Smart Exercise Modifications for Knee Pain

By , Karyn D. Klein, M.A.
For many of us, exercise is the part of the day we look forward to. But for those who struggle with chronic pain, working out isn't enjoyable. It hurts.
Knees are particularly vulnerable to pain during exercise (and afterwards).  There are several common exercises (from lunges to those performed in kneeling positions) that are known to cause knee discomfort. But rather than skip some of these very effective moves, you can modify your workouts and still get great results—minus the pain.  
Here are four exercises that can cause knee pain, along with some simple tips to modify the exercise so that you can perform it safely and effectively.
Lunges are notorious for producing twinges or uncomfortable sensations in the knees. Sometimes that cause of that pain is nothing more than improper form: allowing the knee to push past the ankle during the lunge for example. Performing lunges while holding heavy hand weights during this exercise can further aggravate the problem. To fix it, watch yourself in a mirror and make certain the knee is aligned directly over the ankle during the movement. Click here for a proper lunge exercise demonstration

Squats are a great exercise for the lower body, but they can also cause pain if you let your knee push past your ankle.  A couple of things you can do that will help: 1) Push your weight back into your heels—not on the balls of your feet—during the squat. This will help you to target your glutes and quads. 2) You can also place a wedge or five-pound weight plate under your heels if you are tight in your calves. In addition, if you are using a weighted bar or hand weights, try the exercise with less weight or none at all while you master your form. Click here for a proper squat exercise demonstration.
Child's pose is meant for relaxation, but it can wreak havoc on your knees. The extreme degree of knee flexion (bending) in child's post is too much for many people. Get the most from child's pose by opening your knees to a diamond shape rather than keeping them close together. Sometimes, this small change is enough.  If not, place a rolled up towel/mat or small pillow under your thighs (so your thighs rest on the prop instead of your calves) to maximize the distance between your glutes and heels while still benefiting from this yoga pose. Click here for a proper child's pose demonstration.
Quadruped exercises (where you rest on hands and knees on the floor) are common in Pilates, yoga and even traditional strength training. For some people, simply placing weight on their knees like this causes a lot of pain when the kneecap is in direct contact with the floor.  Cat/Camel stretch, for example, is a wonderful way to warm stretch the spine, but many people complain that their knees hurt while doing it.  A cushioned surface can help lessen or alleviate discomfort. The DOD Knee Donut is an excellent option in providing cushion while still offering plenty of support.  Unlike rolling up a towel or mat and placing it under the knee, the knee donut has a hole in the center so the kneecap never touches the floor. It allows you to focus on moving your back rather than how much your knees hurt.
Exercise shouldn't be painful, and pain shouldn't stop you from exercising! Be mindful of the number of repetitions you perform, select the proper amount of weight, and focus on your form. Whatever exercise you choose to do, there are always modifications that can be made so you do not have to miss your daily workout.
Karyn Klein has a master's degree in dance from UCLA and is an adjunct professor of dance, Pilates and injury prevention at Glendale Community College in Glendale, California. She owns a Pilates/Gyrotonic studio in South Pasadena and is the co-owner of Do Or Die Fitness, a company devoted to creating innovative products for anyone who exercises. She is offering SparkPeople members an exclusive 20% coupon off of all DOD fitness tools. Get yours here.
Do you suffer from knee pain? How do you modify your workouts to make them more comfortable on your knees?

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NEPTUNE1939 9/23/2020
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MWHIGGINS 9/14/2020
Thank you for this... Also, the DOD Fitness website is no longer active for ordering the knee cushion Report
PATRICIAANN46 7/16/2020
Thank You................ Report
NELLJONES 6/15/2020
Thanks. Report
I love this! So often people will say, because of my knees, I cannot exercise. It becomes "I can't exercise at ALL" Which is sad. And often, exercise trainers or videos do not modify and unsuspecting people with knee problems get hurt.

I strengthen my muscles that support my knees. That has prevented knee problems.

McDougall Plan Coleader Report
All information helps me even when that issue I may not be facing at that time, but may eventually face. Report
Arthritis is the main common reason which leads to the need of knee replacement surgery.More on knee replacement surgery
acement-treatment Report
PICKIE98 2/1/2020
Proper form is key to relieving the pain and getting the biggest benefit from an exercise. Report
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Following partial knee replacement on find that kneeling is uncomfortable on that titanium piece do I do use extra pillows & double up my yoga mats. However some things just are too sore so I skip thrm Report
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Thanks for the advice. I definitely need to make modifications to some exercises. Report
Thanks for the great information! :) Report
I definitely need some help here! Tried squats and now I'm hobbling. Great article! Report
I've had knee pain for a while, so I went to my doctor in hopes of a brace or something to let me exercise. His suggestion was to lose weight. I haven't really worked out since. I'm trying to drop weight with diet alone. Keto seems to be my only salvation. This just might help :-) Report
Great tips Report
Thanks for the tips on how to modify exercises that are hard on the knees. Report
Thank you for your wonderful article. I have injured both my knees and sometimes I feel a stabbing pain in them like a knife. I could just be standing there and it happens. I injured my right knee years ago while doing a yoga pose where I was on my knees and you hold your ankles and bend your head back. I probably stretched back too far and I hurt my knee. It took a year to heal. And I occasionally get a pain in my right knee. I injured my left knee May of last year by rushing around and walking too fast and somehow twisting something in my knee. It is pretty much healed now. I just have to be careful not to over extend myself when working out or making sudden twists. I probably have some arthritis in my knees. Sometimes the muscles around my knees feel very stiff and I have to massage them. If I over-do-it, my knee swells up. I have learned that I can do most exercises if I modify them. I still do yoga, I still walk, I still use weights and I do squats and lunges. I just modify and it works for me. This article helped me and the comments helped me by letting me know that I am not alone with my occasional knee pain. I know that keeping mobile is the answer. I know that keeping my circulation going alleviates the pain. Thanks again for your great article. Report
I just had a total knee replacement in December ,right it keep busy doing my total knee replacement excercise. I know Ihave to be carefully of the knee and excercises I do. Low impact excercise are good. Have to watch I don't put to much stress on the knee so it well last. Trying to figure out I can do and should not do. Report
Had occasional knee pain since high school. Sometime so bad can't do stairs. Started getting back into shape with gentle ballet exercises. Demi-plie', releve', tendue, passe. Starting out with small movements. (barely lifting the foot from the floor for passe and not at all for tendue) then more. Eventually my knees and more importantly the muscles around my knees got much more strength so I didn't almost collapse when having do take a stair. Report
I have had both knees replaced. My problem is doing floor exercises, (because the surgeons tell you not to kneel on your knees!). Getting down and the up off the floor. Is there another way to do these exercises, especially abs. Ladyella 4 Report
I had arthroscopic knee surgery done on 2-27-13 and am still recovering slowly. Due to the knee pain for the last 5 years, I have gained a lot of weight and am now starting to make some changes to get healthy, and lose some weight. I am taking it slowly, only doing what I comfortably can with my knee still recovering, but I am hopeful. I do find that walking on my health walker, gazelle like machine is helping somewhat. Thanks for the article.
Thanks for the article. I recently had arthroscopy surgery in my right knee for the second time. I am looking at a total knee replacement soon. Exercising has been painful for me. I am glad that you mentioned the DOD knee donut. I am considering giving that a try, as well as the suggestions in this article. Report
Thank you so much for addressing this point and for the great modification tips. Report
I have had knee issues for years. Ever since I tore the cartilage. Since my surgery, I AM better, though I still can NOT squat, or sit on my knees. Still taking hylauronic acid is what did give me back my mobility. I also take ALOT of antioxidants with my Elations every day. That all helps. Report
I suffer from extreme knee pain. I'll have my right knee replaced in November, and the left about 6 months later. I try my best to do yoga, but even with pillows and props, it is very difficult. Once you are down, it's no picnic to get up either. I go to the pool, and it is a perfect form of exercise, for those who suffer with arthritis. Report
With JRA, my knees often hurt. I have heard countless times to work on the muscles around the joint and that would alleviate the pain. I'll try the modifications you have listed. ARCHIMEDSEII mentions yoga and I do enjoy yoga but I have the hardest time holding positions without the joints becoming stiff. I do think I just have to be more dedicated and consistent to see real improvement! Thank you for the blog! Report
Please in the interest of saving your knees do NOT stop at parallel when doing squats, it places shear forces on the knee joint. The current research has demonstrated the fallacy of the parallel squat myth.

This is a reference, Are full squats bad for the knees This forum will not allow the posting of a web address so convert to a url to read article. Report
I have also found in working with my trainer that often knee pain can also be related to weaker muscles on the inside or outside of the upper leg since many workouts seem to mainly focus on the quads, hamstrings and glutes. Making sure I work all the leg muscles (inner and outer thigh) often has helped with some of my knee pain as well as stretching real well after any workouts. I still have knee pain and cannot do the kneeling pose or frog poses in yoga, but hopefully it will get better as I continue to work on it.
Of course age may be a factor too!! ; ) Those parts do wear out as others have mentioned with tears and arthritis. Report
Thank you for this timely article. I have osteo arthritis in both knees. Swimming is wonderful and pain free, however , summer is over. I started doing exercise videos in September and started with severe knee pain in one knee. Since then I have not done squats or lunges. I will be trying some of your suggestions and hope and pray for better success. Report
Thanks for this article. I will be using several of these suggestions as I'm sure many of us older Sparks will be. Exercise is so important and we need to find ways to continue to be active without pain or injury! Report
It would have been more informative if the article included a side view of the squat. The proper form is to sit back as if you were sitting down on a chair, with the knees never going beyond the toes. But the view shown is forward facing, so you can't tell whether the woman is doing it correctly.

For the lunge, you should have shown the modified lunge, where you lunge backwards. Instead of going forward on the working leg, you move the working leg behind you and bend at the knee. This puts less pressure on the knee joint, but still gives a good workout. Report
I started experienced a little discomfort in my left knee when going uphill a few weeks after I started riding my bike to work everyday (daily total: 20 miles). Even though I'm relatively short (5'4"), it turns out that the frame of my bike is too small for me. My seat was too low. I worked harder at pedaling, and I never got a full stretch in my left leg. It would always start to bother me about half way through the trip home.

Rather than spring for a new bike, my physical therapist took some measurements and helped me modify my bike to suit my needs. I bought a new seat and a longer seat post, and I adjusted my handlebar upwords as well. She gave me an exercise to do as well.

Now I only feel the occasional twinge in my left knee, so I think it is getting better. I'm also moving a lot faster, and I now enjoy going uphill. Report
I've recently been diagnosed with Bone on Bone arthritis due to knock knee alignment problems. Lunges and squats were what caused me to go get the pain checked out. Shot reduced pain and swelling but nothing will fix it except knee replacement in 10 years...bummer. Report
I found the info to be very helpful. Report
Great info! Thanks! Report
I tore my menicus 3 years ago and had an operation. I have never recovered from the operation and there is usually a lot of fluid swelling whenever I do exercises. This article is helpful and I will try more modifications. I do use a stationary bike and it is helpful in stretching the bad leg. The one thing I miss is step aerobics. Report
I have a torn meniscus from a few years ago and was inactive for a while after the injury. But with my weight loss and increased walking/strength exercises it doesn't hurt nearly as much. I do have to modify my squats, etc., however to avoid a flare of the pain. Report
While reading up on the benefits of increasing water intake I ran across an article about how adding water can help keep your joints hydrated and moving more smoothly. It was a very scientific explaination and I cant remeber all of it but I know it worked for me. Even just a small weight lose with the extra water and the "stick-to-it-ive" to get moving have made a difference. Report
Walking and modified exercises really works for me. This article gave me more ideas and options. Thank you. Report
I have pain with lateral movements---like in zumba. Any thoughts on that one? Report
I am finding that just walking and doing modified knee exercises (like in the blog) has actually decreased my knee pain. Report
Sometimes it's so difficult to exercise, my knees are so bad. I'm sure I'm looking at arthritis in those areas but I don't let it stop me- right now. The modifications listed here, I already use. I was praying for something more but I'll be fine. Thanks for the article. Report
I have really bad knees. I blew the ACL on my right knee years ago and it's been screwed up ever since. What do I do ? I modify my exercises so that I'm not putting too much stress on my knees. Also, a few years ago, I learned that yoga could help improve people with bad knees. I figure it couldn't hurt. Well, I am glad I did it. Yoga has helped my knees a lot. They aren't perfect. never will be.

But, I have seen subtle improvements. I do have a bit more mobility and as a result, fewer overall problems.
I am looking at having double knee replacements and found this article very helpful and was happy to see that I was already doing some of the modifications. Thankfully I live in South FL and am able to be in the pool almost every day. Report