Back PainShoulder Pain | Knee Pain | Upper-Body Workout | Lower-Body Workout

It doesn't always get the same attention as back pain or shoulder pain, but knee pain shares a lot of similarities with those two types of injuries. First and foremost, it's not picky about who it attacks. No, not just big-squatting powerlifters have sore knees! In fact, boot-camp and HIIT fans also have surprisingly high incidents of knee pain. And runner's knee? Well, they call it that for a reason.

The nice thing about knee pain, if there is one, is that it often responds more predictably to some simple solutions—things like strengthening your weak links, picking non-aggravating exercises, and taking a break from something you may be overdoing.

To be clear, this isn't a guide for ACL surgery rehab, or temporary knee pain from a single class or squat session. We're talking chronic knee pain—which can be plenty painful and limiting in its own right. Here's how to work through it.

Step 1: Stop Making Things Worse

Perhaps more than shoulder or back pain, athletes often try to "gut it out" through knee pain. Unfortunately, this is just the sort of approach that can turn temporary aches into chronic knee pain.

Here's what often makes a painful knee worse, or keeps it from having the space to heal:

  • Squatting shallow. We've all seen it: Someone whose squat pattern is awful, so they cut the range of motion. Believe it or not, the knees take the brunt of the hit. This person needs to lighten up the bar and try a new squat variation that allows them to go deeper, more safely.
  • Sticking with activities that contribute to pain. Knee pain shouldn't feel like the "price" you pay for your fun. Take a few weeks off from an activity that makes you sore, and use that time to fortify and stabilize your knee. 
  • Skipping squatting altogether. Squatting isn't the problem when it comes to knee pain—it's poor squatting. Pick variations from the squat movement pyramid below that you can do pain free, and focus on doing them right. 
  • Not having enough variety in leg training. Sticking to just a few movements and hitting them hard can add up. Mix up your leg training and the rep ranges you use. Always squat heavy and regret it? Try high-rep goblet squats instead.  
  • Focusing too much on your quads. Your posterior chain—and specifically your hamstrings—play a crucial role in knee health and resiliency. It's time to beef up your backside with low-impact, single-joint movements like hamstring curls.

Knee sleeves are a light, inexpensive accessory to help you squat without fear—or pain.

Step 2: Make Intelligent Movement Substitutions

These two movement pyramids show progressions of the most common knee-aggravating exercises. The bottom movement is the most approachable and the top is the most technical or difficult.

Your objective is to determine the most advanced variation you can perform without pain. Then, use that variation in your training.

Lunge Pyramid; Peak: walking lunge, step-up, lateral lunge, reverse lunge, rear-foot elevated split squat, front foot elevated split squat, split squat
Squat pyramid; peak: barbell back squat, barbell front squat, barbell box squat, goblet squat to box, goblet squat, bodyweight squat

If you're following a program that has a squat or lunge variation that you know will cause you pain, here's what to do: Use these two movement pyramids to find a version of the movement that feels strong, safe, and doesn't cause pain.

This is crucial: Don't feel like you have to aim for the top of the pyramid! Focus on doing what you can well and getting stronger at it. That could mean performing split squat variations instead of walking lunges. The benefits are largely the same, and for many, the risk is far less.

For more in-depth training guidance on how to use these pyramids, and to see demonstrations of each movement, check out Unstoppable in BodyFit.

Step 3: Get Back to Training

Want to see what training through knee pain looks like in action? Check out the Unstoppable Back and Knee-Friendly Lower-Body Workout. If you're creating your own workouts, here are three big principles to guide you:

1. Get to know box squats. The barbell box squat is tragically overlooked by many lifters who end up limping out of the gym because their pride says they "must" squat freestanding. It's time for that idea to be put to bed! This can be your big strength movement with absolutely zero downside.  

2. Do your curls. Only doing hamstrings once a week on leg day? That's not enough. Hamstring curl variations for sets of 15-20 can also be great "filler" exercises you can integrate into all kinds of workouts multiple times a week with no negative impact whatsoever. Here are just a few variations to alternate between:  

3. Stretch your quads during workouts. When you squat, use your rest periods for more than just standing around. Stretch your quads as a "filler" move between sets for 30 seconds or so. This could be just the thing to keep you from hating life the day after leg day. I show my preferred stretch in the article, "3 Simple Secrets to Overcoming Knee Pain."

Yes, You Can Lift Pain Free

You're not doomed to be in pain or go under the knife. You have options! Use the movement pyramids to optimize your training for your body, and start working through knee pain rather than just around it!

Want to get proactive about ridding your life of pain? Use the other tools in the Unstoppable series. 

Want to stay in the game? Take care of your joints both inside and outside the gym.

About the Author

John Rusin, DPT, CSCS

John Rusin, DPT, CSCS

Dr. John Rusin is a coach, speaker, and writer who runs a sports-performance physical-therapy practice in Madison, Wisconsin.

View all articles by this author

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