Stretching Part II: Knees and Back

This is a lengthy post, bare with me! I'm sure that you will find the information contained here beneficial.

Friday's post introduced the topic of stretching and the important role it plays in our fitness routines. Many of you commented that stretching was something that you didn't do on a consistent basis. I'm here to try to change your mind. Trust me, once you add stretching to your routine, you'll never want to stop. I find stretching after a workout to be like the icing on the cake, the reward for all of the hard work. Not only does stretching feel good, it is invaluable for prevention of injury.

From reading many of your blogs, I have noticed that knee pain and low back pain are two common complaints. Pain can lead to decreased activity-never a good thing when you are trying to lose weight and increase your level of fitness. Often times, the pain you are experiencing is caused by tight muscles. When one muscle is tight, another muscle must take over. In turn, that muscle may begin to feel tight. For instance, if your hamstring muscles (the three muscles located on the back of your thighs) are tight from lack of stretching, you may begin to experience pain in your low back. If you continue to leave stretching out of your routine, knee pain can become an issue too.

Muscles that make up the hamstrings

The knee is the most complicated joint in the body and the site of numerous muscle attachments both above and below the knee on both the front and back of the legs. Because of this, it is imperative that all of the muscle groups that surround the knee joint get the benefit of a good stretch.



Failing to stretch even one of those muscle groups can cause knee pain. For example, if you fail to perform an inner thigh stretch, the tightness in that area can cause the outer thigh to have to work harder. The result may be pain on the outer side of the knee cap. (Weak muscles can also lead to pain, but we'll save that for another post.)

This is an oversimplified explanation of the correlation between tight muscles and pain, but gives you a general idea of why you may be experiencing pain in the knees or low back. Let's move on to some of the stretches that can help you. Personally, I do several stretches after every workout. I find that holding a stretch between 20-30 seconds gives me the optimal benefit. (In group fitness classes that I have attended, rarely has an instructor had students hold a stretch longer than 5 seconds.) Often I will perform each stretch once then follow up with a second set. I find that during the second set I am able to settle a little deeper into the stretch. The whole routine takes me about 10 minutes-not a huge time commitment considering the benefits.*

My personal routine includes the following stretches:


When performing this stretch, I like to imagine pressing my hip bone forward and pressing my foot against my hand. You should feel a nice stretch along the front of your thigh.

Quadriceps Stretch (Stretches the four muscles on the front of the thigh)

Psoas Stretch (Also referred to as Hip Flexors)

The psoas muscle attaches to the vertebrae of the lower back and the head of the femur (thigh bone) It is the muscle responsible for flexion of the hip and thigh. Sitting for extended periods of time causes shortening of the psoas and can lead to low back pain.

When performing this stretch, be sure to keep the knee from extending in front of the toes to protect your knee joint. You should feel this stretch in the upper thigh of your rear leg.

Piriformis Stretch

The piriformis muscle is located beneath the gluteus muscles and runs across the upper buttocks and is superficial to the sciatic nerve. If this muscle becomes impinged, it can lead to low back and sciatic nerve pain. This muscle is notoriously tight in runners.

If you are performing this stretch correctly, you should feel a nice stretch in your hip area.

Hamstring Stretch

Stretching the muscles at the back of the thigh is a surefire way to avoid low back pain. Don't force the stretch. Gently bring your extended leg toward you.

Standing Calf Stretch

Because the muscles of the calf area attach to your knee, tight calves (and weak calf muscles) can lead to pain in the knees. Be sure to lean forward slightly and keep your heel planted to get the maximum benefit from this stretch.

Outer Thigh Stretch

The outer thigh is often forgotten in stretching routines. I like this stretch because it helps loosen the low back as well. Be sure not to pull on the knee, but rather press into the stretch. This stretch also targets the piriformis muscle described above.

Inner Thigh Stretch

Press the soles of the feet together as you gently press your arms into your thighs. Never press directly on the knees. There are a number of muscles in this area and most of us don't do nearly enough to strengthen these muscles. As a result, these muscles are often weak and tight. Be patient and don't force the stretch to the point of discomfort.

Low Back Stretches

Some of the best low back stretches come from yoga. Two of my favorites are pictured below.

You need not limit yourself to these stretches. There are dozens of variations on each stretch. A few things to keep in mind:

-Beginners may feel a bit of discomfort due to extreme tightness. Never force a stretch.
-Increasing your flexibility takes time, be patient.
-Never push directly on the knee
-Stretching is best done when muscles are warmed up
-Even if you do not exercise daily, stretching is a beneficial activity that can and should be performed every day.


For more information and illustrations of stretches, try Sportsinjuryclinic.net.


*In the state of Ohio where I earned my license, Licensed Massage Therapists are able to show clients stretches, but it is outside the scope of practice to instruct clients to perform particular stretches or the duration to hold the stretch. It is considered practicing medicine without a license. The above information is intended to illustrate my personal approach to stretching. Please consult a professional for information specific to your needs.


Images for this post were found at cycling info.co.uk, expertbackcare.com, scan.ac.uk, sport-fitness advisor, stronlifts.com,gettallernaturally.net,piriformis-syndrome-advice.blogspot.com and spine-health.com