Exercise With Knee Pain: What to Avoid (and What to Do Instead)

Knee pain often creates a difficult question: should you keep exercising, change what you are doing or stop completely? The answer depends on the cause of the pain, how severe it is and how the knee responds to movement, but for many common knee problems the goal is not to avoid activity indefinitely. It is to find a level of movement and loading that you can tolerate and then progress from there.

This article gives general guidance on exercising with knee pain. It cannot diagnose the reason for your symptoms, so new, severe or unexplained knee pain may need individual assessment.

Does knee pain mean you should stop exercising?

Not automatically. Some knee problems are irritated by particular movements or by doing too much too quickly, but complete rest can also lead to loss of strength and confidence. A more useful approach is often to reduce or change the aggravating load while keeping as much comfortable activity as possible.

For knee osteoarthritis specifically, NICE recommends therapeutic exercise tailored to the person's needs, including local muscle strengthening and general aerobic fitness. NICE also advises that some pain or discomfort can increase when exercise is first started, but regular and consistent exercise can improve pain, function and quality of life over time.

Read theNICE osteoarthritis recommendationsfor the full guidance.

The difference between acceptable discomfort and a problem

There is no single pain rule that works for every diagnosis. A small increase in familiar symptoms during an exercise may sometimes be manageable, whereas sharp pain, major swelling, giving way or symptoms that continue to escalate afterwards may be a sign that the exercise needs to be changed or assessed.

Instead of judging an exercise only by how it feels for a few seconds, also consider what happens later that day and the following day. If the knee repeatedly becomes much more painful, swollen or functionally worse after a session, the amount, range, resistance or exercise choice may need adjusting.

What can you change if an exercise hurts your knee?

• Reduce the range of movement temporarily

• Use less resistance or body weight

• Reduce the number of repetitions or sets

• Slow the movement down and focus on control

• Swap a high-impact option for a lower-impact alternative

• Allow more recovery between sessions

These changes are not necessarily a permanent step backwards. They can be a way of finding a tolerable starting point before building the challenge again.

Why strengthening matters

Strong muscles around the hip, thigh and lower leg help the knee cope with everyday tasks such as walking, stairs, standing from a chair and carrying loads. Strengthening does not need to begin with heavy gym exercises. It can start with movements that match your current ability and then become more challenging as tolerance improves.

Examples may include sit-to-stands, supported squats, step work, knee-extension exercises, calf raises or other lower-limb strengthening. The right choice depends on the reason for your knee pain, your current function and which movements you can perform comfortably enough to progress.

Is walking good for knee pain?

Walking can be a useful form of activity, but the dose matters. If a long walk repeatedly causes a substantial flare-up, it may be better to use shorter walks more frequently and build distance gradually. Walking also does not replace strengthening if strength loss is contributing to difficulty with stairs, chairs or longer periods on your feet.

What exercises should you avoid?

There is not a universal list of exercises that everybody with knee pain must avoid. An exercise that is unsuitable during an acute flare may be useful later in rehabilitation. Likewise, a movement that aggravates one person's knee may be completely comfortable for somebody else.

It is usually more helpful to identify which loads, ranges or movements are currently aggravating your symptoms and modify them, rather than banning squats, stairs, cycling or gym exercise forever.

When should knee pain be assessed?

Consider a physiotherapy or medical assessment if the pain is not improving, is repeatedly limiting normal activity, follows an injury, is associated with persistent swelling or instability, or you are unsure how to progress exercise without aggravating it.

NHS guidance advises seeking GP review if knee pain has not improved within a few weeks. More urgent help is needed for very severe pain, inability to move the knee or put weight through it, marked swelling or a knee that has changed shape.

See theNHS knee pain guidancefor current self-care and urgent-care advice.

Physiotherapy for knee pain at home

If knee pain is stopping you from exercising or you are unsure what to modify, a physiotherapy assessment can look at your symptoms, movement, strength and the activities that matter to you. The aim is to identify an appropriate starting point and give you a plan that can progress rather than simply telling you to rest.

Tom Morgan Physio Solutions provides mobile physiotherapy across Kidbrooke, Blackheath, Greenwich, Eltham and surrounding areas of South East London. You canview availability and book a 60-minute physiotherapy assessment here.

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