How to train and exercise with bad knees

Do you suffer with painful knees? Physio James Davis explains how to train and exercise with bad knees

Young runner suffering with knee pain

Bad knees is a common problem! One thing we know about knee pain is that it can be stubborn if left unaddressed, so I would recommend consulting a physiotherapist if possible. Tailored advice is always preferable, but see below for a more general guide:


Knee pain in triathletes is almost always a training load issue, i.e. the amount of training you’re doing and your body’s ability to handle it. Although there can be different structures to blame, it all comes back to conditioning the body (and knee more specifically) to handle the demands of training.

The first thing to ascertain is what movement or activity, and how much of it makes the pain worse and work out a new baseline at which you can exercise in less discomfort. This is the same regardless of the discipline or type of exercise, be it running, cycling, gym work or swimming.

The aim is to reduce load through the joint, allow it to settle and then slowly reintroduce the activity, closely monitoring the response of the knee. Guidance here is useful if you have access to it. If you don’t already, keep a training log and include notes about your pain as you make changes to your training.

It doesn’t mean you have to stop doing that activity all together, instead, consider breaking it up so it becomes more manageable. This may look like short intervals on a treadmill or turbo with plenty of rest and recovery throughout. If swimming or gym work is the culprit, consider a pull buoy to reduce leg kick or reduce the weight used during leg exercises.

The aim is to limit pain during and after exercise, and this can take some trial and error. You’ll then have a baseline from which to progress forward. Be honest with yourself here: don’t just push through it! Knee pain is far easier to treat when caught earlier.

Hopefully, as you adapt and reduce the amount of the aggravating activity, pain will begin to settle. With the help of a physio, you may have identified an area for address e.g. a need to improve strength, endurance, and/or control in areas such as; gluteals, hamstrings and quads. If you can exercise these areas without pain, that’s a good sign.

There aren’t too many instances in which I’d recommend against improving these areas! A running assessment or bike fit may also be useful here. As you then look to reintroduce or build your training back up, plan it out allowing plenty of time for recovery and acclimatisation.

As mentioned, knee pain can vary greatly but the above is a rough framework to stop it from impacting your season too much. Knees can be stubborn so don’t rush it, allow plenty of recovery, look to increase your conditioning in those key areas and gradually build back up, avoiding those spikes in training volume!

James Davis is a physiotherapist with Six Physio Moorgate

If you have any concerns at all, like with any health issue, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist. During this lockdown time Six Physio are offering virtual physio appointments.


Image credit: Getty Images/Martin Novak