How to Exercise With Bad Knees

Knee pain can make it tough to exercise. However, it's important to keep moving because exercise is key to restoring knee function, decreasing pain, and losing extra pounds. The best exercises for bad knees are low impact and help strengthen the muscles that support the knee. Read on to learn which exercises are safe for painful knees versus those you should avoid.

Causes of Knee Pain

There are numerous causes of knee pain. Arthritis, injury, and overuse are the primary culprits.

Arthritis

Knee pain can strike at any age, but older people are most at risk. Knee joint degeneration occurs as a natural part of aging, which may culminate in osteoarthritis later in life.

Osteoarthritis (or degenerative joint disease) is called the "wear and tear" form of arthritis since it develops over years of normal activity. Knee osteoarthritis is a chronic condition and primarily found in people who have had a knee infection, injury, or are overweight. Being overweight increases the load on the knees, which accelerates joint damage.

Rheumatoid arthritis (RA) is another source of knee pain. RA is a chronic autoimmune disease, which means the body's cells attack its own tissues. It develops on both sides of the body (bilateral).

While symptoms develop gradually over years in most people, it's also possible for symptoms to appear suddenly. What causes RA may be related to a combination of abnormal immunity and genetic, environmental, and hormonal factors.

RA causes swelling, pain, and stiffness. Over time, rheumatoid arthritis can cause the cartilage to wear away. When cartilage is completely gone, bones can rub against each other causing extreme pain.

Injury

Falls, sports, and trauma can cause knee injuries. The anterior cruciate ligament (ACL), medial collateral ligament (MCL), and meniscus ligaments in the knee are often torn or damaged when an injury occurs. Common injuries include:

• ACL injuries: This can occur by changing directions too quickly, sudden stops, jumping, or landing, and hyperextending the knee. ACL injuries are common, sports-related injuries.
• MCL injuries: A hit to the outer knee is what commonly causes a stretch or tear of the MCL, though pain is felt along the inside of the knee.
• Meniscus tears: These are common injuries with the inner meniscus most often getting injured. Sudden twisting, resulting in swelling, pain, and knee locking often cause meniscus ligaments injury.

Overuse

Overuse injuries are muscle or joint injuries that are caused by repetitive trauma or overdoing an activity. Common examples of overuse conditions that cause knee pain include:

• Bursitis
• Tendonitis
• Baker's cyst
• Patellofemoral pain syndrome (PFPS) or runner's knee

Benefits of Exercise

Exercise is one of the best remedies for arthritic knee pain, and it also helps with other types of knee pain. Exercise:

• Alleviates swelling and stiffness
• Improves range of motion in the joint
• Strengthens the muscles around the knee

Exercise can also help you lose weight. Extra weight takes a toll on the joints. Reducing the weight load on your knee can ease pain and help your knees heal. Strengthening the muscles around the knee also takes pressure off of the knee. For example, strong quadriceps can offset the shock-absorbing role usually played by the meniscus or cartilage in the knee.

A 2018 study shows that physical activity for arthritic knee pain often results in better outcomes than medications, injections, and surgery. Another benefit is that exercise therapy doesn't pose the risk of serious harm like other treatments such as pain medications and surgery.

Research shows that exercise may also reduce the progression of knee osteoarthritis. The study authors recommend exercise as a first-line treatment for knee pain because it has so many advantages.

Best Exercises for Knee Pain

The quadriceps are the main muscles that support the knees. Weak quads can lead to knee instability, which increases wear and tear. So strong quads play an important role in knee function and pain rehabilitation. A 2019 study showed that weak quadriceps are universal in people with knee osteoarthritis and may be a modifiable risk factor.

Hamstrings are another important muscle group supporting the knee and should be emphasized. Each person's pain level, fitness level, and underlying medical condition are different, so there is no one-size-fits-all list of best exercises for knee pain.

Low-impact exercises that help stretch and strengthen the knee and supporting muscles (especially quadriceps) are generally best for people with knee pain.

Exercises to consider include;

• Walking: This lubricates the joints, burns calories, and aids in weight loss. Walking also increases blood flow to tight muscles and helps strengthen the muscles surrounding your knee. Longer, slower walks are more knee-pain friendly.
• Cycling: Biking is a safe, overall workout for people with knee pain. Cycling provides aerobic and strengthening benefits. It promotes range of motion and targets the quadricep muscles. The peddling strengthens the hamstrings and glutes as well.
• Water exercises: Swimming and water aerobics are go-to exercises that can help strengthen knee muscles. The buoyancy of the water allows you to exercise without putting pressure on your joints. A 2016 study showed that regular swimming exercise reduced joint pain and stiffness associated with osteoarthritis and improved muscle strength and functional capacity in middle-aged and older adults.
• Strength training: This is critical to improving your knee function. Weight machines—such as the seated knee extension—help strengthen the muscles. You can also use bodyweight in place of weight machines. Straight leg raises and squats or modified squats, are some good exercises for knees.
• Stretching: Tight knee and leg muscles add to pain, so it's critical not to skip stretching after exercising. Stretches that help the knee and surrounding muscles include knee quadriceps stretch and standing hamstring stretch.

Yoga and Pilates have been shown to be beneficial in increasing overall knee strength without overextending the joints.

Finally, you should start exercising slowly and gradually build up to increasing weight, duration, or reps.

Don't ignore pain. Pain is a sign you should stop the exercise you're doing. And don't overdo it. Overdoing exercise can cause a setback to recovery. 

Exercises to Avoid

While exercise is great for pain relief and knee strength, it's important to do the right exercises or you can end up doing more harm than good. Here are a few pointers:

• Follow your healthcare provider's and physical therapist's recommendations: They will know specifically which exercises are best for your knee pain and which are not based on your diagnosis.
• Listen to your body: Stop any exercises that make the pain worse.
• Watch your form: Any exercise can make knee pain worse over time if done improperly.
• Avoid exercises that overextend or put excessive pressure on the knees: Deep squats, lunges, and running, are probably not ideal.

Physical Therapy

Physical therapy is often part of any treatment plan after a knee pain evaluation from your healthcare provider. After a thorough assessment, the physical therapist will use your healthcare provider's diagnosis and instructions and your input to create a path forward.

A physical therapist can tailor a specific exercise program to help you recover from injury or surgery. Physical therapy is a crucial part of recovery after knee surgery.

Physical therapists also work to alleviate pain and improve mobility associated with various other knee ailments. You can expect help with learning low-impact exercises and stretches that:

• Strengthen knee muscles
• Improve stability and flexibility
• Lessen joint stress

They can also suggest modalities, such as heat, ice, or massage to ease the pain.

All of these treatments are designed not to aggravate knee pain in the process. You will see your physical therapist, sometimes several times a week, and have exercises and stretches to do at home between appointments.

Other Tips

Here are some additional tips for knee protection during your workouts:

• Wear the proper shoes: Keep your workout shoes in good repair. Worn shoes lose adequate support over time and can make knee pain worse. On average, people who work out 30 minutes a day should replace their shoes every six months. However the heavier you are, the faster the wear. You may consider cycling through two or more pairs of shoes and alternate them to spread the wear over a longer period.
• Warm up before exercising: A warm-up increases your body temperature and promotes blood flow to loosen up your muscles. Warming up is also good for the joints since it prepares them for exercise-related activities.
• Change your routine: Be sure to cross-train by doing different exercise and workout routines that work a variety of muscles. This will help prevent overuse injuries.

A Word From Verywell

Painful knees don't have to sideline your workout efforts. Check with your healthcare provider to get guidance on which moves are best for your situation.