Strength Training with Bad Knees: My Journey as a 40+ Trainer
- Mark Edwards
- 3 days ago
- 9 min read
Table of Contents
Introduction
As a nutrition, strength and conditioning coach who's battled through multiple knee injuries as a consequence of sports-related osteoarthritis, I know firsthand how challenging it can be to maintain a strong, capable body when your knees aren't cooperating and trying to make every movement miserable. My journey through arthritis in my right knee, a cartilage replacement in my left knee, and a torn meniscus has taught me valuable lessons about adapting my strength training to help me thrive both in and out of the gym.
These aren't just words on a page; they are real challenges I've faced and continue to manage every day. My goal is to share what I've learned about strength training and conditioning, specifically with bad knees, focusing on what has worked for me, not as a prescription for what you should do.
Hopefully you can take away something from my experience that you can use and adapt to your own circumstances.
At the very least, my hope is to show you that physical setbacks shouldn’t stop you from being strong, fit, and healthy.
My Personal Experience with Knee Issues
When I first faced my knee issues, I worried my training days were over. The arthritis in my left knee made simple movements feel like a challenge, and even after having lab-grown cartilage implanted into my left knee, a post-surgery meniscus tear in the same knee and later diagnosis of early-stage arthritis in my right knee forced me to completely reimagine my approach to strength training and staying fit.
But here's the thing - these challenges led me to discover methods that not only maintained my strength but actually improved my overall functionality.
And as an added "bonus," I'd had shoulder issues for years, resulting in a rotator cuff repair and biceps tenodesis about 2 years ago. Post-surgery, training had to be thoughtful, slow, and methodical for me to get back in the game.
Believe me when I say it was tedious and very frustrating.
One of the resources that really helped was "Built From Broken," by Scott Hogan. Hogan has a very effective approach to training post-injury and post-surgery. I highly recommend his book.
A Different Approach
Through years of experimentation and adaptation, I've developed a training style that allows me to build and maintain strength while respecting my knee limitations. Now, I prioritize proper form, and focus on listening to what my body is telling me, not what my ego might be telling me.
I've had to experiment to find exercises that I could do that not only didn’t aggravate my knees, but made them stronger and more resilient. So, what worked for me? First, here's a look at my strategy, keeping in mind my limitations and needs.
My Approach: Training that Worked For Me
Prioritizing Form over Weight: This is foundational. No matter what exercise I am doing, my number one priority is keeping good form. I've learned from experience that bad form not only limits results, it often leads to further injuries. I've found that videoing my movements once in awhile to make sure I am doing movements correctly is essential. Review what you're doing. You'll often find that what felt correct actually was way off the mark.
And no, gazing at yourself in the gym mirror is NOT the way to check your form.
Low-Impact Exercises: High impact exercises, like running or jumping, took a back seat for a long time. It was frustrating, but it had to be done. Patience, young Padawan.
Gradually, I was able to begin jumping rope and doing box jumps again, but it took time. Running? It was a slow process. I began with short shuttle-runs, gradually progressing to 400m and 800m intervals.
But I had to adjust my mindset to accept that running balls-out wasn't in the cards until full recovery. Low-impact was the order of the day. I included exercises like wall sits and modified step-ups, gradually progressing to more dynamic movements involving plyometrics.
Focusing on Specific Muscles: I've realized that just targeting the area around my knee is not always best. By focusing on muscles above and below the knee, the knee itself is better supported. So, for me, exercises that target the glutes, hamstrings, calves, and quads have been key.
Some Key Movements
1. Supported Knee-Over-Toes Training - Lunges or ATG Split Squats
One of my game-changing discoveries was supported knee-over-toes movements (Both KOT lunges and ATG Split Squats, courtesy of the Knees-Over-Toes-Guy). In my experience, the key was starting with minimal range of motion and gradually progressing. I used a wall or power rack for support at the beginning, which allowed me to control the load on my knees while building strength in previously painful and unstable positions. While I don't have the joint mobility to do a full ATG Split squat, I do very well (for me) with KOT Lunges.
This has allowed me to progress back to regular weighted lunges, both forward, reverse, and walking lunges.
2. Low-Platform Step Training
After my cartilage replacement, I found that step-downs from a low platform (starting with just 3-5 inches) while holding onto support were incredibly effective. I focus on controlling the eccentric (lowering) portion of the movement, which has helped build stability around my knee joint without aggravating it.
Gradually, I increased the height of the platform to make the step-down more challenging at slow tempo. If you can maintain a 4-5 second count on the descent, that's a pretty good benchmark to increase the height of the platform and perhaps add some weight like a dumbbell or kettlebell.
3. Modified Lower Body Training
My knee issues led me to discover several variations of traditional exercises that work exceptionally well:
Cossack Squats with Support
I perform these while holding onto a power rack, or lightly placing my hands on a wall, which allows me to build lateral strength and mobility without putting excessive dynamic lateral stress on my knees. The key for me has been moving very slowly and staying within a pain-free range.
Once I was able to do them without support, I started doing them about a foot away from a wall, facing away, and pushing my hips back until my butt touches the wall. That's a good cue to ensure that the movement initiates with the hips and not the knees.
Single-Leg, Single-Arm Kettlebell Romanian Deadlifts
This has become one of my favorite exercises. It builds tremendous stability and strength while putting minimal stress on my knees. I started with very light weights using a wall as support and focused on form before progressing. Keep the trailing knee straight, toes turned in, to ensure that the hips stay flat.
Modified Squats
The main modification I’ve used with my squats is slower tempo and holds in the bottom position. A 3-second eccentric with a one-second hold in the bottom can be done weighted or bodyweight. Either way, the slow tempo forces me to be intentional and mindful of hips, foot position, knee tracking, and torso. And slowing the movement down, over time, will build resilience into knee ligaments and other tendons.
Body Weight Variations
I use a slow cadence (typically 5 seconds down, 5 seconds up) with bodyweight squats, which helps me maintain control and build strength without aggravating my knees. The slower pace allows me to really tune into how my knees are responding.
Split-Stance Training
Dumbbell split-stance squats have become a staple in my routine. By distributing the load between both legs and controlling the tempo, I've found I can train effectively with less weight while minimizing knee stress and improving structural balance for better form in standard squats. This has allowed me to gradually increase load while rebuilding the strength in the muscles around my bad knee. Absolutely invaluable.
Nordic Hamstring Curls
I often use bands to isolate my hamstrings. I focus on a slow, controlled movement. Nordic curls are also a real burner that help build eccentric strength around the knee’s support muscles. Eccentric strength is one of the keys to staying strong as we age and ultra-important when it comes to protecting the knees.
Calf Raises
I used to think that calf raises were just something bodybuilders did for show. However, if you want to reduce the risk of Achilles tendon injuries, ankle injuries, and build a solid foundation from the ground up to give the knee a solid base of support, calf isolation movements are a great way to do so.
Calf raises provide support for my knees. Living in Tokyo and using the subways, I find myself on escalators pretty often, even if I'd rather take the stairs. Don't let that time on the escalator go to waste! It's a perfect time to do Calf isometrics, calf stretches and hold. Calf isometric contractions are a great way to build a solid foundation for the knees and resilient Achilles tendons.
4. Carrying Exercises for Overall Strength
Different variations of Farmer's carries - suitcase, racked position - and overhead carries (waiter's walks) have been invaluable. for building overall strength while being cautious with my knees.. They allow me to build full-body strength and stability without directly stressing my knees, something that running might do.
I typically start with moderate weights and focus on maintaining proper posture throughout the movement.
This is a movement that's very easy to scale up or down by increasing or decreasing the weight and/or distance.
What I've Learned About Recovery and Progression
Post-surgery and post-injury, making time for recovery and doing proper progressions are critical for long-term progress. You cannot rush it. Healing takes time. Effective healing requires movement, but that movement must be slow and controlled to provide a stimulus for healing.
Sitting it out and waiting for things to get better is not the way. Movement is medicine. Just make sure it starts off slow, light, and then progress from there.
My “Minimalist” Approach
I try to keep things simple. I've learned that a minimalist approach not only keeps me consistent, but also makes the workouts more fun and less time-consuming. I don’t need a ton of fancy or expensive equipment, and I do a lot of my strength training outdoors at home. I have dumbbells, kettlebells, a jump rope, a slam ball/medicine ball, a sandbag, some heavy resistance bands and mini-bands, and a TRX. That's it.
I do train in the gym, but my point is that you can keep things very simple and still get strong.
I've also found that this minimalist approach has helped me focus on the fundamentals that are actually fun while making me stronger, healthier, and helping me to live longer.
Nutrition and Recovery
Strength training is only a part of the picture. Nutrition plays a vital role in recovery from injuries and surgery. I focus on eating a balanced diet that includes ample protein, some complex carbs, a ton of vegetables, and healthy fats. Hydration is also critical.
Alcohol. I've mostly eliminated it. It made my joints puffy and painful, even at small amounts. I was never a "drinker" but research suggests that even moderate amounts contribute to the development of osteoarthritis, increased systemic inflammation, glucose metabolism, and visceral fat levels. The latest research also shows that cognitive decline (dementia) is directly linked to alcohol consumption.
But my "mostly" abstinence began with the desire to reduce inflammation in my joints.
I also make sure to get enough sleep, which is where the body does the most important repair. I pay attention to my supplementation. I take vitamins for men over 50, and to give my body every nutritional advantage possible for its repair, I take several supplements that have shown some efficacy in tendon and joint health: l-Lysine, Type II Undenatured collagen, Types 1+3 collagen, and hyaluronic acid.
Looking Forward
While my knee issues haven't disappeared, they no longer define nor severely limit my training. By adapting my approach and listening to my body, I've found ways to stay strong and capable. The key has been patience, consistency, and willingness to modify exercises when needed.
Final Thoughts on Strength Training with Bad Knees
My journey with knee problems has taught me that strength training isn't about pushing through pain – it's about finding smart ways to work around limitations while still challenging yourself. Through careful progression and modified exercises, I've maintained my strength and even built new capabilities despite my knee issues.
Remember, this is my personal journey and experience with training around knee problems. Everyone's situation is unique, and what works for me might not work for others. Always consult with healthcare professionals about your specific situation before starting any new training program.
Disclaimer: All information provided on this website is for informational purposes only. No information provided is to be construed as medical advice. If you have medical issues, always consult your doctor..
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