At Mount Sinai Hospital, here in New York City, I lectured last month to a group of orthopedists, physiatrists and physical therapists. Our topic of interest was the patella, and my specific lecture was how to protect the knee from undue stress. As a clinical director, I can tell you without looking at numbers or charts: Knees give people a lot of problems! They are right up there with low back pain. So how do we protect this extremely useful joint (you never realize how much you walk until the knee starts to hurt)?  In a word—stability. But before I write about what the word stability really means, let’s take a moment and imagine the stresses we place on our knees. You can picture it this way.

Cover via Harlequin Blaze, Inc.

Imagine the body as a long, straight rod extending from the floor up to five or six feet. Now have a large muscular individual (go on have some fun, I’m thinking of those romance novel covers) grab the top of the rod and bend it into a bow. The force applied at the top of the rod is transferred along the rod and results in strain from the top to the bottom. Guess where the body has significant vulnerabilities? If you are glancing suspiciously at your knees, then you get two points for the correct answer.

Let’s take our example and translate it into what this means for a human being. Whenever the upper or lower half of your body moves from being centered over or under the hips (i.e., during activities of daily living, going from sit-to-stand, climbing stairs, reaching for that tennis shot, etc.), you put serious strain on the knee joints.  Over time, as the knee puts up with this wear and tear, we eventually run into problems. This usually manifests itself as pain, weakness or swelling and in serious cases requires surgical intervention. So how can we protect our knees?

Simply put, you need a strong, stable core (area from the bottom of the ribs to the bottom of the pelvis). This allows you to control your alignment. Now this is when I say, consult your local physical therapist for further details. Why? Because gaining control over the core is not the same as developing six-pack abdominals. Controlling the core is a very complicated process that involves kinesthetic awareness (fancy term for movement awareness) of both superficial and deep musculature, balanced muscle length, strength and endurance. It involves more than just performing non-stop crunches. A strong, stable core requires a sophisticated exercise program.

A physical therapist can guide you through this process, devising and implementing a program that will get you core control. And if your knees are already giving you problems, that is probably the optimal solution. But if you aren’t currently experiencing knee issues, then I might recommend some approaches to your exercise routine that will be helpful. As with any written recommendation, you should consult a medical professional before implementing the following information.


Keeping in mind my cautionary sentence above, what can you do to challenge your core musculature? You can start by bringing a bit of instability into your life. Basically, incorporate balance training as an underlying condition of exercise. How? Well, these days every gym has a Physioball, Bosu (inflated half-globe), balance boards, etc. All of this equipment was designed to challenge your core. For instance, consider using a Wobble-Board or a Bosu (right) when you perform your squats. The squats not only become much harder to perform correctly, but your core muscles get a tremendous workout.

  • Try sitting on top of a Physioball and carefully lifting one foot off the floor, while maintaining your balance.
  • For something completely different, lie down on a pliable workout mat with your legs on a Physioball (knees at a 90-degree angle). Once you are positioned correctly, carefully raise your hips into a bridge position while straightening out your legs; if you feel any neck or upper-back strain, stop immediately. Hold for 10 seconds; then lower and repeat.
  • How about putting your feet on a Physioball while maintaining a push-up position? Don’t worry, everyone looks awkward trying to get into this position.
  • Eventually work up to an actual push-up.

If you really want stability incorporated into your exercise routine, consider Pilates exercise routines, and equipment specifically designed to connect your core musculature with the rest of your body.

Once again, I strongly recommend that you perform the above exercises with a professional’s help. He/she can also help you in developing an exercise routine, increasing the difficulty, checking your form, and preventing falls.

The benefits of a strong and stable core are plentiful. Real strength at the core protects your joints (not just the knees), prevents falls, improves athletic performance, and gives you confidence that you can handle what life throws at you. When done properly, it works on the waist, stomach and hips. Toning, trimming and generally giving you a longer, sleeker form. So what are you waiting for? Think about putting a little instability into your life. It can pay big dividends.

Eveline Erni is a physical therapist with 27 years of experience, who has run a private practice in New York City since 1990. Along with four colleagues, Erni has helped more than 2,000 patients. Erni is also a member of the Hospital for Special Surgery’s Rehabilitation Network, one of New York’s premiere surgical orthopedic hospitals.

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  • Willse Elizabeth May 12, 2009 at 11:23 pm

    Brava! A wise, and well-written post. I have the utmost respect for the work physical therapists do, and the wealth of knowledge they bring to guiding people’s exercise programs.

    In the work I’ve done as a personal trainer, I find myself giving very similar advice to the information you present, about core strength and balance improvement.

    These guidelines will help enhance anybody’s exercise program, as well as their daily life.

    – Elizabeth W.