Should you exercise with knee pain? Tips + Scientific insight.

Not-so-fun fact: A little over 46% of the population has experienced knee pain. (1) There are many reasons why this happens, too, with osteoarthritis and obesity at the forefront. With exercise being a crucial part of living healthy, this begs the question: Should you exercise with knee pain?

The short is: Yes, exercise generally helps with knee joint pain. However, there may be times where rest becomes the better option.

Below, I’ll address – in detail – both sides of the coin and suggest a few good exercises you can try. Let’s get to it!

How exercise helps with knee pain:

1. Exercise helps with weight loss

A recent study described obesity as a “robust risk factor” for knee osteoarthritis. They even go so far as to say that the risk for acquiring the disease rises by 35% for every 5 kg/m2 increase in your BMI.

This makes sense because your knees absorb forces amounting to as much as 3x your bodyweight when you walk. So, the more weight you carry, the pressure your knees need to take in. This, in turn, accelerates cartilage degeneration and, eventually, osteoarthritis and joint pain. (3)

On the other hand, losing weight takes pressure off of your joints and therefore helps ease knee pain.

While there are certain exercises that are gentler on your joints, any kind of exercise will inevitably promote movement. More movement means more calories burned which, in turn, helps with weight loss.

2. Strengthening exercises help fix imbalances

On the topic of movement, many of us are stuck sitting for many hours and this can lead to a number of biomechanical imbalances, including tight hamstrings, weak quads, patellar maltracking, and so on.These imbalances alter the forces acting on your knees which can lead to knee pain.

Engaging in strengthening exercises helps fix these imbalances and, ultimately, find pain relief. Add some stretching exercises to your routine further accelerate your results.

3. Exercise strengthens your knee joints

Well, technically speaking, not the joints themselves but the muscles surrounding them. This relates to exercise fixing imbalances. But, even without any significant imbalance, stronger leg muscles will help fix your knee pain they’re better equipped to help your knees better absorb and disperse impact.

I’m not just talking about strengthening your calf and thigh muscles either as strengthening your hips will likely result in faster pain relief. (4)

4. Functional exercises help you move better

More on these exercises in a bit but it’s no secret that painful knees can limit you from doing certain activities. Walking long distances, for example, may be more difficult. Not to mention climbing up and down the stairs.

Exercises that mimic everyday movement – such as lunges and deadlifts – help with both strength and flexibility, making movement all that much easier and painless. The key to these exercises, however, is that they have to be done right to prevent making your knee pain worse.

To start, I highly recommend working with a professional (e.g. physical therapists, fitness trainers) to make sure you nail your form. After that, you can then do the same exercises on your own.

5. Exercise goes hand in hand with a balanced diet

A study from the International Journal of Obesity found out that people who engaged in an exercise program were more likely to keep track of what and how much they eat. (5)

This helps relieve pain via a number of ways, including (but not limited to):

Exercise and a balanced diet promotes weight loss.
Mindful eating inevitably makes you eat less pro-inflammatory food.

How weight loss helps with knee pain has already been discussed above (please refer to #1 on this list).

Avoiding pro-inflammatory foods, on the other hand, may help prevent arthritic flare-ups. Plus, there’s evidence suggesting that it might delay the progression, if not the stop the development of osteoarthritis. (6)

When is exercise bad for my knees?

Well, there might be times where exercise can cause a little bit of knee pain. This is especially true if you’re just starting an exercise program.

However, there are 2 occasions where you’re better off resting:

Rest your knees if the pain becomes near to downright intolerable

From a scale of 0-10 where 10 is the most painful, let’s say for example that your pain levels are at a constant 3. You may experience a slight jump in your pain level during and after exercise – which is fine.

But if there’s a significant jump in pain levels, say from 3 to 9, then you’ve likely done too much or performed the exercise improperly.

This, again, emphasizes the importance of working with professionals at least at the start of your journey.

In any case, rest up for at least a couple of days to allow your joints to recover then slowly get back to training.

You’ve done too much if the pain persists

On a related note, if the jump in pain levels lasts for more than a couple of days, then you’ve likely done too much.

Rest and heal up. Or, better yet, consult with your doctor or physical therapist. A compression sleeve coupled with 10-15 minutes of ice should help as well.

What exercise is good for knee pain?

ANY exercise is good for knee pain. And I mean that in the literal sense. Unless, of course, you’re doing something that’s inherently dangerous.

The most important factor about exercising with knee pain, however, is that you have to progress gradually. That being said, here are a few good ones that I recommend:

Swimming and aquatic exercises

The buoyancy of water acts as a counter-balance to gravity which practically makes exercise much less painful and comfortable for those with knee injuries and conditions.

Furthermore, this buoyant counter-balance increases the deeper you’re submerged in water.

According to a study from the Journal of Human Kinetics (7):

40% of your bodyweight is offloaded when the water is up to your pelvis.
60% is offloaded when the water is up to your belly button.
85% when the water is up to your shoulders.

While there’s a difference in the buoyant effects of salty and fresh water, you can still achieve similar benefits in both the ocean and the pool. It all comes down to preference.

Tai chi

A study from the Journal of Physical Therapy Science describes Tai chi as “a kind of psychophysiological intervention” that “combines deep diaphragmatic breathing and relaxation with many basic postures that slowly and smoothly move from one to another gesture in a circular movement.” (8)

That description perfectly sums up why Tai chi is so good for knee pain.

The way it promotes relaxation, posture, and controlled movement makes it a safe and low-impact exercise that not only helps numb down your pain but also helps you move better.

Yoga

Yoga, in many ways, is a lot like Tai chi in a sense that it also promotes controlled movements and relaxation. Both are also considered low-impact exercises.

To that end, the pain relief and improvements in mobility from yoga can be seen as early as 2 weeks into training. Not to mention the benefits this practice has on mental health and mindfulness. (9)

However, there are poses that aren’t recommended for certain conditions. So, I highly recommend working with a qualified instructor.

Walking

Walking is an underappreciated exercise because, well… it’s just not as exciting. But it’s actually amazing.

For one, it’s low impact. Second, it’s easy to track. Third, you can either do this at home on a treadmill or enjoy the fresh breeze of the outdoors.

Again, start slow. It also helps to get a Fitbit or other similar products to help track your steps. Your phone likely already has a pedometer as well, so use that to your advantage.

Physical therapy (PT)

PT isn’t necessarily an exercise per se. However, physical therapists are adequately trained to guide you through your pain using exercise and other physical techniques.

Your physical therapist should also teach you how to correctly perform knee strengthening exercises at home. These will not only grant you pain relief but also prevent it from happening again. These exercises include:

Different squat variations such as wall squats, chair squats, half squat, and others. Done right, this should strengthen your legs and core without causing pain.
Deadlifts to protect your lower back and knees when picking up heavy things from the floor.
Lunges to safely pick up lighter things off the floor while encouraging posture and flexibility.
Straight leg raises to strengthen your quads, hips, and abdominal muscles.
Side leg raises and clamshells to further strengthen your hips.

So, should you exercise with knee pain?

The bottom line here is that virtually any exercise when done right and gradually progressed will help with knee pain.

While low impact knee exercises such as swimming, tai chi, and yoga are preferred as a start, any exercise that strengthens the muscles around your core, hips, and knees while also pushing for joint flexibility will do the job. If in doubt, always consult with a professional.

Resources: On Exercise with Knee Pain

Kim, In Je et al. “Prevalence of knee pain and its influence on quality of life and physical function in the Korean elderly population: a community based cross-sectional study.” Journal of Korean medical science 26,9 (2011): 1140-6. doi:10.3346/jkms.2011.26.9.1140
Zheng H, Chen C. “Body mass index and risk of knee osteoarthritis: systematic review and meta-analysis of prospective studies.” BMJ Open 2015;5:e007568. doi: 10.1136/bmjopen-2014-007568
D’Lima, Darryl D et al. “Knee joint forces: prediction, measurement, and significance.” Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine 226,2 (2012): 95-102. doi:10.1177/0954411911433372
Ferber, Reed et al. “Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial.” Journal of athletic training 50,4 (2015): 366-77. doi:10.4085/1062-6050-49.3.70
Joo, J., Williamson, S.A., Vazquez, A.I. et al. The influence of 15-week exercise training on dietary patterns among young adults. Int J Obes 43, 1681–1690 (2019). https://doi.org/10.1038/s41366-018-0299-3
Robinson, William H et al. “Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis.” Nature reviews. Rheumatology 12,10 (2016): 580-92. doi:10.1038/nrrheum.2016.136
Torres-Ronda, Lorena, and Xavi Schelling I Del Alcázar. “The Properties of Water and their Applications for Training.” Journal of human kinetics 44 237-48. 30 Dec. 2014, doi:10.2478/hukin-2014-0129
Ye, Jiajia et al. “Effects of tai chi for patients with knee osteoarthritis: a systematic review.” Journal of physical therapy science 26,7 (2014): 1133-7. doi:10.1589/jpts.26.1133
Kan, Laidi et al. “The Effects of Yoga on Pain, Mobility, and Quality of Life in Patients with Knee Osteoarthritis: A Systematic Review.” Evidence-based complementary and alternative medicine : eCAM 2016 (2016): 6016532. doi:10.1155/2016/6016532