At its most basic level, pain can act as a signal – telling us that something is wrong. For example, it’s hard to miss the “popping” feeling that typically accompanies the tearing of an ACL, one of the main ligaments that stabilize the knee. Sharp pain is a clear indication that you need to stop what you’re doing, experts say.
However, aside from such so-called acute injuries, knee pain can often last not only days and weeks, but also months and years. That kind of chronic knee pain can result if an injury doesn’t heal properly. It also often occurs when the cartilage in the joint wears away, or in osteoarthritis, the most common form of arthritis. While a person’s pain level can still serve as a useful guide to the type or amount of exercise that is appropriate, discomfort can also deter people from activity. That’s problematic because a complete lack of activity or movement can be bad for the joint — it undermines mobility and, in the long run, even a person’s overall physical and mental health.
Research strongly supports that keeping the joint active can reduce chronic knee pain and even provide some relief, especially when it comes to osteoarthritis.
“With chronic pain, the body almost goes into this downward spiral where… you get scared of movement, then you don’t move, then you get weak, then you get more pain,” says Douglas Ebner, a physical therapist at Ohio State University Wexner. Medical Center. That fear can lead a person to be sedentary, causing the affected joint to stiffen. “Then they don’t want to do anything, and then they get even weaker,” says Ebner.
Tips for exercising with knee pain
“With chronic knee pain, we actually recommend that people stay active,” says Dr. Amit Momaya, an assistant professor of orthopedic surgery at the University of Alabama at Birmingham and medical director of the UAB Sports Medicine Clinic. “It’s counterintuitive that exercise can sometimes protect the knee and keep it in better health — even if you have chronic knee pain from arthritis.”
Here are ways to stay active when you have knee pain:
- Talk to your doctor first about what’s appropriate.
- Easy into any new routine.
- Try a range of low-knee-impact exercises, such as walking, swimming, cycling, or elliptical training.
- Include activities that improve your flexibility and balance, such as yoga and tai chi.
- Do cardio And weight training.
- Avoid yo-yo exercises: find your happy medium between inactivity and overdoing it.
- Go back if you have swelling or pain that is sharp, worsens, or lasts longer after exercise.
- Consult your doctor if you are concerned about new knee injuries.
- Get guidance from a professional, such as a physical therapist or trainer, to fine-tune your regimen.
While some initial rest or immobilization of the joint — with braces, for example — may be recommended after an injury or surgery to repair the knee, even in those circumstances the emphasis is generally on what is called active recovery. This may mean minimizing the weight exerted on the joint, for example by doing squats without any weight (above your own body weight).
While being smart about choosing activities that are right based on joint condition and one’s abilities, the key is to keep moving, explains Dr. Armando Vidal, a complex knee and sports medicine surgeon at The Steadman Clinic in Vail, Colorado.
He says the active recovery approach also applies to chronic knee pain. “Joints like to move,” emphasizes Vidal.
That doesn’t mean you should try to ignore the pain altogether (if that were possible), but you should look at knee pain in a more nuanced way, experts say. “While mild muscle soreness after a workout is normal, sharp pain during or immediately after can indicate injury,” according to the Arthritis Foundation.
Plus, “swelling to me is like a vital sign for that joint,” says Vidal. “Activity-related swelling is often a sign that more damage is being done to the joint and they should stop or seek expert advice before continuing.”
Get into a routine
Likewise, just because you might be pushing back on the impulse to stop activity when you have knee pain doesn’t mean the sensitivity is out the window. “Obviously there are things to avoid… such as high impact activities – jumping a lot, walking very long distances. Things like that can sometimes make it worse,” says Momaya.
That said, you definitely want to choose activities that you enjoy doing so you’re more likely to stick with them. So, for example, if you’re a runner or a skier and you’ve been on the fence because of knee arthritis or a past joint injury, talk to your healthcare provider to see if there’s a way you can cut back on the activity. can customize to ensure it is safe yet fun and motivating for you.
Adjust yourself too. Instead of trying to get out of the gate before the gold, then inevitably back off, push hard again and so on – or eventually quit – set a reasonable and consistent training pace. Like yo-yo dieting, that kind of up and down isn’t the best way to see results, says Ebner. “I prefer it to be a slow and steady gain.”
Have a plan for dealing with pain or discomfort after a workout. That includes stretching before and after exercise — and not staying too still to tempt stiffness in the joint.
In addition, make comfort care a priority. For example, place a heating pad on a tired joint, use over-the-counter pain relievers, or work with a healthcare provider to determine what other ways to treat pain work best for you. This will help reduce the tendency to avoid exercise for fear it will cause more pain than gain.
Build up your other joints as well
From a musculoskeletal standpoint, the joint in the middle of your leg has a supporting cast that also deserves your attention.
“If you strengthen the hips and ankles, they can help take some pressure off the knee,” says Ebner. By extension, most exercises that work the knee naturally include movement at the ankles and hips, he notes. Still, there are targeted ways to strengthen these joints and increase knee support.
“One of my favorite hip exercises is a simple hip bridge,” says Ebner. To do this, he explains, lie on your back with your knees bent and your feet flat on the floor. Next, tighten your glutes and lift your hips off the floor until you are at full extension, or as far off the floor as you can lift your hips.
“For ankles, I like to do a lot of reactive balance exercises,” he says. “The position of the foot/ankle can influence the position of the knees, and a strong foot position helps with that. Balance exercises can be anything from standing on one leg to walking heel-to-toe (think walking the line on a sobriety test).
The point when it comes to exercising with knee pain, experts say, is not to make yourself miserable by pushing too hard, nor to resign yourself to doing little or nothing out of fear.
There is no scientific evidence to support the idea that activity level is related to the development or progression of knee osteoarthritis, Vidal points out. With his patients, he tries to allay the fear that if they are active, they will wear out that joint more quickly. Movement even improves lubrication in the knee (synovial fluid in the cartilage is used during movement) which in turn reduces friction in the joint.
Likewise, a sensible approach is still warranted to prevent falls — especially in older adults who make up the majority with arthritis — or other knee injuries that can ultimately negatively impact a person’s ability to keep moving. Pay attention to warning signs, such as sharp pain or swelling. And avoid, or at least limit, high-impact exercise, get your doctor’s approval before doing vigorous activities that can put stress on the knee.
For the vast majority with chronic knee pain, continued activity that suits one’s abilities, desires, and limitations is just what the doctor ordered. If you’ve been sedentary, taking those first steps can help you regain a mental edge and reverse a downward spiral so you’re able to get into a groove and keep improving. “Where you build some confidence, you build a little bit of strength and then you move a little bit better,” says Ebner. “Then you build up more self-confidence, more strength and you move better.”