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How to train someone w/ Knee Pain

Apr 18, 2023


How to train

w/ Knee Pain

SUF-CPT's understand the human body, and the average trainer understands their body. That's how you know you are in good hands when the trainer has SUF-CPT, takes time to assess and has a team to refer out if need be (Show Up Fitness Level 2 teaches trainers how to build a book of business around a TEAM of physical therapists, registered dietitians and doctors.)

Muscles around the knee

The knee is one of the most complex joints of the human body. There are a lot of muscles: Quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris) Hamstrings (biceps femoris, semimembranosus, semitendinosus), Sartorius (medial, longest muscle of the human body – read more HERE), IT-Band (thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius, tensor fasciae latae muscles and inserts into Gerdy’s tubercle on the anterolateral aspect of the tibia – read more HERE), Gastrocnemius (only calf muscle; soleus does not cross the knee joint), and the popliteus & plantaris (small posterior knee muscles of which the latter is absent in 7-20 % of the population – read more HERE)

Ligaments, tendons, &

connective tissue

around the knee

A ligament connects bone to bone; a tendon connects muscle to bone. The four ligaments around the knee are (could there be a 5th knee ligament? Read more HERE):

ACL – Anterior Cruciate Ligament (Cruciate in Latin means CROSS)

PCL – Posterior Cruciate Ligament

MCL – Medial Collateral Ligament

LCL – Lateral Collateral Ligament

Quadriceps Tendon – Connects the four quad muscles into the patella.

Patella Ligament – Connects the knee cap (patella) to the tibia (shin bone)

Meniscus (medial & lateral) – C-shaped cartilage that sit between the tibia (lower leg bone) and the femur (thigh bone) and protects the lower part of the leg from the shock created by our body weight – read more about the menisci HERE.)

Common Knee Injuries

Common knee injuries can be seen over on our partners at The PreHab Guys and their website and amazing app: Runners Knee (patellofemoral pain syndrome), Jumpers Knee (patellar tendinopathy), ACL tear, IT Band (iliotibial band) friction syndrome, Meniscus tear – Read more about knee injuries HERE.

How to train clients

with knee pain

The adage of “When in doubt refer out” remains true today, but there's a grey area. When you have a detailed background in movement and have a team of physical therapists who you consult with, SUF-CPT's can take clients through movement patterns with proper regressions to find appropriate exercises for the individual. It's unrealistic to train 100% out of pain. I suggest eliminating shooting and throbbing pain (especially if it's still swollen) and then explaining to your clients that pain is multi-factorial as illustrated in the following image. As long as the pain doesn't hurt significantly more during the exercise and/or worse after the movement – then it's probably fine. All things that the qualified personal trainer will be able to determine with their experience.

Full body workout

with knee pain

Warm – up using positive words for your client. For example, “Lets foam roll your adductor muscles as it can help with knee pain.” Begin in the sagittal plane of motion, then move into more complex movements that tackle the 10-check points of a warm-up.

1- C1 (Core, Core, Accessory)

Core – Uni-lateral – Side Step-Up (a lot of clients report of anterior knee pain with the step-up, by applying pressure to drive the knee out OR doing a frontal step-up significantly help with knee pain.)

Core – Horizontal Push – Push-Ups

Accessory – Planks

Perform 6-8 step-ups, 3-5 help with assisted push-ups (band under stomach) and/or eccentrics, planking for 15-30 seconds alternating leg lifts w/ abduction, adduction, extension.

2- C2 (Core, Core, Accessory)

Core – Hinge- Bridge

Core – Horizontal Pull – Aussie Pull – Ups – (try chaos aussie's here)

Accessory – Side Planks

Perform 10-15 bridges, 8-12 Aussies and side planking for 15-30 seconds alternating leg lifts w/ abduction, adduction, extension.

3- C3 (Core, Core, Accessory)

Core – Squat – Body weight / Goblet

Core – Vertical Push – Landmine Press w/ trainer engagement HERE


Perform 10-15 squats, 10-15 landmine press w/ trainer engagement and everything pallof video has plenty of variations.

MOST IMPORTANTLY, if a client grimaces, regress the movement and/or plane of motion.

How to become a


personal trainer

Show Up Fitness CPT has a 2-month in-person internship in Los Angeles and San Diego (The next class is June 5th until end of July), DAILY live calls that are recorded on-demand within the Show Up Fitness App. Great trainers are made by asking questions and learning from professionals, not by reading a textbook. If you want to schedule a zoom call to speak with Chris Hitchko,

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