Aching knees are surprisingly common. While you may be tempted to hang out on the couch if one or both of your knees hurt, exercise — Pilates in particular — may be a much better option. It all depends on the reason for your pain.
About 25% of adults experience knee pain, according to a 2018 study published in the journal American Family Physician. The report also found the prevalence of knee pain has increased 65% over the past 20 years.
Osteoarthritis is often the cause of knee pain, especially for women and older adults, according to the Arthritis Foundation. But sore knees may also result from an injury, weak or tight muscles, obesity, overuse, or muscle imbalances.
“Establishing a correct diagnosis is super important,” said Dr. Adam Kreitenberg, a rheumatologist and internal medicine physician at Rheumatology Therapeutics Medical Center in Tarzana, California. “You’ll want to know if the pain is from, say, a fracture, meniscus tear, osteoarthritis or rheumatoid arthritis.”
Knee pain from poor biomechanics is the driver behind much of the knee issues seen by Shari Berkowitz, a biomechanist and founder of The Vertical Workshop, a studio in New York’s Westchester County that provides continuing education to Pilates instructors.
“People have a malalignment, and then irritation or strains occur,” Berkowitz said. “Over many years, it can be compounded into a catastrophic injury like a muscle tear, or it can become something that affects the cartilage and turns into osteoarthritis.”
If you experience sudden knee pain, it’s probably best initially to rest your knee, Kreitenberg said. But you don’t want to be immobile for too long. “In the long term, that results in weakness and muscle atrophy,” he said. “Working on strengthening the supporting structures of the knee, particularly the surrounding muscles, can frequently help relieve stress on the injured area, and help with flexibility and pain.”
Pilates exercises can be beneficial in warding off knee pain. The regimen was deemed significantly effective at reducing pain associated with knee osteoarthritis and osteoporosis, back pain, and neck pain in a systematic review published in the March 2022 edition of the journal Musculoskeletal Care.
Protect your knees with Pilates exercises
Even those with no knee pain can benefit from strengthening the structures supporting the knees since these joints are the largest in the body and quite complex. They are also extraordinarily powerful, absorbing a lot of force from daily activities, a process known as knee loading.
Knees absorb about 1.5 times your body weight while walking on level ground. That jumps to 316% of your body weight while climbing stairs and 346% while descending stairs, according to an August 2010 study published in the Journal of Biomechanics.
To stave off knee pain, you primarily need strong quadriceps, hamstrings, glutes and calves, Kreitenberg said. It’s also helpful to have strong hip joint muscles. “Everything is connected,” he said. “If you have a weakness in any area of your body, it can cause poor alignment and excessive force on areas where you don’t want it.”
The low-impact, simple movements of Pilates were found to improve people’s mobility, gait and postural stability in a September 2021 meta-analysis.
Here are five easy exercises to try.
Shoulder bridge prep
Lie on your back with your knees bent and your feet on the floor. Make sure your feet are parallel and a fist apart, Berkowitz said. Breathe from your diaphragm and engage your core, then lift your pelvis and spine off the floor. Hold for five breaths and then lower back down.
Half roll-down
In this Pilates exercise, you begin by sitting upright on a mat with your knees bent at a 90-degree angle and your feet flat on the floor. Place your hands under your knees with your elbows out to the side, Berkowitz said, then lightly round your spine. Inhale and roll your pelvis and spine away from the legs until your arms are straight, then exhale and roll your pelvis and spine back up.
Squat
Stand with your feet and legs parallel to one another and shoulder width apart. Lower yourself down, as if sitting in a chair, making sure to press your heels into the floor.
It’s also important to keep the middle of your knees in line with the middle of your feet, which is the space between your second and third toe joints. Hold, then rise.
“You want that proper knee and foot alignment,” Berkowitz said. “This is a huge component of why knee problems develop.”
Straight leg raise
Lie on your back with your right knee bent.
Engage your abdominal muscles and, keeping your chest open, squeeze the muscles in your left thigh and lift your left leg up to the same height as your bent right knee. Hold, then slowly lower. Repeat on the opposite leg.
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Standing hamstring curl
Stand up straight with your knees 1 or 2 inches apart. Holding onto a stable chair or countertop, slowly bend one knee to a 90-degree angle. Hold several seconds, then slowly lower your foot to the floor. Repeat with the other leg.
You can work your way up to three sets of 10 to 15 repetitions for these exercises, although Berkowitz said you generally do three sets of three to five repetitions of an exercise in Pilates.
The most effective Pilates experience to lessen knee pain would also include exercises on the reformer, a Pilates machine that facilitates precise movements, muscle engagement and body alignment, and additional mat exercises.
Experts agree these five exercises should help alleviate knee pain, although they are not cure-alls.
“While it’s impossible to say how much they’ll help any given person, incorporating these exercises could help relieve about 20% to 30% of your knee pain,” Kreitenberg said.
Berkowitz agreed. “When you have a serious thing, like an injury to a joint or an ailment like osteoarthritis, no five exercises can fix it,” she said. “They’re just a little supplement. You also have to do things like only wear shoes that stay on your feet themselves — no flip-flops, slides or backless shoes. Eat protein since you have to have muscles to support your joints. Get enough sleep. And keep moving. You have to keep moving.”
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