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Exercising with Knee Pain

There’s no doubt that most of us know someone who has or currently is suffering from knee pain. Research conducted in 2011 found a significant increase in the prevalence of knee pain the past 20 years.1 Both obesity1 and joint alignment2 have been found to be significant factors when predicting knee pain or osteoarthritis. In fact, another research study conducted found that for every pound of body weight, our knees bear four pounds of pressure while walking.3 Yes. That means losing ten pounds can off load your knee up to 40 pounds for every step taken. Weight loss is always a good place to start, but what if you’re knees are limiting your ability to exercise? Read on.

For some, the damage has been done. Surgery will be required to either replace the joint (total knee replacement) or to debride the knee itself (arthroscopic surgery). For others, a successful exercise program can successfully restore function and abolish pain. It’s important to note that knee pain is often multifactorial. A combination of balance, strength, and flexibility all contribute to a stable, painless knee.

Strength, Balance, & Flexibility

Strength and balance are both crucial for protecting your knee against damaging forces. When developing a strength and balance program it’s important to think of your body as a whole. A painful, sore knee won’t tolerate a program that simply isolates the knee. Be careful with seated machines that emphasize kicking and pulling motions, too. You’ll want to emphasize strength throughout the entire leg, not specific to a single muscle. A strong ankle and hip can effectively off load your knee during daily activities. In fact, one research study found that anterior knee pain while negotiating stairs was consistent with weakness and delayed onset of muscle activity at the hip, primarily the gluteus medius.4 The same philosophy can be applied to flexibility. Addressing tightness around your knee, rather than at your knee can be the keystone to improving symptoms and function. The entire concept revolves around the idea of improving the supporting cast. If everything around your knee is strong, balanced, and mobile, your knee is responsible for less.

Flying Below the Radar

Exercising with knee pain is a catch-22. The answer is exercise, but a painful knee may prevent you from doing so. A gradual load progression program can be used to slowly increase the load to the knee, improving its tolerance to weight bearing. You’ll be looking to fly below the symptom radar. Adjusting an exercise program can be as simple as modifying your foot position, depth of an exercise, or even replacing it all together. Aquatic programs and biking are two activities that can be stepping stones to traditional weight bearing exercises. Remember though, we are not fish. If you can function outside of the water it’s important to progress your program away from aquatics. If you’re capable, you’ll want to supplement or replace your aquatic program with a land program.

Avoiding Provocative Tasks

When experiencing knee pain it’s important to remove tasks that aggravate symptoms. You can be doing all the right things, but if you offset it with compromising positions and tasks, you’ll likely fail to improve. Here are a list of daily activities and how they affect your knee:5

Activity Peak Force (% of body weight)
Going Down Stairs 346% Body Weight
Going Up Stairs 316% Body Weight
Level Walking 261% Body Weight
Knee Bends 253% Body Weight

For a large percentage of patients a successful exercise program can not only slow the progression of wear and tear, but may restore full, pain-free function. Be sure to add strength and flexibility around your knee and not necessarily to your knee. The golden rule applies, too. If it hurts don’t do it. Try to modify or initiate an exercise program that emphasizes low load and progresses to higher functioning activities.

1. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011 Dec 6;155(11):725-32.
2. Felson D, Goggins J, Niu J, Zhang Y, Hunter D. The effect of body weight on progression of knee osteoarthritis is dependent on alignment. Arthritis & Rheumatism 2004 Dec;50(1):3904-3909.
3. Messier S, Gutekunst D, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism July 2005;52(7):2026-2032.
4. Brindle TJ, Mattacola C, McCrory J. Electromyographic changes in the gluteus medius during stair ascent and descent in subjects with anterior knee pain. Knee Surgery, Sports Traumatology, Arthroscopy. 2003 Jul;11(4):244-251.
5. Kutznera I, Heinleina, B, Graichena F. Loading of the knee joint during activities of daily living measured in vivo in five subjects. Journal of Biomechanics. 2010 Aug;43(11):2164–2173.


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