Exercises for knees, back, and neck

© July 2014 Paul Cooijmans


Over the years I have experienced a number of problems of the kinetic apparatus, and collected exercises to counteract them or at least prevent or postpone their deterioration or recurrence. It concerns common conditions relating to the knees, back, and neck, that many suffer from. Of course I have had simple muscle and tendon injuries too, but those are trivial and largely harmless in the long run. Problems with the knees, back, and neck though are potentially dangerous as they tend to get worse when getting older and eventually keep one from being physically active (which is bad for one's overall fitness and health), and may cause neurological symptoms.

Knee problems as meant here are pain and irritation behind the knee cap, and pain inside the knee which may be beginning arthrosis or a precursor of it. In the (lower) back it concerns pain and herniated disks. In the neck, tension, stiffness, pain, restricted movement, and tension headaches (tension in the jaw and wear of the jaw joints often occur in combination with these neck problems). Knee problems may eventually stop one from running and even walking. Herniated disks in the lower back may severely reduce one's ability to work or be active, and may cause paralysis in the lower body. Tension in the neck may lead to herniated disks there, and ultimately to neck arthrosis, which in turn may cause pressure on the spinal cord, paralysis anywhere in the body, and death.

I believe that one of the causes of these conditions lies in posture and locomotion (how one moves), and that any improvement in that field may help to slow down deterioration or postpone recurrence. I suggest not that posture and locomotion can be truly corrected; I think posture and locomotion are rooted in one's personality and have a genetic basis, and that therefore a bad posture and locomotion will normally get worse throughout life (genetic traits tend to increase with age). Nevertheless I believe it is worthwhile to use that small margin for improvement to keep one's kinetic apparatus in shape as well as one can.

Classes of exercises that appear effective with regard to knee, back, and neck problems

  1. Balancing, automating;
  2. Strength;
  3. Flexibility, relaxation, movement, decompression.

Some explanation and discussion of the classes of exercises follows.

1. Balancing, automating

When balancing, for instance by standing on a balance board, which is a disk with a half sphere under it, one is using a large number of muscles in the lower body and trunk. These muscles mostly work automatically, reflex-wise, unawarely. They are the same muscles used in normal standing and walking, and in normal standing and walking they also function automatically and unconsciously. Thus, balancing is resistance training for normal standing. It trains muscles that work involuntarily and can not be trained for that function with normal strength exercises.

Balancing may be a solution to the problem that occurs when one tries to improve one's posture cognitively, by learning the right way to stand from a book or therapist; once one knows how to stand, one is only able to keep that posture up for a second or so, until one thinks of something else or begins to do something else. Then, one reverts to one's old, bad posture instantly, because posture is automatic and unaware. And since in normal life one is really always thinking and doing other things than focussing on posture, the mere cognitive learning of the right posture does not change one's actual everyday posture one millimetre. To truly improve posture, one needs to get into the automatic system, and balancing may be a way to do that.

2. Strength

An important cause of the wrong posture and locomotion that lead to knee, back, and neck problems is weakness of a number of muscles in the trunk and legs. For instance, weakness of the muscles on the front side of the upper legs leads to knee problems, and weakness of abdominal muscles to lower back problems. Muscle weakness and bad posture reinforce one another in a vicious circle. Exercises to strengthen those muscles are helpful, but only if the newly acquired muscle tension is indeed incorporated in the automatic system that controls posture and locomotion.

3. Flexibility, relaxation, movement, decompression

Another cause of bad posture, also in a self-reinforcing vicious circle with it, is tightness of muscles. Often these are the antagonists of the weakened muscles and thus work together with those in spoiling one's posture. For example, too weak abdominal muscles and too tight lower back muscles result in a hollow lower back and forward-pointing belly. Or, muscles on the right side of the trunk that are tighter than those on the left side help to sustain a scoliosis (sideways curve in the spine). It seems logical that stretching these muscles, or at least making them less tight in some way, would help. Stretching in itself has no effect whatsoever toward improving posture though. It needs to be combined with strengthening and with automating the right posture.

With regard to the spinal column, both too tight muscles and lack of movement cause compression of the spinal disks, which makes them deteriorate. This can be counteracted by exercises that involve careful movement of the vertebrae relative to each other, thus "massaging" the disks, and by exercises that slightly stretch the spinal column, allowing the disks more space ("decompression").

For the cartilage of the knees, too, movement without exerting much force helps regeneration of the cartilage, or slows down its deterioration. Riding on a stationary bicycle with low or no resistance is ideal; cycling outside in low gears is good too, but a bit more strenuous.

The exercises described in more detail

Balancing, automating

Standing on one leg

The simplest form of balancing is to stand on one leg for some time; it can be made a bit harder by doing something meanwhile, like the dishes or closing the eyes. Every one or few minutes one changes leg, obviously. Standing on one leg may be seen as an easy introduction to balancing, but is in my opinion not sufficient to achieve the results one wants. [Video]

Standing on a balance board

A disk with a half sphere under it makes balancing clearly harder and activates many posture-related muscles, such as the small muscles around the vertebrae. Balance boards are sold in sports stores as "fitness" equipment, but can be home-made if one is handy. One can stand on them with two feet, either far apart or closer together, or on one foot, which is not necessarily harder. It may take some minutes before one succeeds in keeping one's balance. Progress can be made by doing things while balancing, like knee bends, throwing a ball, juggling, wearing dark sunglasses or turning the lights out to make it harder, closing the eyes, and so on.

Advanced and alternative forms of balancing

For a change, one may try to balance on a bicycle sur place, that is, standing still, or ride a unicycle. Walking a tightrope is an advanced form of balancing.

Walking with a rucksack or weights in one's hands

One of the hardest things posture-wise is to counteract the tendency to lean backward with the upper part of the trunk, and/or to let the upper part of the spinal column collapse. This is bad for the neck, which is then pointing forward in compensation and undergoes extra strain. Also, the shoulders tend to be forward and pulled up. What must be done is to stretch out the thorax forward and upward at the same time, without pulling the back hollow (which is the typical mistake people make when instructed to "stand straight"). The neck and head can then stand straighter on the trunk, and the shoulders can move backward and down. It is extremely difficult to automate this; ways to help the body to assume this correct position automatically are walking long distances with a rucksack containing some weight, and walking (short distances) while carrying weights in one's hands, the arms hanging down as if carrying grocery bags by the handles. This serves as resistance training for standing and walking with the thorax stretched out properly. Another activity that stimulates a correct posture is walking on one's toes (or on high heels, if that floats one's boat).


Floor exercises for trunk muscles ("core stability")

Something like a yoga mat may be of use.

  1. Lying on the back with the feet flat on the floor, place the hands cross-wise on the shoulders and lift one shoulder while keeping the lower back and other shoulder on the ground. Do this a number of times, like 20, and then the same number with the other shoulder. Then with both shoulders at once, still keeping the lower back on the floor, about half the number of times (so, 10 in this example).
  2. Lying on the back with the legs straight, tighten the abdominal and buttock muscles. Then, with those muscles still tightened, lift both legs a few centimetres off the floor with the ankles stretched and keep them in that position for a number of seconds. Do this about four times. The exercise can be made harder by tapping with the heels on the floor a few times (the heels held together), to the left and to the right, while holding the legs up.
  3. Lying on the belly, lift one arm and the diagonally opposite leg and hold them there for a number of seconds. Then the same with the remaining arm and leg. Then with both arms and legs at once; this is easiest with the arms stretched to the sides, and gets harder the more forward the arms point.
  4. Facing downward, lean on the lower arms and toes with the rest of the body kept tight and straight in the air, and hold as long as possible, like half a minute to a minute. [Video]
  5. Facing sideways, lean on one lower arm and the outside of the corresponding foot, the rest of the body kept tight and straight in the air, and hold as long as possible again. Then the same with the opposite arm and foot. [Video]
  6. Facing upward, place the feet and hands or fists on the floor ("behind" one) while pushing the abdomen and pelvis up in the air as if one were a table, and walk around like that for a while. [Photo]

Exercises while sitting on a chair

  1. Place a ball, like a football, between the knees and press them together as hard as possible; hold this for about 10 to 25 seconds. Repeat if desired.
  2. While sitting straight, hold one leg up horizontally; the leg must be stretched and turned outward, with the foot lifted toward the shin. Avoid leaning backward with the trunk. Hold the hands on the other leg. Hold the position for about 10 to 25 seconds. Do this with the other leg too; repeat if desired. [Photo]

Exercises while standing

  1. Walk around a bit on the heels; then on the toes; then on the inner edges of the feet; then on the outer edges of the feet.
  2. Stand on one bent leg while the opposite side of the trunk (shoulder to hip) is leaning against a closed door. The deeper the leg is bent, the harder it is. The foot on the floor is about 40 cm from the door. Hold this position for about 10 to 25 seconds. Then do the same with the other leg. [Photo]
  3. Step on to a bench or chair, about 45 cm high, using the left leg, without pushing off with the right foot. Step down to the floor again, the left leg first. Then do the same with the right leg. Do this about 15 to 25 times.

Exercises using weights

  1. While sitting on a table, the full upper legs resting on the table top, lift one lower leg to a horizontal position with a weight hanging on the foot or ankle. Hold this for a few seconds, then lower the weight to the floor. Do this about 15 times. Then move the weight to the other leg and do the same there. For weight, an old pair of trousers can be used, with the legs (of the trousers, not the human doing the exercise) tied closed and weights, such as disk weights, put in the legs [Photo]. One may start with 2 or 3 kilograms, and increase this as one advances. The trousers are hanging with the crotch on one's foot or ankle. Some recommend to use a grocery bag, but to my experience those are too fragile to hold the amount of weight needed to make this exercises effective if one has monster quadriceps like mine. Note for further disambiguation: Each trouser leg is tied in itself; the legs are not tied together.
  2. While standing straight, bend the knees about 90 degrees while keeping one's weight on one's heels and the knees above the feet (the knees should not point forward, should not end up in front of the feet). Then straighten the legs again to return to a correct standing posture. Do this about 15 to 25 times. Because this exercise is much too light for many, it mostly needs to be made harder by adding weight, either by holding weights in one's hands hanging down, or holding a barbell on the shoulders, or wearing a rucksack.

Flexibility, relaxation, movement, decompression

Not included here are a number of common stretching exercises for various leg muscles that are described in many places, and of which I am not certain if they are effective in the context of this article (I do all of them myself though). It concerns the calves, insides of the upper legs, front side of the hips, hamstrings, quadriceps, loins, and buttocks. If desired on can find such exercises elsewhere. In case of the hamstrings, I recommend to always keep the trunk more or less straight when stretching hamstrings, and avoid the bending of the lower back that occurs when one tries to go with the nose to the knees or grab the feet or toes. I believe such bending worsens herniated disk problems by pushing the herniation further out, and may cause herniated disks if one is thus disposed.

If one has a herniated disk in the lower back or recently had one, I recommend to abstain from stretching the hamstrings and buttock muscles for the time being because of the risk of making it worse or return. I mention this because some therapists actually advise stretching the buttock muscles in case of radiating pain in the leg, claiming that the cause of such pain lies in too tight buttock muscles rather than in the lower back. I believe this theory is doubtful and comes from the realm of alternative healing.

Exercises for the neck and shoulder area that can be done while sitting or riding a stationary bicycle

Combining these with riding on a stationary bicycle with low resistance (to promote regeneration of the cartilage of the knees) is time-efficient. Before beginning the neck exercises, one should make sure to be sitting straight up with the neck stretched out. That is, the back of the head should move upward a bit while the chin moves downward; the neck and head as a whole should not point forward. Some say one should imagine one's head being pulled up by a wire attached on top of the head.

  1. Bend the head forward and let it hang down, then bend it backward. Do this about ten times. Do not force the neck into its maximum possible positions; it is the mere movement of the vertebrae that matters here, not the going to extreme positions.
  2. Holding the head straight up, turn it to loosely the left, then to the right. Do this about ten times. Again, it is the movement itself that counts, not the amplitude. The movement should be easy, without exerting force. [Video]
  3. Bend the head left-forward and let it hang for a few seconds (notice the stretch of a muscle on the rear-right); then lift the head up again and do the same right-forward. Do this about ten times. [Video]
  4. Lower the lower jaw a bit and push it forward; hold it there for a few seconds. Then pull the jaw backward and a little bit down and hold that for a few seconds. Do this about four times. It may take some trying out to find the right angle and position of the jaw that allow these forward and backward movements to be carried out loosely.
  5. With the hands in front of the chest and the elbows pointing horizontally outward, move the elbows backward a number of times.
  6. With the arms hanging down, rotate the shoulders forward a number of times, then backward a number of times.
  7. Stretch both arms upward, then lower them in front of the body and swing them back up outwardly again, completing the circle. Swing them around a number of times like this in an ongoing motion (forward rotation).
  8. Swing one arm around, forward, a number of times. Then the same with the other arm.
  9. Let the hands grab each other and pull on each other behind the back, one arm over the shoulder and the other from below. Hold this for a number of seconds, and then do the same with the other arm over the shoulder and the one arm from below. If one can not make the hands touch, use a towel to enable the hands to pull on each other. [Photo]

Various exercises for decompressing the lower back while standing or sitting

It is not needed to do them all; just use the object that is available at the time.

  1. Standing next to a (stationary or mobile) bicycle with one hand on the seat and the other on the handlebars, straighten the arms while standing on the toes, then bend the knees while keeping the arms straight so that one is leaning with part of one's weight on the bicycle. It is best to keep some weight on the forefeet. Other objects that allow this kind of leaning can be used instead of a bicycle.
  2. In a chair with arm rests, push oneself up with the arms until the arms are fully stretched so that the behind becomes suspended in the air but the feet stay on the floor.
  3. Lay both hands on top of an open door, each from one side of the door (so one must be standing at the end of the door), and bend the knees so that one's weight is partly carried by the door and partly by one's feet on the floor. [Photo]

Exercises while standing

  1. Standing on one leg, swing the other leg back and forth for a while to loosen the hip. This combines balancing with flexibility. Of course, do it with the other leg too.
  2. Standing straight up with the legs somewhat apart, bend the arms with the elbows pointing outward and rotate the upper body to the left while looking over the left shoulder, then rotate back and through to the right while looking over the right shoulder. Do this a number of times in an ongoing motion.
  3. Standing straight up, cross the right leg in front of the left leg so that the right foot is positioned along the outside of the left foot. Stretch the arms vertically up in the air with the hands holding each other and the trunk stretched out correctly, and bend the trunk to the right to feel a stretch on the left side of the trunk. Hold this position for a number of seconds, then return to the starting position and do the same but opposite. No pain should be felt on the side one is bending to; if there is pain there, one has probably not stretched the upper part of the trunk properly forward and upward.
  4. Standing up straight with the hands behind the head and the feet somewhat apart, carefully move the upper part of the trunk to the left and then to the right a number of times while keeping the pelvis in place. Do not bend the trunk but keep upper part of the spinal column vertical while moving horizontally. In this and the previous two exercises, if one side feels tighter than the other, or moving to one side is harder than moving to the other, this may indicate there is a scoliosis (sideways curve of the spine), though not necessarily bad enough to be clinically significant. [Photo]

Floor exercises

If one has a herniated disk in the lower back or recently had one, I advise against doing these floor exercises as they might make it worse or return (the neckstretcher can safely be used though).

  1. On hands and knees and facing down, carefully tilt the pelvis backward and forward a few times. The goal is merely to have a little bit of movement between the vertebrae of the lower back, thus massaging the spinal disks. Do not go to the extreme positions.
  2. Lying face down, place the hands near the shoulders, tilt the head backward, and straighten the arms while the hips stay on the floor. Hold this position for some time and then lie down again. Do this a few times. The idea is to fully stretch out the thorax part of the spinal column. Some say this is an exercise for the lower back though, but I think they are mistaken. [Video]
  3. Lying on the back with the legs stretched, bend one leg, grab the knee, and pull it toward the chest. Hold that position for a few seconds and put the leg back again. Then do the same with the other leg.
  4. Lying on the back with the legs stretched, push one leg a few centimetres away. Then do the same with the other leg. Repeat this a few times. Again, this is only to have some movement in the lower back. [Video]
  5. Lying on the back with the feet flat on the floor, slowly move the knees together to the left and to the right a number of times (not all the way down to the floor, but just so far as goes easily). This is again to have movement between the vertebrae. [Video] If one has a neckstretcher, this exercise can be combined with lying on the neckstretcher for some time.
Neckstretcher; an ingenious device that
provides some decompression of the
neck and relief of tension in the
neck and of tension

Example exercise sessions

Example of a strength-oriented session

  1. Stand for some minutes on a balance board.
  2. Do the Floor exercises for trunk muscles ("core stability").
  3. Stand for several minutes on a balance board; the idea is that the muscle tension from the previous exercises is incorporated in the posture-related balancing system.
  4. Do the (strength) Exercises while sitting on a chair.
  5. Do the (strength) Exercises while standing.
  6. Stand for several minutes on a balance board again.
  7. Do the Exercises using weights.
  8. Stand for some time on a balance board again, in different modes such as on two legs, on one leg, and with some variations to make it harder when needed and possible.

Example of a flexibility-oriented session

  1. Do the Exercises for the neck and shoulder area that can be done while sitting or riding a stationary bicycle.
  2. Do one of the Various exercises for decompressing the lower back while standing or sitting.
  3. Do the (flexibility) Exercises while standing.
  4. Do the (flexibility) Floor exercises.
  5. Ride on a stationary bicycle or with low resistance for some time (or outside on a normal bicycle).