Short answer: there's no single best exercise. The best exercise for knee pain is one that builds strength around the knee, doesn't flare your pain, and that you can do consistently. For most people that means strengthening your quadriceps (the muscles at the front of your thigh) and your glutes, plus low-impact activity like walking or cycling.
If your knees hurt, it's tempting to rest them completely. But for many people, the right kind of movement is part of the solution.
Why there's no one-size-fits-all exercise
Knee pain has many causes. It might be wear and tear (osteoarthritis), pain around the kneecap, an old injury, or a sore spot that flares up when you do too much. What helps one person may irritate another.
That's why the best approach is usually to:
start at a level your knee can tolerate
strengthen the muscles that support the joint
build up gradually
adjust based on how your knee responds over the next day or so
Why your quadriceps and glutes matter for knee pain
Your knee is a hinge joint that depends on the muscles around it for support. Two groups do most of the heavy lifting: the quadriceps at the front of your thigh and the glutes at your hip.
Quadriceps. The four quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis and vastus intermedius) straighten the knee and control how it bends. When you walk down stairs, lower into a chair or step off a kerb, your quads work eccentrically, which means they lengthen under load to slow your body down. That absorbs force that would otherwise pass straight into the joint surfaces and the tissues around the kneecap. Weak quads are commonly seen in people with knee osteoarthritis and kneecap (patellofemoral) pain, and quad strengthening is a core part of exercise therapy for both.
Glutes. The gluteus maximus extends the hip, which drives you up out of a chair or up a step. The gluteus medius and minimus keep your pelvis level when you stand on one leg, and you're on one leg every time you take a step. When these muscles can't control the pelvis and thigh, the thigh can drift inwards and the knee can collapse towards the midline, often called dynamic knee valgus. That changes how force travels through the knee and has been linked to kneecap pain. Current guidance for kneecap pain generally supports strengthening both the hip and the knee muscles, not the knee alone.
A chain, not a single muscle. Your hip, knee and ankle share the load when you squat, step and walk. If one link is weak, the others, and your knee, tend to pick up the slack. Forces through the knee can reach several times your body weight on stairs, so strong quads and glutes to share that load really matter.
Strength isn't the only factor in knee pain, and weakness isn't always the cause, which is why a proper assessment is worth it.
Strengthening exercises to try
These exercises load the quadriceps and glutes in different ways, so you build strength through the whole thigh and hip. Move slowly, control the lowering phase, and keep things comfortable.
1. Wall Sit. Start with your back against a wall with your feet shoulder-width apart and about 2 feet from the wall. Slide your back down the wall keeping your shins vertical. The deeper you go, the higher the intensity.
2. Glute bridge. Lie on your back with your knees bent, squeeze your bottom and lift your hips until your body forms a straight line from shoulders to knees, then lower slowly. It targets gluteus maximus (hip extension) with relatively little load through the knee.
3. Terminal knee extension (with a band). Loop a resistance band behind your knee, anchored in front of you. Start with the knee slightly bent, then straighten it fully and squeeze the muscle at the front of your thigh. It works the quads through the last part of knee extension with relatively low joint load, which many people find comfortable when their knees are sore.
4. Step-ups (low step). Step up onto a low step, then lower back down slowly, pushing through your whole foot. You're loading the quads and glutes on one leg, while the gluteus medius works to keep your pelvis level and your knee tracking over your toes. Start with a small step and only go higher as it gets easier.
5. Banded side steps. Place a light band just above your knees, bend your knees slightly and take small steps sideways, keeping your knees in line with your toes. It targets gluteus medius and minimus, which control how your thigh and knee move when you stand on one leg.
A good starting point is 1 to 2 sets of 6 to 10 repetitions, two to three days a week. Add repetitions or resistance gradually.
Low-impact activities that are often knee-friendly
Movement that raises your heart rate without pounding the joints can be a good fit:
walking, starting with short distances
cycling or an exercise bike
swimming or water-based exercise
If one feels uncomfortable, try another or adjust the intensity.
How much pain is okay?
A mild ache during or after exercise is often acceptable if it settles within a day. Pain that is sharp, gets worse as you go, or leaves your knee noticeably more swollen or sore the next day is a signal to scale back.
If in doubt, do a little less next time and build up more slowly.
Common mistakes with knee pain
Stopping all exercise. Complete rest can leave your muscles weaker, which doesn't help your knee in the long run.
Jumping into high-impact activity too soon. Running or jumping too early can aggravate a sore knee.
Only stretching. Stretching can feel good, but strengthening usually plays a bigger role in rehab.
Doing it all at once. A big jump in activity is a common trigger for flare-ups.
Pushing through sharp pain. Discomfort is one thing; sharp or worsening pain is another.
When to see your GP or a health professional
Get your knee checked promptly if you have:
a knee that locks, catches or gives way
a hot, red, very swollen knee
fever along with knee pain
inability to put weight on the leg after an injury
pain that is getting worse or isn't improving after a few weeks
How an exercise physiologist can help
An exercise physiologist can assess how your knee moves, pick exercises to suit your pain and goals, and progress them as you get stronger. I had a client come to me with Patella tendinopathy, which is tendon related pain around the kneecap. She was an avid hiker, and found that hiking, particularly descending hills caused pain. We started with isometrics, these are holds, such as the wall sit above. Aiming to keep pain below a 3/10 (LINK), we progressed these exercises to isotonic (or regular) lifting movements, initially with an emphasis on the lowering (eccentric) phase of the movement, before progressing to activitiy specific movements, all the while gradually increasing volume and intensity.
At Move You Exercise Physiology, I come to you across South East Queensland, whether that's at home, a local gym or another convenient location. If you'd like a knee plan built around you, get in touch to book a session.
This article is general information only and isn't a substitute for personalised medical advice. If you have concerns about your health, speak with your GP or an accredited exercise physiologist.
