What Does Your Knee Pain Mean?
If you're reading this, it's likely you've felt some some kind of pain or stiffness in your knees when exercising, or maybe experience creaky noises.
These kinds of symptoms are quite common when it comes to your knees, but it can be concerning if you're feeling any kind of pain or discomfort during your workouts.
We've asked our resident exercise experts Tony Boutagy (B.HMS, Dip.Ex.Sc, ND, PhD) and Nirav Iyer (BExSS Hons) to help us decipher the most common culprits of knee pain. Keep reading for their investigative insights and best tips backed by years of research and hands-on experience.
A few words on cracks and pops
Even if you don’t have any pain or discomfort in your knee joints, you may still have noticed the odd cracks, pops and other strange noises when exercising.
Noisy knees (called crepitus, if you want to get fancy with medical terminology) are especially common when performing exercises such as squats and lunges, or other moves that involve knee extension and flexion. In fact, approximately 40% female athletes are familiar with these symptoms.
If you’re in the creaky squad, there's no need to worry - in most cases, noisy knees are completely harmless. All bodies are different, but typically sounds of clicking, popping, clenching, grinding or anything else of sorts, can be explained by physiological reasons such as:
Recent evidence shows that in many cases, knee cracking may be related to tiny air bubbles forming in the joints. When this happens quickly, real-time MRI imaging shows that it causes popping sounds. This can happen to other joints too - for example you might have also heard your knuckles pop like this.
This may sound a bit scary, but isn’t necessarily harmful in nature. Ligaments and tendons around the knee joint may stretch slightly as they pass over a small bony lump and then snap back into place, causing a clicking sound in the knee. In the knee joint, this is generally caused by the biceps femoris (hamstring) tendon on the side area of the knee joint.
There are other potential explanations for noisy knees, mostly related to anatomical structures rubbing against each other. For example, knees may pop when a fold in the knee tissue lining catches onto something; natural hypermobility; or individual physiology such as an unusually shaped meniscus.
So, when should you worry about noisy knees?
Knee noise is not usually a cause for concern, but make sure to see a doctor, a physiotherapist or a sports physician if it’s paired with any pain, swelling or discomfort.
These symptoms paired with popping or clicking may indicate damage to the ligaments or the meniscus, so don’t delay getting examined!
Even without any of the worrying signs, if your knee noises bother you, pay a visit to the pros for management tips specific to your situation - which might look like strengthening activities (such as steps ups, squats and adductor work), stretches (often or hip flexors, quads, iliotibial band and calves), or other methods to help target the anatomical structures around the knee.
Sometimes, it’s more than just an odd crack though, and unfortunately knee pain is super common in active individuals.
Let’s dive into the possible reasons for knee pain and some tips on managing it.
Overuse generally occurs in the tendons around the knee and can present above or below the kneecap; or on the inside or outside of the knee joint. The main reason overuse injuries happen is by doing too much, too quickly. From going too hard on cardio (like cycling or running), to overdoing strength exercises without sufficient rest and conditioning, it’s quite easy to acquire an overuse injury.
If you suspect overuse may be the case, it's a good idea to dial back how much you are doing until the pain recedes and then slowly build activity levels back up. The key phrase here is slow progression: start slowly with days of recovery between sessions that load the knee, and only increase activity when your body is ready to handle it.
Poor movement mechanics
Bad technique when performing knee dominant exercises is another common cause of pain. If the knee is not stabilised with the right muscles working in concert with each other, then the load can be transferred to weaker muscles or to other joints. This can then cause disproportionate loading, which is a sure-fire shortcut to pain and discomfort.
The solution is putting proper form above anything else! Use a mirror, or get a workout partner or qualified trainer to make sure you're performing lower body movements correctly, such as squats, lunges, leg presses or other knee dominant exercises. If this means dropping the weight to ensure perfect form and joint tracking, then don’t hesitate to go lighter.
Skipping the warm up
Warming up prior to your training session is super important, as it helps with:
- Increasing the temperature in your muscles
- Lubricating the knee joint and the surrounding structures
- And activating the knee stabilisers
If you are finding it difficult to stabilise the position of your limbs during complex movements, it's a good idea to complete a few accessory exercises for your ankles, glutes and the VMO (vastus medialis oblique) muscle in your quads.
As a bonus, these exercises will also strengthen the supporting structures and give you an amazing foundation for more challenging moves.
Tight muscles can cause pulling on other structures or restrict knee movement, which results in disproportionate loading of the knee joint. One good way to prevent this is to foam roll, trigger point and stretch the lower body regularly. This should be done prior to training the lower body if you tend to have achy knees in certain movements.
It’s very important to remember that even if the pain is focused in your knees, it may not be originating there! Structures around the hip, calf or hamstring can often be the culprit, so don’t overlook them either.
If you are suddenly feeling sharp pains while performing movements, dull pain at all hours of the day, or seeing swelling or other irregularities around your knee, these are signs you may have suffered an acute injury.
In this case, the best course of action is to see a physiotherapist or sports physician straight away to obtain a prompt diagnosis and come up with a plan of action.
Knee pain FAQs
Q- When doing Bulgarian split squats, I am getting pain in the front of my knee. Is there any way I can fix this?
A- Check that your knee is tracking in line with your toes and an equal sharing of load between the hip and the knee. It might be that the knee is collapsing inward or is doing all the work by travelling too far forward, allowing the heel to lift, downplaying the glute muscle. Try and sit your back knee straight down instead of pushing forward through the movement.
Q- Crab walks cause sharp pain on the inside of my knee - how can I correct my form to avoid this?
A- Make sure you are constantly pushing out against the booty band throughout the whole movement. You should feel your glutes doing the work here!
Q- During squat pulses, just below my knee cap hurts - any pointers?
A- Try and sit your butt back more each time you squat, you might be loading through your quads by initiating the movement with a knee bend!
Q- Running causes sharp pain outside of my knee. Is there anything to stop this from happening?
A- You might be tight through your ITB (side of your hip all the way down to the side of your knee). Try and trigger point or foam roll that area often and also trigger point the outside portion on your hamstring.
Knee pain and discomfort are incredibly common among new and experienced trainers alike. We hope you find the troubleshooting tips above helpful to understand and manage your knee problems.
However, if the pain is severe or persists no matter what, the best thing you can do is book in with a health professional, to ensure correct diagnosis in person and a speedy recovery!