Pain in the knee is one of the most common joint problems and can limit physical activity.  Depending on the cause of the pain exercise may be decrease or even eliminate the amount of knee pain you have.

If you have severe knee pain, pain that started with no explanation, or your knee pain is rapidly getting worse see your doctor before beginning an exercise program.

How should I begin an exercise program?

Start slowly and see how your knees react to exercise.  You may need to begin with just a few minutes of exercise each day.

Aerobic Exercise

Begin with exercise that will not put stress on your knees such as:

  • Cycling
  • Swimming / water aerobics
  • Elliptical trainer
  • Walking on a cushioned surface

It is better to do too little than too much when you first start exercising.

Strength Training

Begin with exercises where you are not putting full weight on your legs.

Many people find knee extension exercises to be painful when they start an exercise program or that the first few repetitions of each workout are painful.  This is OK and it will improve as long as the pain is not severe and it does not last for hours after your workout.

  • Bridging
  • Side leg lift

Strengthening the thigh and hip muscles, especially the quadriceps (the muscle on the front of your thigh) will help the knee move properly and decrease irritation to the knee joint. Begin with 5 to 10 repetitions and a weight that you can easily lift.

Flexibility / Stretching

Thigh and calf and hip muscles.

Balance / Agility Training

Improving the ability to control your balance and movements will decrease stress on your knee joints.  Start these exercises only if they cause little to no pain.  If they are painful then wait until your strength and flexibility improves to begin these exercises.

  • Single leg standing, eyes open, eyes closed
  • Bosu, wobble board, pool noodle, foam cushion   (link to photos and videos)

I tried an exercise program and my knees are killing me.  What now?

How your knees react to exercise is the best way to determine if you are doing the correct amount of exercise.  If exercise is irritating your knees they will become inflamed more so than your usual level of inflammation:

  • Increased swelling
  • Increased stiffness
  • Increased pain
  • Increased warmth to the touch around the joint

If you are having these problems then decrease the amount or intensity of the exercise, or the type of exercise you are doing to the point where you can exercise without these symptoms or stop all exercise for a few days if your knees are very irritated.  The best plan is to start slowly and avoid irritating your knees as much as possible.

Remember, you may have some pain on the first few repetitions of each resistance training exercise and during your first few cardio training sessions but the pain should not be severe and it should gradually improve.  If you are still having increased joint pain hours after your workout or the next day than the exercise program is irritating the joint and you should change your workout.

There is a difference between joint pain and muscle pain from starting an exercise program.  Especially if you have been inactive you may have muscle soreness following your first few workouts or if you change your workout.  This is normal and will improve.  Joint pain, especially pain that lasts for several hours or days after training indicates your exercise program is causing too much irritation to your joints.

If your knees have been irritated by even light exercise, start with stretching and range of motion exercises:

I have had a knee replacement.

Is there anything special I should do?  Is there anything I should avoid?

You can do any of the exercises suggested here.  The main activity to avoid is anything that involves pounding on the knees such as running and jumping.  Also, you can kneel but you should not be on your knees frequently or for long periods of time.  Many times the back of the knee cap is also replaced and kneeling will put stress on your knee cap.

There are several different types of knee replacement surgeries and many different outcomes depending on your condition prior to the surgery and the kind of activities you were accustomed to doing before surgery.  If you have questions that have not been answered here, consult the information that was given to you when you had your knee replacement or contact your surgeon.

I want to ride a bike but my knees do not bend enough?

There are a few options:

Exercise bike.

Start by moving the pedals back and forth through a partial arc, gradually moving further until you can go all the way around.Medical supply stores and some department stores sell a Restorator bike.  It is a small device that sits on the floor.  It has pedals but no seat or wheels.  The crank arms are shorter than on an exercise bike, requiring less bend in the knee to pedal.  You can set the resistance from none to quite stiff.

Begin with stretching and range of motion exercises until you are able to pedal.

Some gyms have elliptical machines and steppers that allow you to exercise while seated and move your knees only as far as you are able.

My knees are feeling better!

What should I do now?

Progress your workouts as your knee pain and your fitness improves.

Aerobic Exercise

Increase the time and intensity of your exercise sessions as your knee pain improves while staying aware of any signs of inflammation or irritation.

Strength Training

Progress to exercises in standing to further improve your strength and balance.

  • Knee bends going only as low as you can with minimal to no pain.
  • Lunges
  • Step ups / step downs

Focus on the position of your upper body, hips, and knees during these exercises.

Flexibility / Stretching

  • Hip, Thigh and calf muscles.

Balance / Agility Training

Continue to progress to more challenging but still safe exercises.  Progress from static (standing still) exercises to dynamic (moving) exercises.

  • Stepping with eyes closed
  • Stepping and turning
  • Strength training exercises while standing on a BOSU ball, wobble board, or half pool noodle.