If your knees hurt, every instinct tells you to protect them. Stop squatting. Take the elevator. Skip leg day. Wait until things settle down before doing anything demanding.
The research points almost entirely the other way. Loading your knees properly, with weight that goes up over time, is one of the most consistently supported things you can do for knee pain in the whole exercise science literature. Not resting it. Loading it.
This is the most common thing people bring to us. Out of the last forty people who told us about a physical limitation before starting, knees came up more than anything else, ahead of backs and shoulders. Most had been working around it for years, and the working around had quietly turned into not training at all.
What the research says
Exercise therapy is a first-line treatment in knee osteoarthritis guidelines worldwide. That’s not a gym theory or a fringe position. It’s the clinical default.
A 2025 network meta-analysis pulled together 46 randomized controlled trials covering 3,463 people and found resistance training significantly improved pain, stiffness, and physical function. An earlier meta-analysis of 17 trials and 1,705 patients found the same thing on pain.
Two details from that 2025 analysis matter if you’re actually going to do this. The effective dose sat at moderate intensity rather than light, and the timelines that produced results were measured in months, not weeks. Weights too easy to be challenging didn’t get there. Neither did six weeks of effort followed by quitting.
One honest caveat, because you should be suspicious of anyone who doesn’t give you one. A 2024 Cochrane review rated the certainty of this evidence low to moderate, with results that varied between individuals. Strength training reliably helps a lot of people with knee pain. It isn’t a guarantee for every knee.
Why loading helps when resting doesn’t
The instinct that pain means damage, and damage means rest, is reasonable. For joints it’s usually wrong.
Your knee is held in position and controlled by the muscles around it, mainly the quadriceps, hamstrings, and glutes. Weak quads are associated with worse knee joint outcomes. When those muscles are underdeveloped, more of the load goes through the joint structures themselves instead of through the tissue built to handle it.
Rest makes that worse in both directions at once. The muscle gets weaker, so the joint takes more of the load. And the tissue sees less load overall, so less of it starts to hurt. That’s the trap most people with sore knees are stuck in. Every month of avoidance lowers the point at which the knee complains, which gives you a reason to avoid more.
Progressive training turns that around. Stronger muscle takes back load the joint was absorbing. Tissue that gets exposed to gradually increasing demand starts tolerating more of it. The knee isn’t being repaired so much as surrounded by a system that can do its job again.
What good coaching around a knee looks like
The word doing the work in every study above is progressive. Not heavy on day one. Not the same weight forever. Start where you are, go up over months.
In practice that means a handful of judgment calls that are difficult to make for yourself:
- Where to start. The right first load challenges the muscle without setting the joint off, and that point is different for every knee.
- What to swap. Most exercises have variations that change how load runs through the knee. Finding the version yours tolerates usually beats cutting the movement out entirely.
- How to read what it’s telling you. Some discomfort during training is normal and means nothing. Some is information. Knowing which is which is what an experienced coach gives you that an app can’t.
- When to add weight. Go too slow and the training stops doing anything. Go too fast and the knee lets you know about it for a week.
That’s why nobody gets handed a program on day one. Everyone starts with the Transformation and Fitness Strategy Session, a 60 minute in person appointment before training begins. It covers your goals, training history, lifestyle, schedule, current ability, and any pain or joint concerns, and it includes a physical assessment. A knee that hurts going down stairs and a knee that hurts after sitting are telling you different things, and neither one shows up on a questionnaire.
What we don’t claim
We’re strength and nutrition coaches, not physicians or physical therapists. Coaching doesn’t diagnose anything, doesn’t treat injury or disease, and doesn’t replace medical care when you need it. If you’ve got knee pain you haven’t had looked at, go get it looked at.
What coaching does is build training around what your knee currently tolerates and expand that over time. For a lot of people, that’s exactly the thing the research supports.
The cost of waiting until it feels better
The version of this we hear most often is some form of: I’ll start once the knee settles down.
Knees rarely settle down on their own while the muscle around them keeps getting weaker. Meanwhile the years go by. Muscle mass declines with age without a training stimulus, and it picks up speed after the mid thirties. Somebody waiting for their knee to feel better at forty is often still waiting at forty five, with less muscle than they had, which makes starting harder rather than easier.
Starting from a compromised position is normal. Almost everyone we work with does. Some have never trained seriously in their lives. Others trained hard once and lost it to an injury or a stretch of work that ate everything. Neither is a reason to wait.
Training with knee pain in Dallas
Gryffon Performance is in person strength and nutrition coaching in Dallas, TX, out of a private 15,000 square foot facility. Training gets built around what your body currently does, including the parts you’ve been working around.
If your knees are the reason you haven’t started, that’s not a disqualification. It’s most of the reason to.
Apply for coaching and tell us what your knee has been doing.
Related reading: strength coaching in Dallas and personal training in Dallas.
This article is general information about exercise research and is not medical advice. It does not diagnose or treat any condition. If you have knee pain, speak with a physician or physical therapist.
References
- Optimal resistance training strategies for knee osteoarthritis symptom relief: a systematic review and network meta-analysis. BMC Musculoskeletal Disorders, 2025.
- The effects of resistance exercise in patients with knee osteoarthritis: a systematic review and meta-analysis, 2015.
- Cochrane review of land-based therapeutic exercise for knee osteoarthritis, 2024.
- Gong Z, et al. Quadriceps strength and knee joint structural abnormalities. BMC Musculoskeletal Disorders, 2022.