Knee discomfort is something that many of us experience during a workout or when performing specific exercises or activities, including squatting, lunging, or running. This experience has prompted many of my clients to ask me what exercises they can do for their “bad” knees.
While there is no clinical diagnosis or specific exercise prescriptions to help “bad” knees, understanding why you might have knee discomfort can help you:
To understand why you might have sore knees, it helps to know a little bit about knee anatomy. Your knee is what is sometimes called a modified hinge joint. It is made up of three bones and is where the bottom of the thigh bone (femur) and the shin bone (tibia) meet. The kneecap (patella) is a small triangular bone that articulates with the thigh bone and helps protect and cover the front of the knee joint.
Within the knee are two cartilage-based pads called menisci (singular, meniscus). These pads reduce friction within the joint when the thigh bone and shin bone articulate relative to one another. On the inside, outside, and within the knee are ligaments, which stabilize the joint and prevent the thigh bone and shin bone from sliding too far backward or forward.
Behind the knee is a small fluid filled sack called a bursa, which cushions the knee and helps the tendons and ligaments glide at the joint. The knee is also supported by tendons, which are attached to muscles, to bend and straighten the knee. These actions are also referred to as knee flexion and extension.
While the knee primarily flexes and extends, it also does small amounts of internal and external rotation. Also, because it is located between the hip and the ankle, it is heavily influenced by how well the joints above and below it move.
For many people, these nuanced rotations within the knee joint, combined with limited mobility or a lack of control in the hip and ankle, can contribute to knee soreness, even if there isn’t anything wrong with the knee itself.
Sometimes there is an underlying condition that is contributing to knee pain. Some of these conditions include arthritis, bursitis, or a ligament tear. If you experience an ongoing sense of instability around the knee, an inability to control how your knee straightens and bends, or ongoing pain and grinding, then it is recommended that you consult your medical provider for diagnosis and treatment.
That said, as mentioned above, it is possible to experience mild to moderate knee discomfort without a knee injury. In these instances, the soreness is often caused by a movement compensation due to limited mobility or a lack of control in the hip and ankle. This happens because much of the sitting and footwear required by modern daily life doesn’t set us up to use our hips and ankles in their fullest ranges of motion or as optimally as we could.
While this isn’t a crisis, it can contribute to inefficient movement patterns and knee stiffness and discomfort during exercise. However, taking time to strengthen and mobilize the hips and ankles can often reduce soreness and promote better movement patterns during activity and daily life.
Additionally, sometimes a person will have knee discomfort because of how they are executing a specific movement. For example, their knees will feel fine, except when they lunge, because they are driving their knee forward, creating additional pressure on the knee. However, if they hinged the hips slightly back and then performed the lunge, it could lessen the pressure in the front of the knee and in turn reduce discomfort.
In this case, sometimes making some small adjustments to how you practice an exercise can resolve the issue. If you are unsure of how to make these adjustments, you may want to consult a physical therapist or fitness professional who is trained to evaluate exercise form.
There is no one-size-fits-all solution or exercise sequence for addressing knee soreness and if you experience ongoing pain or discomfort, you may want to consult a medical provider to make sure there isn’t an underlying issue that needs to be diagnosed and treated. Still, many of us can benefit from movement and self-care approaches to address low-grade discomfort.
While foam rolling, massage, and soft tissue release work won’t create permanent changes to the tissues, they can temporarily reduce soreness around the joint and increase the range of motion in the hips and ankles. This can promote better movement patterns during exercise, which over time could contribute to less discomfort.
In the case of knee pain, it can be beneficial to address the muscles and tissues above and below the joint. This could include rolling the inner thighs, hamstrings, quadriceps, calves, and the portion of the IT band located just above the knee.
Once you have rolled or performed soft tissue release to this area, it can be beneficial to also perform mobility, stability, or strength exercises to teach your body how to use this new range of motion, which can create longer-lasting changes.
Similar to foam rolling and soft tissue release work, stretching can sometimes reduce knee discomfort and temporarily increase the range of motion at the hips and ankles. As mentioned above, in this case, it can be helpful to gently stretch the muscles above and below the knee, paying specific attention to the hamstrings, calves, inner thighs, and hip flexors.
The exception to this is if you suspect that you have an acute injury to the structure of the knee, such as a ligament tear or if you are hypermobile and have found that stretching makes your knees feel worse. If you experience swelling at the joint or suspect that you an underlying knee injury, you should consult a medical provider.
Again, because stretching can create similar results as foam rolling, if you follow up stretching with some sort of movement work to improve stability, mobility, and strength, you may experience better results.
Addressing hip mobility, stability, and strength can promote better knee health, because the muscles of the outer hip and inner thigh play a large role in knee alignment and controlling the impact on the knee during movements, including walking, running, squatting, and lunging.
While everyone is different, most of us will benefit from practicing exercises that allow us to move and strengthen our hips in multiple directions. Some examples of this include leg circles, quadruped rocking, bird dogs, monster walks, and bridging with a yoga block between the knees.
Additionally, for some people, exercises that activate the hamstrings and quadriceps and integrate VMO activation can reduce knee soreness. The VMO (vastus medialis oblique) is a part of the quadriceps located to the inside of the leg, just above the knee that plays a role in kneecap tracking when the knee straightens.
Sometimes stiff or unstable ankles can create movement compensations that affect the knee. For example, limited ankle dorsiflexion, which is when the front of the ankle creases, can cause the feet to turn out and collapse in when squatting or walking. This can create additional pressure or discomfort at the knee.
Additionally, weakness in ankle plantar flexion, which is when the foot points down away from the shin, can create additional impact or movement compensation around the knee when walking or running.
In both scenarios, ankle mobility and strength drills can be beneficial for indirectly addressing knee soreness. Some examples of ankle drills include calf raises with an emphasis on keeping equal weight across all ten toes and ankle circles.
Did you know that strength training exercises such as squats can reduce knee discomfort and even promote better knee health? This is because strength training can increase your tolerance to movement in your joints and the added lower body strength can help you control the forces through the knees when walking and running.
The key thing is to find a way to practice strength training exercises in a way that doesn’t create more knee pain in the moment. This might mean modifying your set up for the exercise or picking a different exercise entirely. For example, some people who experience knee pain during squats might find that taking a wider stance and hinging their hips back allows them to squat without pain. For others, a band around the thighs or elevating the heels may also help.
Again, there isn’t a single solution. Nevertheless, thoughtful exploration or working with an appropriately trained professional can help.
Knee soreness can stem from a variety of underlying causes and there isn’t a single solution. However, knee pain doesn’t mean that you have “bad” knees. Oftentimes, you just need to find an individualized approach and in some cases seek medical treatment to understand and address the discomfort.
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