Today we’re going to look at 3 common scenarios involving knee pain. Knee pain shows up in the gym at a frequent rate so it’s a situation any good coach / gym will be familiar with. In many situations, folks are encouraged to “rest” through their knee pain. As we’ll discuss in this article, this is almost never the best course of action.

I say almost never because there are situations where movement should be avoided for some amount of time. These situations might include during the healing of a recent fracture or an immediate post-surgical situation.

Disclaimer: if you’re dealing with a new injury (or reduction in function), it’s probably best to start by seeing a professional and getting an accurate diagnosis.

At Brentwood Barbell, we aim to help people in pain in a few important ways:

Bridge the gap between therapy and training, I can’t tell you how many times I’ve seen folks complete a traditional therapy program full of bands and gravity resisted exercises only to be told “you’re good to go”. It doesn’t work like that.
Mitigate injuries, at least to the degree that we actually can. When folks are productively strength training, their injury risk decreases … although the risk is never fully removed.
Keep folks training productively over the long term, all the benefits we want from strength training (bigger muscles, more strength, better joint support, stronger bones, better metabolism, reduced blood pressure, improved confidence, etc. etc. all come from having a robust training history. These benefits cannot be bought or achieved during a “90-day transformation”.

Let’s break down how we would approach three of the most common knee conditions: patellar tendonitis, meniscus tears, and arthritis.

Patellar Tendonitis (aka “Jumper’s Knee”)

This is an overuse injury involving the tendon that connects your kneecap to your shin. It’s common among active adults who squat, run, jump, or train hard without enough recovery. Effectively, the tissue is unable to meet the demands, whether that’s because of too much activity and/or too little strength and function from the joints and muscles involved. Or, more realistically, some combination of both.

Training Focus

Most protocols around tendonitis will include these elements:

Reducing pain and inflammation initially
Gradual loading of the tendon (not total rest)
Strengthening the quads, glutes, and hips
Improving movement mechanics when appropriate, this may also include increasing mobility in relevant areas (hips for example).

Typical prescriptions include slow eccentric tempo squats, step-downs, and isometrics designed to rebuild tendon tolerance. Additionally, the isometrics are excellent for immediate pain reduction.

Here’s a real example of these ideas in action for a client experiencing knee tendonitis (again, this would be an individual that has already been evaluated by the appropriate medical personnel).

Initially, we would determine the athlete’s workable range of motion in the squat pattern. How deeply can they squat without pain or with minimal (<3/10) pain. Once we figured this out using a simple box squat strategy, we would then begin loading the pattern as described above.

We might start with sets of 4-6 reps, using a slow-ish tempo to the bottom of their workable range (using a 16” box for example). From here, we would progressively load the box squat each week based on response and athlete feedback.

Additionally, we include other exercises like:

knee extensions
knee curls
step downs
calf exercises (seated and standing)
hip flexors

Nothing special here but the takeaway is: tendons need progressive loading to heal. Over time, you would expect the athlete to (1) experience less pain, (2) increase his/her workable range of motion, and (3) to get stronger.

Meniscus Tears

The meniscus is a cartilage pad that cushions your knee. It acts as a cushion and a knee stabilizer. Tears can happen suddenly or gradually over time, especially in adults over 40. Most commonly, the inner or medial aspect of the meniscus is the injured area. This has implications for training as the hamstrings directly attach to this area.

Training Focus:

Effective recovery depends on the size and type of tear, but quality training in the gym would aim to:

Restoring knee range of motion (swelling reduction)
Strengthening surrounding muscles (especially quads and hamstrings)
Improving stability and balance

Deep knee bending or twisting will likely be limited early on, with a gradual return to full movement as symptoms allow.

Here’s a real example of these ideas in action for a client experiencing a meniscal tear (again, this would be an individual that has already been evaluated by the appropriate medical personnel). Typically, conservative management works best for folks that are not experiencing locking of the knee joint.

Again, we would determine the athlete’s workable range of motion in the squat pattern. How deeply can they squat without very minimal pain. Unlike our tendonitis protocol, it’s typically beneficial to be a bit more cautious around pain during exercise. Ideally, we’d want a range of motion that provokes very little (probably not zero) pain.

A great indication that we’re on the right track would be a reduction in swelling and pain associated with joint movement (in this case flexion and extension).

It’s also fair to assume that our loading progression would be a bit slower when working with a torn meniscus and more likely to be based around how the joint is responding to our loading protocol.

Like the tendonitis protocol, we would also be interested in strengthening the musculature around the knee joint.

quadriceps would be a major focus and again, I really like knee extensions
step down protocols are typically very valuable here as they seem to stimulate knee stability (I won’t refer to this as VMO training but historically, that’s been the though here), I just know that these work really well
hamstring training would also enter the picture as well, both at the hip and at the knee. Interesting, I’ve found training the hamstrings at the hip to be a better place to start, while training them at the knee can be painful initially (likely due to the insertion point of semimembranosus muscle).

The takeaway here is about restoring function while protecting tissue healing. Like our tendon-based protocol, the meniscus will respond positively to progressive loading, however, it seems to be a bit pickier in the progress. Expect to see progress followed by regression, and so on. The key here is to be patient and back off when symptoms persist / increase.

Knee Arthritis

Arthritis is a degenerative condition involving joint cartilage, and it often comes with stiffness, pain, and reduced mobility. I can’t say this enough, arthritis is NORMAL. Joints age over time like every other part of the body.

Historically, the term “wear and tear” was associated with arthritis. I guess this was to blame the person experiencing the problem or perhaps to simply discourage activity? Makes no sense to me. As you might guess, the typical prescription was to stop doing all things arthritis related (basically stop being a functioning human).

Training Focus:

Quality training for knee arthritis would be less about “fixing” tissues and more about managing symptoms and improving quality of life. Training would focus on:

Increasing joint mobility
Strengthening muscles to offload the knee
Improving walking and movement patterns (although this is a slippery slope and often gets way too much credit for the origin of the problem)
Building long-term consistency with strength training

Low-impact strengthening, range-of-motion work, and gradual resistance training are staples in good training, but these are even more critical when the athlete is experiencing joint pain.

There is really nothing new here. We would simply find the athlete’s workable range of motion and begin loading that range of motion with exercises that we feel are useful. For us, that will always involve at least some form of squatting, stepping, and perhaps lunging as these are the activities of daily life.

Somewhat like the meniscal protocol, I’ve found that the coach and athlete need to be very communicative about the loading progression. An overly aggressive approach will lead to increased pain and decreased range of motion via swelling.

In the interest of prolonged independence and mobility, you’d have a tough time making a case for anything more important than the muscles protecting joint(s) in question. As you might expect (by now), there aren’t magical “arthritis exercises”, instead you need a steady dose of lower body training using basic exercises like squats, lunges, step ups, and heel raises.

Why This Matters for Your Training

While each condition presents in slightly different ways, there are many common features amongst the various knee conditions we see folks working with. Hopefully, you’ve picked up on the theme here: smart, progressive strength training is part of the solution.

Whether you’re working through tendon pain, recovering from a meniscus injury/surgery, or managing arthritis, the goal is almost always the same: build resilient muscles, improve movement, and return to the activities you care about.

That’s why good coaching matters. An overly aggressive approach will provoke symptoms and an overly cautions approach won’t provide the necessary stimulus (this is the most common issue with rehab programs). If you’re dealing with one of these conditions, you aren’t broken and don’t need to be led out to pasture. You can train effectively and make progress back toward what you were previously doing.

At Brentwood Barbell, we regularly help clients transition from physical therapy back into real-world strength training — safely, intelligently, and at their own pace.

If your knees have been holding you back, you don’t have to guess your way forward.

Ready to see what your plan would look like? Book a Meeting with one of our coaches and we’ll put you in motion.

Hope this helps,

James