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Q1: Healthy Joints

I’m planning to run a half-marathon next year, so I’m looking for ways to build up joint strength. Any advice?

A1: Fantastic question, considering how prevalent joint pain is among runners. My first thought — aside from the importance of building up your mileage by no more than the standard recommendation of 10 percent each week — is that you might try focusing on eccentric exercises when you’re in the weight room. Emphasizing the eccentric, or slow, lowering phase of a lift has been shown to strengthen connective tissues over time. Try heel drops from a stair for your Achilles’ tendons and super-slow-mo squats for your knees. (See link to video demos in At a Glance.)

Probably even more helpful is to minimize stress to your connective tissues altogether by improving your biomechanics, says Craig Friedman, MS, ATC, CSCS, director of the performance innovation team for Athletes’ Performance in Phoenix, Ariz. Too often, muscle imbalances and neuromuscular inefficiencies result in excessive stress on the joints. For example, most distance runners have poor glute function, says Friedman, resulting in a chain of dysfunction from there outward. Because your glutes aren’t firing, your hip capsule, lower back and IT bands (the connective tissue that runs along the outside of each leg from hip to knee) take on excess load, and femoral rotation is exaggerated, which places more stress on the ligaments and tendons in your knees; this, then, increases pronation at the ankle and multiplies the stress to your lower legs. I realize that that reads like a textbook, but it just means that because your buns don’t work, you run knock-kneed, which is hard on the joints.

So, in most cases, the trick isn’t so much strengthening connective tissue but identifying and correcting any muscle malfunctions that could manifest as joint pain down the road (literally). If you’re going to embark on a long-distance-running plan, consider asking a physical therapist to evaluate your muscles and mechanics first.

Because “gluteal amnesia” is so prevalent, Friedman recommends everyone incorporate the following exercises: “forward lunge, elbow to instep”; “mini-band external rotation”; “mini-band bent-knee lateral walk”; and “glute bridge.” (Go to for details — and go armed with these exercise names, because there are 40 pages of exercises!)

band walk

One simple way to strengthen glutes is to incorporate mini-bands (find the bands here) into sideways and backward walking drills. Pictured above: the mini-band bent-knee lateral walk.


Q2: Vitamin D

I’ve read that vitamin D3 is anti-inflammatory. Does that mean it could be a useful postworkout recovery supplement?

A2: The short answer is yes. Not only can vitamin D help prevent (and treat) osteoporosis, heart disease, diabetes, hypertension, chronic pain, autoimmune diseases and certain cancers, but it can also act as a powerful anti-inflammatory agent, says John Berardi, PhD, CSCS, founder and chief scientific officer of Precision Nutrition. Vitamin D supplementation has also been shown to improve muscle strength and athletic performance, especially when an individual is vitamin deficient — as most North Americans are.

Just keep in mind that D’s anti-inflammatory properties and performance benefits accumulate. An acute dose — after exercise, for example — wouldn’t have much impact on the exercise session itself. Rather, daily dosing would help prevent the excessive inflammation seen in joint pain and injury. So it’s feasible, Berardi says, that this could lead to small improvements in recovery. Although the RDA for vitamin D is 200 to 400 IU each day, Berardi contends that this amount is too low, and instead recommends 1,000 to 2,000 IU per day; even bumping that number up to 3,000 to 4,000 IU per day during the winter, if you live someplace cold or dark.

See “Vitamin D: What You Need to Know” for more.

Q3: How to Progress Pushups From Knees

I can’t do a lot of regular pushups, but doing them from my knees feels so much easier, I wonder if they’re really doing me much good. Would I be better off doing a few the “real” way than a whole bunch from my knees?

A3: In my view, yes. Bent-knee pushups feel like a Caribbean vacation compared with toe pushups, because you’re cutting the lever of your body by around 30 percent and changing the angle of the exercise so you’re not fighting gravity as much. This lightens the load substantially.

Unfortunately, it also detracts from the benefits you reap: core, shoulder and back strength; better body control and coordination; and good scapular stability (crucial for healthy shoulders — see “Balance Your Blades”). Don’t get me wrong: You still develop those things even if you’re not on your toes — just to a lesser extent.

So, if you can do even one or two regular pushups, do them. When you can’t do any more, do as many more as you can from your knees. And for those who can’t yet do a regular pushup, make it a goal, because doing an ever-increasing number of bent-knee pushups isn’t ideal.

Jim Smith, CSCS, strength coach at, concurs. He suggests evolving from knee pushups to a combination of knee and toe pushups, then transitioning entirely to toe pushups, and eventually to feet-elevated toe pushups (harder still). Smith, a renowned core-training specialist, also notes that since full pushups require you to stabilize your entire body, you’ve gotta build core strength along with upper-body strength to do them well. He put together the following progression, which you can do every other day.

Set 1: One regular pushup (or attempt at a regular pushup); five to eight reps of knee pushups; 30-second plank hold.
Set 2: Two regular pushups (or one attempt at a regular pushup); eight to 10 reps of knee pushups; 30- to 60-second plank hold.
Set 3: Three to four regular pushups (or  one attempt at a regular pushup); eight to 10 reps of knee pushups; 60- to 90-second plank hold.

One last thing: Tighten your core, glutes and upper back, and don’t let your hips sag. If form deteriorates, stop the set and rest before completing another rep.

Fitness Fixes: The Quad-Hamstring Imbalance

If your quads are significantly stronger than your hamstrings, you’re making yourself more susceptible to knee injuries and muscle pulls.

One of the neuromuscular factors leading to knee injuries and muscle pulls is the all-too-common strength imbalance between the quadriceps (the muscles on the front of your thigh) and the hamstrings (the muscles on the back of your thigh). A healthy ratio is for the hamstrings to be at least 60 percent — and ideally closer to 80 percent — as strong as the quadriceps, but the vast majority of us don’t even come close to that. Women, especially, are prone to this imbalance, which decreases the hamstrings’ ability to stabilize the knees and probably contributes to the markedly higher incidence of ACL injury among active females.

“People tend to gravitate more toward quad-dominant activities such as squats and lunges for one reason or another — they like them more, or they’re a larger part of most workout programs,” says Sara Wiley, CSCS, associate director of strength and conditioning for athletics at the University of Minnesota. But, she says, we’d be better off including more pulling exercises, such as dead lifts (a wide grip further emphasizes the posterior chain), Romanian dead lifts and good mornings. Generally, think bending-over exercises.

“I don’t train athletes based on muscle groups — that is, we don’t do ‘hamstring workouts’ or ‘quad workouts,’” says Wiley. “But, I do evaluate my programs to make sure that lower-body pushing exercises [which activate the quads] are balanced with lower-body pulling exercises [which activate the hamstrings], either within that workout or within the week.”

Muscles don’t operate in a vacuum, however, and other factors can have implications for injury. It’s important to have strong hamstrings, but they must also be able to coordinate with the quads. That’s why plyometrics help with injury prevention, and why you should focus on compound movements rather than isolation exercises.

An (Unofficial) Hamstrings Strength Test

There’s a fancier way to measure hamstring strength using something called the Cybex Test, but considering it takes special machinery and a bid to play pro football (it’s primarily used in the NFL Combine), try Wiley’s more accessible option.

hip raise

• Lie on your back with feet hip-width apart, the soles of your feet on an 18-inch bench or step.
• Push down into the bench with your feet, lifting your hips high. Don’t lift your shoulders or neck off the floor, and keep your upper back flat.
• Lower the hips until your butt is just off the floor, and then push down into the bench with your feet and raise your hips again.
• Continue for 15 repetitions, rest for 45 seconds, and then complete two more sets.

“A person with decent hamstring strength should be able to handle this,” says Wiley. “If, on the other hand, you struggle to complete the sets, work on those hammies.” Start by doing this exercise once or twice a week. When you can do three sets of 20 reps, try them one-legged. Start with three sets of 10, and build to three sets of 20. For a further challenge, try these on a stability ball; first double-legged, then single-legged.

Stiff-Legged Good Morning

Another solid hamstrings strengthener Wiley recommends is the good morning (see “How to Do the Barbell Good Morning” for more on this move). Begin doing this exercise with little to no weight, and progress from there.

  • Inside a squat rack, set up with a barbell across your upper back, gripping it as you would if you were about to perform a squat.
  • Unrack the weight and step backwards a few feet, then position your feet shoulder-width apart.
  • Keeping your legs stationary, slowly bend your torso forward, maintaining a neutral spine and keeping your head up, eyes forward. The straighter you keep your legs, the more you’ll engage your hamstrings, though a soft bend in the knee will be present.
  • Just before you hit the point you would no longer be able to maintain a neutral spine (approximately parallel to the floor, for most people), switch directions and return to the upright position.
  • Repeat for 2–3 sets of 12–15 reps, 1–2 times per week.
Jen Sinkler

Jen Sinkler, PCC, RKC-II, is a fitness writer and personal trainer based in Minneapolis. Her website is

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