What Does It Really Mean to Have ‘Bad Knees’?


Ah, knees. Next to backs, they’re probably the most often complained-about “oh-my-aching” body part when it comes to working out. But what does it even mean to have “bad knees”?

For active women, there are two types of typical knee-pain culprits: overuse injuries and acute/traumatic injuries. The most common overuse injury is patellar pain syndrome, or a discomfort, soreness, or pain in the front of the kneecap or slightly below it. “I call it the ‘migraine’ of the knee,” says Nicholas DiNubile, M.D., a Philadelphia-area orthopedic surgeon and author of FrameWork for the Knee: A 6-Step Plan for Preventing Injury and Ending Pain. “It happens when you overload the joint from repetitive movements—miles of running, or endless squats, lunges, and step-ups—generally from doing too much, too soon, without enough recovery.”

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He’s quick to point out that these exercises in particular aren’t bad for the knee, per se (in fact, they can help strengthen important muscles that support the knee, such as the glutes, hamstrings, and quads), but rather it’s when you make a sudden change in frequency, duration, or intensity of your workouts—like joining a CrossFit gym and doing the Workout of the Day every day, or starting a program for a race and upping your days running and mileage dramatically—that trouble can crop up.

The other type of injury, an acute, traumatic one, most often happens to the athlete who does what DiNubile calls “3-D activities,” including cutting and twisting, common in sports like tennis and basketball. Most often, the normally stable-joint knee, which is designed to go only forward or backward, torques sideways, resulting in ruptured cartilage or a torn ACL (anterior cruciate ligament). “These are often also the result of pushing too hard without proper pre-training,” says DiNubile, though he also notes that physiologically the female knee is far more vulnerable than a guy’s, with torn ACLs occurring five to seven times more often in women.

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Here’s where we interrupt this article for a Public Service Announcement: If you experience intermittent or chronic knee pain and haven’t gotten it checked out by an orthopedist or sports medicine specialist, get thee to an M.D. This article is not designed to facilitate self-diagnosis or self-treatment.

OK, now: The good news is, you can head off potential issues before they start. “Most often, knee injuries are preventable—not like getting hit by lightning,” says DiNubile. His advice for keeping knees safe from either injury type:

Ease into a New Workout Plan
This allows time for your body to acclimate to the new demands you’re placing on it. Start with sessions two to three days a week, watch your intensity and duration (a half hour might be plenty), and listen to your body. If you’re excessively sore the day after a workout, or something specific is hurting, dial it back or see a doctor. Most essential: Give yourself a day or two of rest or active recovery after a hard workout. And if you’re picking up a sport, don’t just go out and play it—train for it by strengthening and stretching the appropriate muscles to prime yourself for the stresses of game play.

Don’t Do the Same Thing Every Day
Following the same workout plan day in and out isn’t just boring—it wreaks havoc on the joints. “Your muscles can usually take a lot more of those squats and lunges than your knees can,” says DiNubile. Even when you’re training for a specific event, such as a running race or other competition, it’s essential to have cross-training days as well as days off—what DiNubile calls “balanced” fitness.

Strengthen Your Core
While you might think your leg muscles need all the attention, it’s actually poor core stabilization that can leave you weak in the knees. DiNubile recommends focusing not only on the abdominal muscles but also on the hips and glutes (using moves like planks and bridges), which are also part of the core. “Improving your all-over core strength is like getting a flu shot for the knee,” he says.

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Train for Balance and Agility
If you’re playing a sport or looking to get into one, drills that challenge balance, body awareness, and reaction speed will up your abilities come game time. And the surer you are on your feet, the less likely you—or your knees—are to go off-kilter in an intense moment on the court or field.

Do Yoga!
DiNubile says that its combo focus on core strength, balance, and flexibility, plus its low-impact nature, makes it ideal for active recovery days. Even with yoga, though, if you’ve never done it before, ease in slowly.

Consider Your Actual Impact When You Do High-Impact Activities
The pounding of running or jumping isn’t just about how your feet hit the ground. “While a lot of people take up running to lose weight, every extra pound you’re carrying adds to the impact,” says DiNubile. “Running is a great workout, but it may be wise to lose excess weight [through lower-impact means] before you start logging miles on foot.” The gist: Because running puts so much more impact on your joints for every extra pound you’re carrying, if you’ve got a lot to lose, you might be better served—from a knee-saving perspective—by beginning with an exercise that’s still calorie-burning but lower-impact. Biking, using the elliptical, even Zumba all fit the bill.

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Amy Roberts is a certified personal trainer.