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Working with Clients with Knee Pain

New clients come to us with a variety of needs and conditions, many of which can be overcome with focused and consistent training. One of the most challenging conditions for a trainer to work with is chronic knee pain, often seen in clients who are overweight with sedentary lifestyles. Knee pain poses a number of programming obstacles that can slow the rate of progress and make it difficult to keep your client motivated.

Causes of Knee Pain

While some clients have already had a medical assessment and are able to specify the nature and cause of their knee pain, such as an ACL tear or other injury, many others have non-specific knee pain, meaning their medical provider was unable to pinpoint the exact cause.

Some causes of non-specific knee pain include:

  • Core instability that causes misalignment of the lower extremity joints
  • Poor postural habits like locking the knees when standing
  • Muscle imbalances, with underdeveloped hamstrings and overdeveloped quadriceps
  • Tight hip flexors and tight hamstrings, with weak hip extensors, from excessive sitting
  • Excess body weight, with poor overall conditioning
  • Chronic systemic inflammation that causes knee osteoarthritis
  • Ankle instability that affects knee alignment

Most causes of non-specific knee pain can be overcome with targeted exercise and stretching, to promote joint stability and achieve optimal range of motion.

Programming for Non-Specific Knee Pain

Because the muscles of the pelvic region mediate load transfer between the upper and lower body during physical activity, core training for strength and stability is fundamental to resolving knee pain. It is not enough to train the rectus and obliques: you must train the transverse and deep core muscles as well, to establish core stability.

It is also important to remember that the quadriceps and hamstring muscles act at two joints: the hip and the knee. Many people have lax hamstrings at the hip joint and tight hip flexors, along with tight hamstrings and lax quads at the knee joint, caused from too much sitting. Establishing balance at both joints is crucial for optimal knee function.

Strategies for improving knee joint integrity include:

  • Always do a general warmup before exercise
  • Establish core stability early on
  • Strengthen the hip extensors (gluteals) and stretch the hip flexors
  • Strengthen the hamstrings from both the hip (deadlifts) and knee (curls)
  • Do extra stretches for the hamstrings at the knee and the quadriceps at the hip
  • Do not overtrain the quadriceps
  • Maintain balance between the quads and hamstrings
  • Educate about posture
  • Encourage healthy weight loss

During training, it is important to monitor your client’s perception of joint pain, and to educate them to distinguish between pain and discomfort. Never encourage your client to “work through” pain.


Keeping up with the latest research and learning about innovative approaches can take your training knowledge to the next level. W.I.T.S. is always here to help you grow your career with continuing education in fitness and business. Visit our online store to browse our course catalog, and see how far you can go as a fitness professional.

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