the quads are too strong. And this is what most healthcare professionals just aren’t keen on identifying. They’re not trained to identify it and much less to treat it. If you can’t identify something that you’re not going to consistently successfully treat that problem.

And of course, doctors are going to be doing their best to help you with what they know which they know, medications, they know injections. And if you talk to a surgeon, they know surgery, and if something’s torn or worn down, if there’s something that they know how to fix, surgically, they’re going to go try to fix that in an effort to help you the best they can with their knowledge.

But if the root problem is a muscle imbalances, quad muscle dominance, then they’re not going to fix you for the long term, they’re only going to be able to provide you with a short term fix, whether it’s medications, injections or surgery, this muscle imbalances, quad muscle dominance is really the root problem.

Because even if you have a surgery in your knee joint and you carry over this muscle imbalance after surgery, then you’re going to still mess up your knee joints, your now your replaced knee joints, where you’re still going to have problems elsewhere, you can still get tendinitis and bursitis and still have swelling in the area because of these pressures that have accumulated in your knee joint.

From that resting muscle tension and the improper sequencing. Now I’m going to begin to tell you how to fix this problem because you’re probably asking, Okay, I get it. This makes sense. How do I fix this issue?

Now I need to explain to you something called Reciprocal inhibition. Big words I know but let me explain it very plain and simple. Reciprocal inhibition is a reflex that works between your muscles. And the simplest way to put it is if you think of your arm here, here’s the bicep and here’s the tricep back here. In order for you to be able to bend your elbow to reach your hand to your mouth.

For instance, this muscle the bicep has to shorten has to contract and work. And in order for it to contract the muscle back here, the tricep has to be shut down or inhibited. So we call this Reciprocal inhibition.

When this muscle tightens up, this muscle reciprocally inhibits it shuts off, in order for you to effectively bend your elbow, bring your hand up. And of course it happens the other way around to have your tricep wants to fire so you can straighten out your arm, then this muscle has to be reciprocally inhibited, so that your triceps can activate and do its job and straighten out the elbow.

Now, what if you override Reciprocal inhibition, and both muscles firing at the same time what’s going to happen? So that would mean that you’re getting an isometric contraction in both things, both sides of the joint are firing, and you’re not moving anywhere. Now you have to compensate with other muscles in order to accomplish whatever you want to do. Now, that’s a simple explanation. When it comes to the knee and the hip. It’s a little bit different.

Of course, everybody thinks here Well, the quads work reciprocally with the hamstrings, but it’s more complex than that you have to factor in the glute muscles in the back of the hip. And the reason for that is because one of the quad muscles, the one that’s right on top on the front, it’s called the rectus femoris muscle, it crosses the front of the hip joint, and it’s technically a hip flexor, in addition to being a knee extensor, a traditional quad muscle.

So the quad muscles can also reciprocally inhibit the glute muscles. That means that if your quad muscles are dominant, you tend to use them they’re the stronger muscle in the area. Or maybe you have focused on getting stronger in your quad muscles than you have been possibly inhibiting your glute muscles for a long time and I’ve gotten weaker and weaker in the glutes, but it works the other way around.

If your glutes have good strengthen them, then they can reciprocally inhibit the quads, and even the hamstrings. When the glutes are strong and they’re doing their job because their job is to stabilize To the hip joint and by stabilizing the hip joint, they can offer control to the knee joint.

Because if you move the ball and socket joint up here at the hip, it positions the knee slightly different when the glutes are doing their job, then it allows the quads and the hamstrings to behave more like they should, in decelerating motion at the knee joint. Now, if this is just all over your head, I mean, put it real simple for you.

If you get the glutes stronger, you can make your quads and your hamstrings work the way they’re supposed to, and take pressure off your knee joints, and keep it from progressing in arthritis and actually work the backwards the other way, where you’re making your knee joint move more freely, and hurt less.

So once you understand this. And you might need to rewind this video and play it back and maybe even take some notes. But there’s two questions that arise Let me answer the first question.

The most common question that I get is, uh, when can I work on my thigh muscles? When can I strengthen my quads in my hamstrings? Or can I even ever do it? Should I never work on my quads, your hamstrings? And here’s my answer. Eventually, yes, you can start to do focused exercises on your quads, and your hamstrings.

But if you’re dealing with an active knee problem, you know that you have arthritis limitations right now, your knees bone on bone, you have stiffness in the morning, you don’t trust your knee right now, because it will swell and hurt, it hurts at night, it wakes you up sometimes don’t work your thigh muscles do not actively try to do exercises that focus on getting your quads and your hamstrings stronger, avoid it completely.

But once you’ve improved your glute strength, you feel like your knees much healthier, your knees normal, you can trust it or at least more normal, the most normal it’s been in a long time, you can confidently be on your feet for a while you know that it’s not going to swell up and you’re not going to take a bunch of steps backwards, then your muscles are probably more imbalanced at that time. And it wouldn’t hurt you to do focused Thigh Exercises.

But you should feel confident at that time that when you go exercise, that you’re glute dominant, that you’re using your glutes consistently and you make your glutes get tired. The only other exception when you do need to work on your quads. And your hamstrings is if you’ve just had knee surgery, like within the past two to three months, because very often whenever the knee is operated on, or if there’s a traumatic injury to the knee, like you had a really bad knee sprain.

That’s another situation, an ACL tear, for instance, that in that situation, the thigh muscles can kind of shut down they don’t work normally, especially if you went through a lot of swelling like you will after surgery or after a traumatic knee injury. In that situation, you might benefit from strengthening your quads from doing quad focused exercises in the short term.

But once your quad muscles come back, they’re working normally again, then the focus needs to change back up to strengthening the glutes. Now the next question, the second question I get is what exercises should I be avoiding completely and the answer to that is real simple. It’s anything, anything that makes you use your quads very much or your hamstrings very much.

Now some common exercises that are especially bad are knee extension exercises like the knee extension machine. These are often found at the gym. Very often in physical therapy clinics. It’s a machine where you would sit down your leg would be positioned like my skeletons leg right here. And there’s a pad that goes against right here.

 And there’s usually a stack of plates, you put the pin in, and then you have to straighten out your knee with the here and force your knee to straighten out and use the quad muscles right here. And there’s a similar machine where you can bend your knee against resistance, the pad goes on the back of the leg here, and it’s making the hamstrings work quite a bit.

That exercise those two exercises directly force the thigh muscles to work. They focus the contraction through the thigh muscles, which is going to increase the pressure inside your knee joints in the moment but definitely over time as you continue to do that and get those muscles stronger. Other exercises would be wall sets like where you’re leaning up against a wall with your knees bent and holding that position.

Quad sets are a commonly done exercise in a physical therapy clinic and that’s where you might be lying down or sitting and you have your leg like this. You’re trying to push the back of your knees down and make these thigh muscles work to work on the extension on straightening out your knees and force these muscles to tighten up.

And a more commonly done gym exercise very often done in CrossFit is pistol squats, which I am not able to do and I have no intention of getting good at them because they’re so quad dominant, but it’s where you’re standing on one leg and your legs out and you’re bending down all the way.

I mean your butt’s practically touching your head And then you’re coming up out of it, it’s a very quad dominant exercise puts a ton of strain on the knee joints. And you know, if you don’t have any knee problems and you feel like you’re pretty good imbalance, you could probably go for pistol squats or other quad focused exercises.

But if you’re suffering from bone on bone, knee arthritis, do not do pistol squats, do not pursue any of these quad exercises, all those that I just mentioned would be red flag exercises, red light, stop, don’t do them. Now, let me tell you some yellow light exercises, these might work for you, but they might not too.

The reason is they can be glute dominant exercises, you can make your glutes work more in them. But it’s very common that you’ll use your quads if you’re not conscious about trying to make your glutes work. One is normal squats like where you had your feet apart like this, and you’re just coming down, up and down.

If your knees tend to be more together and bending forward, when you come down and your butt sticks out backwards, you’re going to feel your quads work. But if you can open up your knees and more so drop your butt and not stick your butt out backwards not do this, but drop it straight down, then it makes your glutes want to work more.

But if you don’t have enough glute strength, then you won’t be able to successfully do that exercising, you might need to do some easier glute exercises before you get to squats. Lunges are a similar situation. Lunges are where you have one leg forward like this and you’re coming down, you might do walking lunges where you take a step and drop your body down with one leg forward or one leg back.

Same thing you can use your quads quite a bit, but you can do it in such a way where your glutes work more. And then there’s more simple, seemingly straightforward exercises that are I would say yellow light exercises, walking and cycling and other cardio exercises are very often recommended by healthcare professionals.

But if you feel that you’re using your quads a lot, like if you go on a brisk walk, and you feel your quads getting tired, it’s not good for you, it’s making you use your quads, more your hamstrings, and it’s going to pressurize your knee because you keep strengthening your quads gradually over time. And you’re just working your knee into a more pressurized situation, which is going to wear down the cartilage in there and worsen the bone on bone joint situation.

But if you make your quads shut down during walking and get your glutes to become more active, every step you take, then it is a good thing for you to go walking or even running and cycling. But the key thing is that you feel that you’re using your glutes. And that’s something that nobody else can tell you. You’ve got to tell yourself, am I using my glutes?

Or is it more my quads and a health care professionals not going to know to tell you this, it doesn’t even matter as much how the exercise looks? What matters much more is what you feel. Because very often I’ve seen it happen all the time in physical therapy clinics, people will patients will be asking the therapist, Am I doing it right? And the therapist looks at the exercise and says yeah, that looks right.

Meanwhile, the patient’s working their quads or their hamstrings quite a bit. But the therapist doesn’t understand that that’s not a good thing because they don’t get muscle imbalances. So you as a patient, equipped with this knowledge, need to be able to decide this is working on my glutes, it’s good, or this is working my quads, it’s not good for me.

Now one more question that I want to add that I often get as a result of learning this stuff is why didn’t anybody tell me this, I get this comment all the time here in the clinic. And we’re getting it online all the time to people say I went to physical therapy, nobody told me this. I had surgery. And the surgeon ever mentioned this to me.

Everybody told me to strengthen my quads. And that’s how you fix knee arthritis. I’m in physical therapy right now doing quad exercises, and they’re cheering me on doing it. It’s important that you know that this knowledge all of this with this whole video was about this is not mainstream knowledge. There’s not a ton of research, there’s not a ton of medical literature done on this stuff. And just because the research isn’t out there published doesn’t mean that it’s not possible that this is this is false information.

It just means that it hasn’t been studied and proven yet. In other words, this is a head of the research and what I foresee happening soon, especially as I put out more videos like this and more people get to know about it is that it will be researched one day and this will become mainstream, but it’s going to be decades before that happens. So why wait you might be getting a knee replacement soon if you don’t put this into effect.

Now, this is an advanced specialist thinking that I’m packaging into a video for you. So I’ve got two things for you. There’s two videos with glute exercises specifically for people suffering from knee pain. So they’ll fit you and your knee arthritis situation. Those videos are linked in the description below. And then you also should learn more about my knee arthritis recovery program.

It’s in Online comprehensive program that walks you through all the phases of knee arthritis so that you can get from a very swollen, uncomfortable can be on your feet situation to feeling normal again, and all the steps in between. And that’s also linked in the description below.

I really hope that this was helpful for you give us a thumbs up if you thought it was please share this with somebody that you think needs to hear this, consider supporting our channel the super thanks. And please don’t forget to subscribe and turn on your notifications so that you don’t miss out on any of the helpful tips we share every single week. I’ll catch you in the next video. Bye