Our 7 Tips for Training with Knee Pain

Injuries are annoying! Some are more serious than others but generally it's not a reason to stop training altogether. You've often worked hard to be where you are today so don't let this injury get in the way. Here are 7 strategies to still keep working out with knee problems.
Before we go any further we would like to point out that the tips we are discussing here NOT for traumatic knee injuries. Traumatic knee injuries are knee injuries that occur as a result of an accident.
Examples include:
  • Contact injury in sports such as football, rugby, martial arts
  • Rotational trauma, twisting of your knee
  • Displacement of the kneecap
  • Hearing and/or feeling a distinct snap/crack during this accident
Always seek professional help for these kinds of complaints before resuming training!
The complaints we discuss here fall more into the category of strain complaints. These complaints often arise gradually and are more of a nagging presence than a sharp pain give.
Training with knee pain

1. You may pain feel but do not suffer pain

Training through pain is never the intention and it will get you nowhere in the long run. It is not worth doing the exercise if you know in advance that it will cause you more problems. So make sure the complaints you have remain acceptable. To make this more understandable, we often use a pain score. When you score the pain on a scale of 0 to 10, you can score a maximum of 3 for the complaints you are experiencing at that moment. When it is a 6, 7, 8 or higher you know you are doing something wrong! This also applies to the reaction of the knee AFTER the training. If you get up the next day and have more complaints than the day before then you know that you have to adjust something in your training. Sets, repetitions, weight, exercise choice are all variables that you can adjust.

2. If you want to train the legs do more exercises that are hip dominant than knee dominant

Movements that we describe as hip dominant are a; deadlift, glute bridge and for example a step up. These exercises are often much kinder to the knee than knee dominant exercises such as a squat or lunge. A tip from us is that if you are going to train legs with knee pain, you should do the hip dominant exercises first. If you do choose to do a squat and it does not score too highly on pain, your legs are already a lot more tired. This means that less weight is needed in the last exercises in order to still get a decent stimulus. But still keep the pain score in mind, this will not change!

3. Train at a different angle

This advice is very similar to the previous one. But still a little different. Let's say first of all that there is nothing wrong with knees past your toes when doing a squat. Just walk up the stairs without your knee going past your foot. Good luck! But if you suffer from knee pain, it's kinder to move more hip dominant during a squat. A good example of this is a box squat. With this exercise, the knees stay more behind the toes than with a normal (back)squat. Don't worry that your quadriceps are not getting enough attention. The factor for success in strength training and muscle building is consistency. Not squatting for a few weeks will do nothing to your current muscle mass. It takes much less to maintain muscle mass than to gain it. So always think about what works best in the long run. The goal should always be; which way can I keep this up the longest with the most results.
Below is a boxsquat. In this variation of the squat, the shin remains more vertical. This way there is less pressure on the front of the knee. So it is still a squat variation but a bit more friendly.
The same principle applies to a reverse lunge. This is also a more hip dominant exercise that you can do instead of your normal walking lunges. Less stress on the knee but still using your quadriceps mainly in the upper part of the exercise.

4. Use resistance bands

If you find it difficult to put more focus on the hip during a squat, it can help to use resistance bands. This forces you to lean more on the heel of your foot and backwards. This way the peak load of the front of the knee is shifted to the back. The higher you get with the movement the more you load your quadriceps anyway. It is generally the case that if you experience knee pain, it is primarily during the squat, i.e. when you are low down in the movement. In this way, you are still training your quadriceps but in the more secure higher position. Below is an example:
Spanish squats:

5. A powersled is the perfect rehabilitation tool!

It cannot replace other strength exercises but training with a sled is the perfect way to start. During an exercise such as the squat you have a concentric moment (muscles become shorter) and an eccentric moment (muscles become longer). During this braking the muscles deliver power while they become longer. This can be very stressful when you have complaints. With a sled you only have the concentric moment (muscles become shorter) which is gentler but you can still train a lot of power. Another advantage is that the recovery time for only concentric training is shorter than normal strength training. From only concentric training you generally recover within 24 hours. With a sled, you can train more frequently and your quadriceps will be stimulated sufficiently.

6. Cycling is always good

Cycling is almost always possible with knee problems. Personally, I would always do this as a warm up when you have knee pain and are going to train. Movement dampens pain. When certain fibers are stimulated, these signals enter the brain and extinguish the signal for pain. It also makes stiff connective tissue more elastic so that you can move more easily. Take your time and cycle at least 15 minutes before you start training with a light resistance.

7. Blood flow restriction training (BFR)/Kaatsu

With BFR or Kaatsu training you train with a light training load while creating a low-oxygen environment in the legs. This allows you to achieve the same effects with a low training intensity as you would achieve with a high intensity (in this case weight) training. You do this by using a cuff. This is a kind of blood pressure device that you can inflate. This causes the leg to be pinched off and thus creates a local oxygen-deficient area in the legs. A lot of metabolic stress is released by this method of training. One of the substances that is released is, for example, lactate. Together with other substances, we know that lactate plays a role in building muscle mass. If you want to do this, we advise you to discuss this with a professional at least the first time. This way you will know how to use the cuffs and what you may feel during the training.
These were our 7 tips for working out with knee pain. Also, make sure you give your body some time to recover. We know that not training for 2-3 weeks has no real detrimental effects on strength or muscle mass. When in doubt, just take some rest and look at other muscle groups that may need more attention. We often see that despite this advice people still train too hard and don't really listen to their bodies!

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