Is Knee Pain The New Lower Back Pain?

Knee pain is crippling out physically active society. But not all “knee pain” is created equally, it actually comes in many forms. If you’re reading this, then you:

  1. Currently have knee pain.
  2. Your knee pain has been going on for a long time.
  3. You know (or coach) someone who has chronically pissed off knees.

According to the American Academy of Pain Medicine, chronic knee pain is the 2nd most common cause of chronic pain in the United States behind only low back pain. Whether these numbers are from a single injury, trauma, or repetitive overuse, this continues to be a significant problem that many are facing. Although traumatic knee injuries continue to rise at an alarming rate as well, we are going to exclusively cover the repetitive, overuse, and chronic type of knee pain that many in the active population are constantly battling.

Simple Fixes For Chronic Knee Pain

The focus of this article isn’t to analyze all the different types of knee conditions and give you recommendations based on your specific clinical diagnosis. If it’s a diagnosis you’re seeking, consult with a qualified licensed medical professional in your local area to help diagnose, plan and treat these more serious presentations.

This article will focus on how to help you figure out the origins of your chronic knee pain and the role that your activities and training may be playing in your inability to get back to being pain-free. Figuring out preventative ways to reduce the likelihood of injury should always be best practice. Unfortunately, we live in a highly reactive society when it comes to our health. It’s commonplace to wait until we have a glaring red flag issue before finally addressing it. We simply try and put out the fire when discomfort occurs instead of preventing it from ever becoming an issue, as being proactive is hardly ever an initial thought.

It would be extremely short sighted to say that all knee discomfort is created equal. However, how you manage knee discomfort is a whole different story. Have you gone the traditional route of rest, medications, and conservative treatment with minimal to no results? Are you at the point where you are considering surgery because all those traditional methods of managing knee discomfort didn’t work?

We’re seeing a significant rise in surgery being performed to address degenerative knee conditions. The problem with this? Although initially the client might feel improvement, long term outcomes aren’t really showing that surgical intervention is more beneficial than managing these conditions conservatively.[1] Now don’t get me wrong, there is a time and place for knee surgery, but in most cases there are so many other factors to consider, with of course, movement capacity and quality being the huge pink elephant in the room of a majority of knee pain problems.

15 Exercises To Instantly Improve Knee Pain

Be honest with yourself, have you really tapped into and addressed all the things that could be the reason for your knee discomfort and exhausted every last conservative option before jumping into a reactionary model of medicine? Probably not. So that’s why I’ve put together my 5 most effective approaches to eradicating chronic knee pain from your training, including the best exercises in each category for you to start using right away. It’s time to identify the problems, strengthen the weak links and get back to being pain-free once again.

Focus Your Efforts Elsewhere

Just because you are experiencing knee pain doesn’t necessarily mean that the knee itself is the source of the discomfort. When assessing knee pain, looking at how the foot/ankle moves, is a great place to start.

Failure for the ankle to move throughout its full range of motion can lead to compensatory movements, which normally ends up finds itself occuring at the knee. Attempting to perform compound movements in the gym, jumping, sprinting, or even simple things such as going down stairs, all require adequate ankle mobility, especially into dorsiflexion range of motion. Address and clean up your ankle mobility with these drills below:

#1 Half Kneeling 3-Way Ankle Mobilization

The 3-Way Ankle Mobilization is a great drill for addressing joint mobility restrictions that restrict the ankle’s ability to meaningfully move into dorsiflexion. But remember, we must first figure out what type of ankle mobility restriction we have. Here’s a great article from our colleague and fellow expert Andrew Millett: “10 Exercises To Instantly Improve Ankle Mobility” 

#2 Push-Up Position Dorsiflexion Rockbacks

The foot/ankle is the first thing that makes contact with the ground, so it is really important for its ability to absorb force. Failure for the foot/ankle to absorb force efficiently can put excess stress on the knee joint over time which can cause some irritation. Improve your ankle mobility and your knee will thank you in the long run.

Another important area to assess when figuring out knee pain is the hip complex. The hip can be a really good protector of the knee in a number of different ways. The stronger the muscles in and around your hip are, the less likely the knee will give you trouble.

There continues to be a growing body of evidence showing that strengthening the hips, in particular your glute muscles, can help reduce the incidence of knee pain from occurring.[2] Your glutes are the strongest muscle in the lower body, so failure to tap into this vast resource can make your lower body less likely to be able to handle the daily stresses of athletics or training. Add these exercises into your program to get your hip muscles fired up:

#3 Glute Bridge Variations

The glute bridge differentiates itself from the hip thrust by the available range of motion at the hips moving from flexion into extension. Since the glute bridge sets up off of the floor, the hips move through a smaller and more controllable range of motion into extension, making it a perfect movement to start addressing activation and control of tension at this muscular region.

We can also extend the range of motion at the hips by elevating the shoulders and torso on a bench with hip thrusts as a progression:

#4 Double Banded Hip Thrusts

These variations can start off by being programmed with bodyweight only, then progressed to banded variations, and finally be challenged from a strength and hypertrophy standpoint by loading a barbell across the hips. Earn your progressions and choose the glute building movement that feels and functions the best for you.

Be More Aware of Controlling How Your Knee Moves

The knee joint does a lot more than just bend and straighten the leg. It allows for rotation around the knee joint, translation back and forth, and adduction/abduction (think someone who has bow leg or is knock kneed). What does that all mean? It means that your knee has to not only be able to perform these motions, but more importantly it needs to be able to resist these motions.

The inability to resist excessive motions in different planes is what can lead to increased stress on ligaments, cartilage, and other structures in the knee, and yes, injuries as well.

There is a reason we continue to see such high rates of ACL injuries, meniscus tears, and other knee related injuries. Failure to make the lower body more resilient to stress, especially when fatigue plays a factor, is what can make you more susceptible to injury. Try these simple exercises to give your routine some variety and help reduce the likelihood that your knee will give you trouble:

#5 Mini Band Alternating Knee Knockers

While the band is positioned around the knees, remember that we are actually working the hips (and glutes) into abduction/adduction, along with slight external rotation and internal rotation with this exercise.

#6 Bowler Squat

These have many different names, but no matter what you call the Bowler Squat, they are a highly effective way to train single leg squat mechanics, while placing an emphasis on lateral hip stability and control. A little loading goes a LONG way here so don’t overdo the dumbbell weights.

#7 Half Kneeling Hip Flexor Stretch With Bent Knee

Since the quadriceps, more specifically the rectus femoris, attach onto the knee cap, moving the hips into extension and mobilizing the hip flexors can be highly advantageous when alleviating chronic front-sided knee pain. Ensure that you are kneeling on a pad or mat, and not smashing your knee into a hard surface, as that will backfire quickly.

Focus On Modifying The Fundamental Movements To Work Around Discomfort

Trying to push through discomfort when doing squats or the notorious knee extension machine, is a sure fire way to knee pain. If your knee pain has gotten to the point where something as simple as going up or down stairs is painful, then figuring out what the right prescription of exercises are can be a challenge.

However, what shouldn’t be negotiated is still trying to implement the basic squat, hinge, or lunge pattern into your routine, albeit with some modifications. Here are some knee friendly variations to the fundamental movements we mentioned above, that will help build strength and capacity in the knee:

#8 Spanish Squat

The Spanish Squat is great as it provides a form of Reactive Neuromuscular Training (RNT) that allows the body to optimize it’s positions and stability, while also helping to rewire some of the faulty movement patterns in the process.

#9 Reverse Lunge with Hip Dominance

The reverse lunge really separates itself from it’s forward counterpart due to it’s more posterior chain dominancy. This means that reverse lunging targets the glutes and hamstrings to a greater degree than the forward lunge, largely due to the tibial (shin) angle and relative torso angle over the front leg.

#10 Split Squat

And for controlling proper knee position via sound hip stability, nothing beats the traditional split squat that keeps both feet on the ground, with the lower body linked to the spinal, pelvic and core positions. Here’s another great in depth article about how the eccentric split squats just may be the #1 exercise to bulletproof knees against pain and future injuries by Tim Danchak: “Preventing ACL Injuries With Eccentric Split Squats” 

Stop Doing Random Quadriceps Exercises

Now don’t get me wrong, your quadriceps muscle is really important for the knee. However, failing to address the other dynamic components and muscles around the knee would be negligent from an injury prevention perspective. Improving strength in your hamstrings, groin muscles, glutes, and calves can go a long way in reducing excessive stress on the knee. Like we’ve mentioned previously, the knee is where most symptoms will arise if other areas are lagging. Start with these exercises to help build up the other muscles that affect how the knee responds to stress:

#11 Romanian Deadlift (RDL)

The truest of the hip hinge patterns, the RDL can be challenged with many different tools and loading parameters. The top down approach moving from an anatomically neutral position at the top and grading down range of motion through both eccentric and concentric muscular actions make this a superior hinge alternative for improving movement capacity and building muscle and strength through the posterior chain.

#12 Physioball Hamstring Curl

Physioball hamstring curl variations, both bilateral and single leg, are amazingly effective for linking up the hips and knees so that they move together as a functioning unit. As the knee flexes, the hips drive up into extension to improve the activation of these two posterior chain muscle groups, but also to set the spine and pelvis into a stabilized position to work from.

So let’s get this straight, I’m not recommending you cut out quadricep exercises all together, I would just modify the load or total volume that you are performing. Like we had mentioned above, a slight forward lean when performing weight bearing quadriceps exercises makes them more hip dominant so you tap into your hip strength as well.

Restore Mobility in the Knee

If you’ve gone through all these recommended exercises and you still have trouble with knee pain, then maybe it is actually the knee that is the source of discomfort. If that is the case, being able to regain full mobility can be a game changer. With that being said, after regaining mobility, being able to re-strengthen and re-stabilize the muscles throughout that new range of motion is vital to maintaining it long term.

Try these self treatments below and see if they help improve some of your symptoms. Be aware that you could experience some discomfort, depending on how irritable your knee symptoms are. Our recommendation is to attempt to perform these tasks as long as your symptoms return to baseline shortly after performing:

#13 Tibial IR with Knee Flexion

Remember that the knee doesn’t just bend and extend, it actually has slight degrees of rotation available. These tibial rotations are game changers for unlocking potential of the knee to articulate properly with the shin bone and lower leg. Grab tight and ensure that you are rotating under control and not forcing your knee into truly vulnerable end range positions (if you’re strong enough to even do that).

#14 Knee Flexion with Towel Overpressure

By placing a towel between the calf and the knee, we can achieve a slight distraction moment at the knee joint itself, allowing the articulating joint surfaces to slide and glide into new ranges, while also alleviating some chronically painful positions at the knee. This specific exercise should allow for some near instantaneous feel good effects.

#15 Knee Extension with Overpressure

Don’t forget about knee extension! Many times so much emphasis is placed on getting the knee to deeper degrees of flexion to improve squats and athletic movements, that we disregard the need for the knees to travel through a full total range of motion, and that includes extension.

The End To Chronic Achy Knees

Expectation needs to be considered when going through some of these guidelines. The length of time your symptoms have been going on, can determine how long it might take your symptoms to subside. If you’re thinking that these are going to solve all your problems after you’ve been experiencing knee pain for months or years, then you will  likely be disappointed. Understand that getting long standing pain under control, and to where you build back up tolerance to the stresses of high level training or athletics, can take time.

In the end, knee pain doesn’t have to be overly complicated. Again the goal wasn’t to provide you with a specific plan to address a certain knee condition. It was more to give you a guide to refer to so that you’re exhausting all of your options before making any long term decisions about your knee. Addressing what the low hanging fruit is to help get your knee discomfort under control is the best place to start. Always consult with a healthcare professional who understands the rigors of athletics and training, as they’ll be able to problem solve exactly what the source of the issue is for you, and then reverse engineer a plan of action to get you back on track.

About The Author

russ manalastas knee pain

Dr. Russ Manalastas is a board certified sports physical therapist, strength and conditioning specialist, and owner of MANA Performance Therapy located in Rochester, New York. Dr. Russ uses a combination of strength and conditioning principles incorporated into his rehab with a variety of sports and orthopedic related conditions to expedite recovery. Connect with him on:

Twitter: @RussPT


[1] Khan M, Evaniew N, Bedi A, et al. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 2014;186:1057–64.

[2] Peterson et al. 2017. Patellofemoral pain in athletes. J Spts Med. 8: 143-154