Our 7 tips for working out with knee pain

Injuries are annoying! Some are more serious than others but in general it is 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 your way. Here are 7 strategies to still keep working out with knee problems.
Before we go any further, we want to point out that the tips we discuss here are NOT up 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 soccer, rugby, martial arts
  • Rotational trauma, twisting your knee
  • Displacement of the kneecap
  • Hearing and/or feeling a distinct snap/crack during this accident
Always seek professional help for these types of symptoms before resuming training!
Complaints we discuss here fall more under the category of strain complaints. These symptoms often occur gradually and are more likely to be nagging rather than a sharp pain give.
Working out with knee pain

1. You may pain feel but no pain

Training through pain is never the way to go and it will get you nowhere in the long run. It's not worth doing that exercise anyway when you know in advance that you're going to suffer more from it. So make sure the symptoms you have remain acceptable. To make this more understandable, we often use a pain score. If you would score the pain on a scale of 0 to 10 you may score a maximum of a 3 for the symptoms you are experiencing at that moment. When it is a 6,7,8 or higher you know you are doing wrong! This also applies to the knee's reaction AFTER the workout. If you get up the next day and have more symptoms than the day before then you know you need to adjust something in your workout. Sets, reps, weight, exercise choice are all variables you can adjust.

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

Movements we describe as hip dominant are a; deadlift, glute bridge and, for example, a step up. These exercises are often a lot gentler on 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, do the hip dominant exercises first. Then, if you do choose a squat and it doesn't score too high on pain, your legs are already a lot more tired. This makes that in the last exercises less weight is needed to still get a decent stimulus. But still keep that pain score in the back of your mind, this doesn't change!

3. Train at a different angle

This advice is much like the previous one. But still a little different. Let's preface by saying that there is nothing wrong with knees past your toes at a squat. Just walk up the stairs without knee past your foot. Good luck! However, when you suffer from knee pain, it is kinder to move more hip dominant during a squat. A good example of this is a box squat. With this exercise, the knees stay behind the toes more than with a normal (back) squat. Don't worry about your quadriceps not getting enough attention. The factor for success in strength training and muscle building is consistency. Not squatting for a few weeks won't do anything to your current muscle mass. It takes much less to maintain muscle mass than to gain muscle mass. So always think about what works best in the long run. The goal should always be; in what way can I keep this up the longest with the most results.
Below is a box squat. In this variation of the squat, the shin remains more vertical. This way there is less pressure on the front of the knee. So still a squat variation but a little friendlier.
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 you use your quadriceps mainly in the upper part of the exercise.

4. Use resistance bands

If you find it difficult to focus more 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 lean backward. This way the peak load from the front of the knee is shifted to the back. The higher you get in the movement the more you still load your quadriceps. It is usually the case that when you have knee pain it is mainly during squats so when you are low in the movement. This way you still train 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 like the squat, for example, you have a concentric moment (muscles become shorter) and an eccentric moment (muscles become longer) in the eccentric moment you brake the movement. During this braking, the muscles deliver power as they lengthen. This can be very taxing when you have symptoms. With a sled you only have the concentric moment (muscles become shorter) which is gentler but you can still train considerable strength. 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 often so that your quadriceps are still sufficiently stimulated.

6. Cycling is always good

Cycling can almost always be done with knee pain. Personally, I would always do this as a warm up when you have knee pain and start working out. Movement is pain dampening. When certain fibers are stimulated these signals enter the brain and extinguish the signal for pain more. It also causes stiff connective tissue to become a little more elastic which makes you move just a little easier. Take your time and cycle for at least 15 minutes before exercising with light resistance.

7. Blood flow restriction training (BFR)/Kaatsu

With BFR or kaatsu training, you train with a light training load while providing a low oxygen environment in the legs. This allows you to have the same effects at a low training intensity as if you were training at a high intensity (in this case weight). You do this by using a cuff. This is a kind of blood pressure gauge that you can pump up. This pinches off the leg and thus creates a localized oxygen-depleted area in the legs. A lot of metabolic stress is released by this type of exercise. For example, one of the substances released is lactate. Along with other substances, we know that lactate plays a role in building muscle mass. If you want to do this, we do recommend that you go through this with a professional at least the first time. This way you know how best to use the cuffs and what you may approximately feel during this workout.
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 once for 2-3 weeks has no real adverse effects on strength or muscle mass. When in doubt just grab some rest and look at other muscle groups that might need a little 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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