Written by Garett Reid | NSCA, CSCS, CISSN, M.S.E.S.S
Fact checked by Kirsten Yovino, CPT Brookbush Institute
FACT CHECKED
Things happen. As we train and get older, more things happen. One of these things that occurs all too often is knee pain. Sometimes it's a chronic pain that's always there, while other times, it's something you just need to ride out for a day. The discomfort can range anywhere from an annoying tickle to a debilitating grinding.
Regardless of the type of knee pain you're experiencing, it can quickly sap all of the fun out of leg day. But what if we told you it doesn't need to? In fact, what if we told you we have 12 reasons your knee pain doesn't have to halt your upcoming leg day? Well, we do, and we'll tell you all about them in this article.
This post will discuss:
- Anatomy of the knee
- Causes of knee pain
- 12 best knee-friendly exercises for strength and muscle growth
- How to prevent knee pain in the future
If you're tired of choosing between pain or an effective leg workout, you don't need to anymore.
Anatomy Of The Knee Joint
The knee is a modified hinge joint that connects the femur (thigh bone) and tibia (shin bone), allowing for flexion and extension.
It's a highly complicated joint where multiple bones, muscles, tendons, and ligaments unite. Together, they function to allow locomotion while carrying the entire weight of the body.
Here's a brief knee anatomy lesson.
- Femur: This is a large thigh bone in the upper leg.
- Tibia: This is a smaller shin bone of the lower leg.
- Patella: Also known as the kneecap, the patella is a triangular bone that articulates with the femur and attaches to the quadriceps tendon. During leg extension, it increases the leverage of the quadriceps, thus increasing force. Its secondary function is to protect the knee joint and prevent the muscle tendon from rubbing against the distal femur.
- Meniscus: A crescent-shaped piece of cartilage that's thick and spongy, each knee joint has two that sit on either side (lateral, medial) of the knee joint to absorb shock and distribute load between the femur and tibia.
- Articular Cartilage: A type of cartilage in the knee joint that reduces friction, distributes load, and cushions force.
As you can see, a lot happens within the knee, and that's not even factoring in tendons and ligaments. While an awesome structure, there's a lot that can go wrong.
What Causes Knee Pain?
Knee pain can rear its head for a multitude of reasons. Common causes include eating a lot of processed and sugary foods that can cause joint inflammation, lack of omega-3, being overweight, poor exercise form, and overuse1,2,3.
When these variables are present, it can result in several conditions such as:
- Patellofemoral Pain Syndrome (Runner's Knee): Patellofemoral pain syndrome injury occurs when the patella rubs on the femur bone beneath it.
- Patellar Tendonitis (Jumper's Knee): An injury to the tendon connecting your kneecap (patella) to your shinbone.
- Chondromalacia Patellae: A softening of cartilage beneath the patella, causing pain and swelling.
- Osteoarthritis: A type of arthritis caused by the breakdown of joint cartilage and underlying bone.
- Meniscus Tear: This occurs when the knee cartilage (meniscus) tears. This is the most common knee injury that's directly caused by squats.
Causes Of Knee Pain During A Workout
If you already have knee pain, certain behaviors can cause it to flare up. To be clear, these things aren't necessarily bad if you have healthy knees. But if you have bad knees, they can make matters worse.
Factors that can lead to knee pain during exercise include:
1. Eccentric Or Concentric Contractions:
Depending on your knee injury, knee pain will be more noticeable during either the eccentric or concentric contraction.
For example, a common cause of knee pain during an eccentric contraction is caused by patellofemoral pain syndrome. On the other hand, chondromalacia patellae cause pain during concentric and eccentric contractions.
Most of the time, it's obvious which contraction causes more pain once you pay attention. With that said, pay attention next time so that you know what NOT to do.
2. Transition From Concentric To Eccentric Contractions:
The one spot where stress is highest on a joint is during the transition between concentric and eccentric contractions.
This makes sense as you must reverse the direction of a heavy load.
During the eccentric contraction, a certain amount of force is produced. To come back up, you must not only generate enough force to stop it, but you must also generate more force to reverse the direction.
This puts a ton of stress on your joints, which is why Louie Simmons created the box squat as it eliminates this quick reverse. Don't worry, you'll see box squats below.
3. Knee Valgus:
Commonly seen in squats, knee valgus is the technical term for when the knee falls inward. This can occur for several reasons, including weak glutes, hips, or ankles, or natural limb formation.
Regardless of why it occurs, knee valgus greatly increases the stress on your knee joint.
The knee is built to flex and extend in one direction. When the knee buckles, it offsets the angle of stress and can cause major issues.
Chronically, it eventually wears down your tendons and ligaments. It can also cause sudden pain. Studies show that greater knee pain is felt with greater knee valgus⁴.
The 12 Best Leg Exercises For Bad Knees
One of the best things you can do to ensure consistency in your training is to "train around the pain." Generally speaking, an exercise is probably safe if it doesn't hurt your knee.
Rather than avoid leg training entirely, learn lower body exercises you can do that don't aggravate your knee injury. Not only can you continue training, but exercise is one of the best things you can do to improve recovery⁵!
But PLEASE, be smart. There are many unknown variables. You should always first speak with your doctor so you have a clear idea of the type of knee issue you're dealing with.
With that said, we have the 12 best exercises for those with bad knees. These are legit exercises to build strength and mass (we have a great article that discusses the difference between strength and hypertrophy for those interested) despite having an injured knee.
1. Wall Sits:
Okay, so maybe we do have a couple of rehab exercises. But wall sits are one of the best bodyweight low-impact lower-body exercises you can do.
It's also one of the best isometric exercises you can do, making it ideal for bad knees.
To perform one, you sit in the lower squat position with your back pushed up against a wall. The wall keeps you from falling back yet still requires your lower body muscles to support you. Because the knee doesn't move, there's minimal, if any, aggravation.
To increase the intensity, place a resistance band around your thighs. You can also pick one leg up, switching legs after a certain point, so both are evenly worked.
How to do Wall Sits:
- Find a sturdy wall capable of supporting your weight. Stand with your feet shoulder-width apart, approximately 2 feet from the wall.
- Place your back on the wall and let it slide down until the top of your thigh is parallel.
- Keep your hands off your legs to get in the starting position. Hold here.
2. Wall Squats:
The next progression after wall sits are wall squats. These are performed by placing a ball between a wall and your back as you squat. As you move up and down, the ball will roll with you as you push into it.
Pushing back into the wall takes the stress off the knees as your body weight is directed backward. If you want to load the exercise, you can hold a dumbbell as well.
How to do Wall Squats:
- Place a Bosu ball between you and a sturdy wall with your feet shoulder-width apart.
- Roll down the wall until the top of your thigh is parallel.
- Push up and back until your legs are extended.
3. Deadlift:
Deadlifts can be an effective exercise to train the legs while mitigating knee discomfort.
Even as you lift a heavy load, several variables exist to keep your knees feeling good, including minimal bend in your knees and only using a concentric contraction.
If you find deadlifts are comfortable to perform, you can also begin doing deficit deadlifts. These are done by standing on an elevated object, increasing the range of motion. They do cause more knee flexion but also recruit your quadriceps more. Just be mindful of discomfort.
How to do the Deadlift:
- Facing your barbell, stand with your shins by the bar, about an inch away. Your feet should be shoulder-width apart.
- Keeping your arms locked, grab the bar on the outsides of your knees.
- Keeping a neutral spine, and with your shoulder blades retracted, pull the bar off the ground by straightening your hips and knees.
- As the bar passes your knees, drive your hips forward, contracting your glutes.
- Slowly lower the bar back down.
4. Romanian Deadlift:
The Romanian deadlift is great for bad knees as they're performed with knees slightly bent. Further, the hips take most of the force. As a result, there's a significant decrease in the force placed on your kneecap. You can use a barbell, dumbbells, or even kettlebells for this exercise.
Also worth noting, the single-leg deadlift, a type of unilateral exercise, is another great option. As you stand on one leg with the standing leg slightly bent, the body must recruit the surrounding muscles to aid in balance and stabilization as well as activate more muscle fibers.
Studies have shown that compared to their bilateral equivalents, a unilateral exercise elicits greater muscle activity with smaller loads⁶. This means less stress is placed on the knee while maximizing muscle activity. Both the RDL and single-leg versions are great to include in your routine.
How to do the Romanian Deadlift:
- Place your feet hip-width apart with a minimal bend in your knees.
- Let your torso bend forward and drop as your barbell, dumbbells, or kettlebells lower to the ground. Keep your core tight, and shoulders pulled back.
- Drop until you feel your form is about to break.
- Power up by driving your hips forward, pulling your weight upward, until you are erect.
5. Good Morning:
When performing a good morning, you'll stand with your leg straight as flexion only occurs at the hips. As a result, there's little reason for your knees to act up.
Good mornings are ideal for maximal work in the hamstrings and glutes with no discomfort in the knees.
How to do Good Mornings:
- Place your left foot next to your right foot, shoulder width apart, in a standing position. Place a loaded barbell on your back. Keep a straight leg, bend forward at your hips, and slowly lower your torso.
- Maintain a ridged back. Go down until your form breaks. Continue to keep your legs straight.
- Power your hips forward to extend.
6. Sled Push:
Commonly seen in Strongman, the sled push and pull are perhaps two of the most underused moves performed in the gym. And it's a shame. The sled push is an excellent exercise to increase muscular strength, while giving the knees a break. When pushing a sled, the primary muscles are the hamstrings and glutes, similar to running.
The correct form for pushing a sled has a trainee lean forward so that they can drive into it horizontally. While this places a huge demand on the lower body, the knee cap has far less range of motion. Further, the load is not placed on the bones like in the squat.
The bottom line is that pushing a sled places far less stress on the knee joints making it one of our favorite leg exercises for bad knees. Studies show that a lighter load results in less flexion, as less force is required⁷.
How to the Sled Push:
- Load a sled with the desired weight. Use a heavy enough load so you can't sprint.
- Get behind the sled and grab the push rods. Step back from the sled and lean into it. Keep your torso as parallel to the ground as possible. Pushing with arms extended will require work from your upper body pushing muscles.
- Pushing with your arms tucked and chest close to the rods will allow more power. Both options work.
- Slowly begin to drive into the sled. Take small steps to create more power.
- The one foot that's planted will drive off its toe, while the other leg will drive up and step forward.
7. Sled Pull:
The sled pull is the obvious perfect compliment to pushing it. Now that you're turned around, you're basically doing a ton of mini-leg extensions. As a result, this move will kill your quads yet save your knees.
The best way to do a sled pull is to use a harness of some sort to attach a rope and drag it.
How to do the Sled Pull:
- Set up a harness or strap to wrap around your waist and connect to the sled.
- Face toward the sled and remove slack out of the line. Lean back into the rope.
- Begin walking backward using small steps.
8. Box Squat:
There's a reason you find box squats in the lower body workouts of some of the top lifters in the world. They work. You perform this squat exercise standing in front of a box (or bench) and sitting down on it as you lower.
This eliminates the transition from eccentric to concentric as well as your knee pain.
How to do a Box Squat:
- Set up a box or bench behind a rack that allows you to get close to parallel (or as close as possible).
- Unrack your barbell and set it up so you're about a foot in front of the box. You can set the box higher if you need to shorten the range of motion. Set up the proper box placement first before you use a loaded barbell
- Slowly lower your body until your entire butt rests on the box or bench. Don't do a tap-n-go! Remember, the point is to get rid of that transition, so going fast completely ruins the point.
- Be sure you come to a complete stop. Using minimal body sway, power yourself back up. Dig your heels and pull them toward you to further activate the hamstrings.
9. Farmer's Carry (Loaded Carries):
The farmer's carry is yet another great exercise for bad knees that originates from Strongman.
Loaded carries are one of the most basic movements you can do and merely consist of holding a heavy object and walking. So we ask, does walking hurt your knees?
Of course, walking under a load will generate more stress, but the flexion and extension of the knees are minimal. A heavier load will naturally cause a smaller gait and minimize the range of motion which can be used if needed.
How to do a Farmer's Carry:
- Pick up two implements, one in each hand.
- Keep your core tight, head up, and shoulders pulled back.
- Walk at an easy pace.
10. Hip Thrust:
Hip thrusts are largely regarded as the single best exercise for your glutes. They're also killer for your hamstrings.
Better yet, they put virtually no stress on your knees. Again, this is because the action occurs at your hip joint. In addition, your body weight is supported by both your back and feet, meaning the impact of your body weight is lessened.
While heavy loads are generally used, you can adjust that if your bad knees bother you.
How to do the Hip Thrust:
- Set up a sturdy bench.
- Sit on the floor with both knees bent. Place a loaded barbell on your hips.
- Keep your feet flat on the ground, and drive them down to thrust your hips up. Slowly lower down, and repeat.
11. Lateral Shuffle:
Lateral shuffles put you in a half-squat position and keep you there. If that's not bad enough, you shuffle from side to side for inordinate amounts of time. Ouch.
Lateral shuffles will challenge your entire lower body, but you'll tend to feel them most in your quads as they must fire to keep you from collapsing.
A resistance band around your thighs will make it even harder in this exercise which will help combat knee pain.
How to do the Lateral Shuffle:
- Get into a half squat position with your knees at about a 45-degree angle.
- Keep your torso straight and chest up, similar to an athletic stance. You don't have to, but sticking your arms straight out in front tends to help keep your back straight and tight.
- While keeping your butt at the same level, reach your right leg to the side and plant it. Next, bring your left leg to the original position with feet shoulder-width apart.
- Continue in one direction for prescribed reps and then switch.
12. TRX Squats:
TRX Squats are supported squats that can still be quite tough. When performing squats, one of the causes of knee pressure is caused by the knees and body weight coming forward. With the TRX, you can be sure your weight is positioned backward.
You can also step forward so you can push backward at an angle. This is a great option. By doing this, you'll get in a nice little upper-body workout.
For a fun variation, switch your routine up with the TRX skater squat, or turn this into a single-squat variation, requiring the leg muscles on one side to do all the work before you switch legs. If the single-leg version causes any knee pain, be sure to switch back to the traditional TRX squat.
How to do TRX Squats:
- Set up a TRX strap, so it's secure. Holding the handles, stand back so that the TRX strap is at an angle that allows you to lean back with your arms straight.
- Stand with your feet between shoulder and hip-width apart.
- Push your hips back with each knee bent to perform a squat.
- While the main movement is the same, the key difference is you can lean back more to mitigate stress on your knees.
How to Prevent Knee Pain
The good thing about the lower body exercises we just covered is they're fantastic whether you have sore knees or not. So while you should be using them, we hope it's because you want to, and not because you have to.
The best way to make this happen is to prevent knee injuries from occurring in the first place. Here are some tips to keep your knees healthy.
1. Include A Proper Warm-Up:
Make sure you're warming up. Too many lifters skip this part thinking it doesn't do anything or something. Bad choice.
A primary purpose of a warm-up is to prepare our bodies for performance, including the joints. Within the cartilage of synovial joints is a thick fluid called synovial fluid.
During exercise, this fluid is secreted and soaks the joint to lubricate it and improve function. Think about it like this: Would you ever drive your car with no oil?
In addition, a warm-up loosens the muscles and joints for optimal function. Try these dynamic warm-up exercises before your next workout.
2. Strengthen Your Glutes And Hamstrings:
As mentioned above, a common cause for knee pain are weak glutes and to a lesser extent, weak hamstrings.
These powerful muscles support the posterior chain. Therefore, when they're too weak, the body does not function properly and excessive stress is put on the lower body joints including the knee⁸.
Make sure you have a strong backside by including glute exercises in your program.
3. Utilize Progressive Overload Effectively:
It's common to see new lifters jump right into a heavy squat and wind up breaking their body. Unfortunately, no surprise there.
While progressive overload is generally thought of as a way to build strength and muscle, it will also prevent injuries.
Go slow and steady with progressions as this not only ensures consistent progress, but it allows for adequate muscle recovery. Keep in mind that your tendons and ligaments grow slower than your muscles. For solid, healthy knees, you need everything working at 100%.
4. Practice Good Form And Then Practice Some More:
If your form is off, it doesn't matter what load you use as you'll still hurt your knees.
In most cases, the cause of the injury isn't necessarily the heavy load. Rather, the heavy load causes your form to break, which in turn causes problems.
For example, beginners shouldn't worry about weight for at least a month. When they do start using progressive overload, they should start very low.
Spending a month or two on form may seem like a lot of time but when compared to a lifetime, it's nothing. Plus, you get to live that life with pain-free knees.
Train Smart When Lifting With Bad Knees
One of the most terrible lifting experiences is developing sudden knee pain. What’s worse is not being able to train as you now have an injured knee.
Fortunately, now you can as you have the correct exercises to use.
Always remember to train hard and smart when working on improving your muscle strength. As we are not doctors, any concerns with your health require medical supervision. Always listen to your body and stop if you need to stop or change things that aren't working for you.
Just be smart. And strong.
Related: 6 Resistance Band Exercises To Relieve Knee Pain
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Garett Reid
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