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Does High Intensity Strengthening Help Knee Pain?

[read time ~2 minutes]

The vast majority of people with knee pain are told to strengthen their thigh muscles or quadriceps.

This is likely due to correlations between a lack of strength and knee pain (source & source). Moreover, many believe that stronger muscles take pressure off the knees (source).

And while this thinking is still commonly held by many physicians, physical therapists, and trainers, a 2021 research study debunked this conclusion. (Read the full publication here.)

The clinical trial, published in the Journal of the American Medical Association (JAMA), occurred over 18 months and involved 377 participants who were at least 50 years old and experiencing limitations due to knee osteoarthritis.

Participants were randomly assigned to three groups:

(1) heavy weight lifting (75-90% of their maximum ability to perform each exercise once), three times per week;

(2) light weight lifting (30-40% of their maximum ability to perform each exercise once), three times per week; or

(3) group workshops providing attention, social education, and health education, meeting bi-weekly.

Participants provided insights about their knee pain by answering the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) at the beginning of the study, after 6 months, and after 18 months. The researchers also measured the forces happening within participants’ knee joints while they walked.

At the conclusion of the clinical trial, no differences were found between the three groups of participants. They all reported a slight decrease in knee pain. And the pressure occurring at their knees did not change significantly.

Researchers concluded, “Among participants with knee osteoarthritis, high-intensity strength training did not significantly reduce… knee pain or knee joint compressive forces…” (source).

However, even with this understanding, strong muscles are still recommended.

Instead of starting with intense muscle strength training, I recommend that people with knee pain begin by strengthening inside their knees. After improving their knee cartilage health– increasing the resiliency of the surfaces deep inside their knees– they can gradually return to activities and exercises without knee pain.

This is the approach that my clients with severe knee pain use. And members of Better Knees for Life– an online program for people with tolerable knee pain– also follow this joint-first strengthening approach.

Muscle strengthening is an important aspect of fitness for active adults, but as the JAMA research article indicates, it’s not the place to start when addressing knee pain.


My colleague, Doug Kelsey, PT, PhD, and I have developed Better Knees for Life, a program for people with tolerable knee pain. Better Knees for Life offers step-by-step instructions that can be performed at home with very little equipment.

What people are saying about Better Knees for Life :

"...well thought out, easy to understand and implement."

"BKL (Better Knees for Life) is an outstanding program -- with graded exercise programs and guidelines for advancing, and outstanding support with the Zoom sessions."

"I've already recommended BKL to 2-3 friends because of the noticeable difference in reducing pain in my left knee."

Better Knees for Life helps you get stronger, feel better and maybe best of all, feel more in control of your life.

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