What you Kneed to Know

I’ll just cut to the chase on this one: No! Exercise is not bad for your knees! In fact, a great exercise habit is one of the best things you can do for your knee health.

There is a persistent stigma that excessive exercise over a lifetime is what causes knee pain, degeneration, and loss of function. This likely came from the incorrect idea of “wear-and-tear” where using the knee joint during things like sports and exercise slowly wears down the padding between the bones. In reality, the opposite is true; it is sedentary behavior, not exercise, which contributes to knee pain and degeneration.

There has been a great deal of scientific research to debunk the myth that exercise is bad for the knees. When comparing older adults who have a habit of running to those who do not, it has been shown that those who run have a lower risk of knee joint degeneration in later years of life. The same is shown for strength training exercises, like weight lifting. It has been shown that those who have a habit of strength training over their lifetime are less likely to experience knee pain, knee degeneration, and loss of function later in life.

Even better, not only can appropriate exercise prevent knee degeneration, it can actually reverse many of the negative impacts of knee degeneration for people who already have “bad knees”. All kinds of exercise, ranging from walking, to aquatic exercise, to heavy strength training, have been shown to reduce pain, reduce inflammation, and improve function in people who have significant knee degeneration.

For these reasons, the vast majority of professional organizations, such as the Academy of Orthopedic Surgeons and the American Physical Therapy Association, list sedentary activity and lack of exercise as a primary factor for knee joint pain and loss of function later in life. Further, these organizations recommend exercise as a first line treatment for knee joint pain and degeneration.

It is sedentary behavior, not exercise and physical activity, which contributes to knee pain and degeneration.

Just about everyone, whether they are old or young, man or woman, or weak or strong, will greatly benefit from the right exercise routine

If exercise is so good for the knees, why do people have knee pain after doing it?

While routine exercise and physical activity most definitely something you want to build into your daily life, it is possible that getting into exercise the wrong way can cause some knee problems like pain or injury. While there is not universal right or wrong approach when it comes to exercise, especially when trying to prevent or work around knee problems, there are a few common pitfalls that people often run into. Some of the common mistakes people often make which can lead to joint pain include:

1. Doing too much, too early: Many of us have experienced jumping into a new exercise routine that we weren’t prepared for. Maybe your significant other ropes you into a 10k run in 3 months when you haven’t gone running in 10 years, or you decide to try that new high-intensity cross-training gym that your friends have been going to. All of the sudden, you go from doing next-to-nothing to training 5 days a week. This is a great way to develop an injury or exacerbate an old one! Remember, you have the rest of your life to develop a healthy exercise habit, so don’t rush into it with the next crazy routine that your friends are doing or that comes across your social media feed. Start small, and build up to a higher level of exercise incrementally.
2. Pushing through pain: While knee injuries can sometimes occur in a single moment, many people develop knee problems which start small and become worse overtime. All too often, people decide to push through the initial injury feeling. “No pain, no gain” right? Wrong! You should not be experiencing sharp or nagging pains while performing exercise. When we push through the initial warning signs of knee injury, we turn a small, easy to fix problem into a BIG problem which may throw us out of activity for weeks or even months. So when you start to feel injury coming on, take a step back, recover, and work your way back up to your desired level of activity.
3. Being the “Weekend Warrior”: As a practicing Physical Therapist, the “Weekend Warrior” is someone I see a lot coming into the clinic with nagging aches and pains. This is the person who may sit in the office for 5 days out of the week, and then they all the sudden decide they’re going to play a game of pick-up basketball on a Saturday or randomly jump into rough-housing with their kids one day. Because this person is not prepared for this level of activity, this creates a very high risk for injury! Consistent, everyday exercise is the key to injury prevention; you can’t just jump off the couch every few weeks and think you’re a professional athlete!
4. Avoiding supportive and corrective exercise: This point builds off my previous point. People develop knee injuries when they avoid exercises which support the activities you really want to do. Sports, recreational activities, and even daily life activities require that you have a certain amount of strength, mobility, balance, and coordination to perform them safely. For example, safely running a 10k requires that you have sufficient strength and mobility in your hips, knees, and ankles, and it requires that you have developed a proper form for running. If you try to run prior to developing these base qualities, you’re at very high risk for injury and chronic pain. To avoid this, incorporate regular strength and mobility training into your consistent exercise routine. The more demanding your desired activity is (think higher level sports like distance running or tennis), the more rigorously you need to prepare with supportive training.
5. Relying on “Band-Aids” when problems arise: You can think of this one as an extension of the mistake of “pushing trough pain.” However, instead of ignoring the pain, people try to “treat” it by covering it up with pain-masking solutions like ice, braces, or over-the-counter pills. While these can be useful tools for addressing knee pain, they do not solve the root problem! In fact, these often allow people to ignore knee pain while they do even more damage to their joints. When you start to feel an injury coming on, or if you’re dealing with a recurring injury, you need to address the root cause instead of just covering it up.

To put all those points together, people most often get injured when they try to jump into exercise activities which they are not physically prepared for. Once they begin to notice problems like pain or swelling, they try to cover up the symptoms with rest, braces, ice, or over-the-counter pills, so that they can jump right back into the exercises that hurt them in the first place. To avoid this all-too-common mistake, remember to start slow, build your capacity for exercise through supportive exercise (like strength training and mobility work), and progressively move into higher intensity activities with a consistent (nearly every day) exercise routine.

So what should you do next?

If I’ve convinced you of the importance of exercise, but you’re worried about the potential for injury, just stick to the basics! You can’t go wrong with starting a daily walking routine with some low-risk strength training exercises a few times a week. These resistance exercises can be as simple as doing squats in your living room! For many, this simple addition to your lifestyle will greatly benefit your knees and overall health with no risk of injury.

While doing a basic exercise routine is MUCH better than not exercising at all, developing a complete exercise regimen is one of the best decisions you’ll ever make for not only the health of your knees, but for your health and well-being overall. If you’re ready to start this journey, I encourage you to seek out a professional, at least when starting out. If you’re younger, a qualified personal trainer can coach you through a proper exercise routine to meet your goals. If you’re older, already have knee pain, or are struggling with balance or mobility issues, go see your local Physical Therapist to get you started on a path to recovery. Regardless of where you fit on this spectrum, follow me on my blog to learn all you Kneed to Know about exercising for knee health!