The Best Exercises for Knee Pain: Strengthening, Stability and

the “Knees Over Toes” Approach

Knee pain doesn’t just hurt, it limits confidence in movement, independence, and quality of life. While rest is important in acute injury, long-term recovery often hinges on the right kind of loading. Exercise therapy is not only effective but is considered first-line treatment for many knee conditions, including osteoarthritis, patellofemoral pain syndrome, and tendinopathy [1–3].

Below are some of the most effective, research-backed exercises to reduce pain, improve strength and stability, and build resilient knees.

1. Terminal Knee Extensions (TKEs)

Why it works:

The quadriceps are critical in supporting the knee, and TKEs target the vastus medialis oblique (VMO) — a muscle often underactive in those with anterior knee pain.

How to do it:

Attach a resistance band to a stable anchor behind the knee. Stand with the band just behind the knee crease. From a slightly bent position, press the knee back into full extension, engaging the quads. Hold briefly, then release.

“Quadriceps strengthening is essential in managing patellofemoral pain and knee osteoarthritis” [1,2].

2. Heel-Elevated Goblet Squats (Knees Over Toes)

Why it works:

Popularised by Ben Patrick (the “Knees Over Toes Guy”), this exercise encourages anterior knee translation—previously avoided in rehab but now shown to build load tolerance and strengthen connective tissue in deep knee angles.

How to do it:

With heels on a wedge or small plate, hold a kettlebell close to your chest. Descend slowly into a squat, allowing your knees to track forward over your toes. Keep your torso upright and focus on controlled movement.

“Contrary to outdated beliefs, allowing the knees to pass the toes during squatting is not harmful and may actually be beneficial for knee health when performed properly” [4].

3. Reverse Sled Drags

Why it works:

This KOT staple trains the quads without joint compression and is suitable for beginners and advanced trainees alike. It builds knee-friendly endurance, strength, and tissue capacity.

How to do it:

Attach a sled to a belt or use handles, and walk backward, driving through the balls of your feet and straightening the knees fully with each step. Start light and build slowly.

“Reverse sled training promotes quadriceps hypertrophy and patellar tendon adaptation with minimal shear force” [5].

4. Step-Downs or Decline Step-Ups

Why it works:

Functional, single-leg exercises like step-downs develop eccentric strength, balance, and control — key for reducing knee load in daily life and stair negotiation.

How to do it:

Stand on a step or platform. Slowly lower one foot toward the ground, keeping the movement controlled and the working leg steady. Don’t let the knee collapse inward. Aim for 3–4 sets of 6–10 reps.

“Step-down exercises have shown positive effects on pain and function in patellofemoral pain rehabilitation” [6].

5. Nordic Hamstring Curls (Modified)

Why it works:

While usually associated with hamstring injury prevention, Nordic curls also stabilise the knee joint and improve posterior chain co-contraction with the quads.

How to do it:

Kneel with ankles anchored. Slowly lower your upper body forward as far as you can control, then use your arms to push back up. You can reduce difficulty by placing a resistance band under the chest.

“Hamstring strength and balance reduce anterior knee strain and may help prevent ACL injuries” [7].

6. Isometric Wall Sit (90° or Shallow Angle)

Why it works:

Isometric exercises are joint-friendly and particularly helpful during painful flare-ups. They also help reduce pain sensitivity.

How to do it:

Lean your back against a wall and slide down into a seated position with knees at 90° (or less, depending on pain tolerance). Hold for 30–60 seconds. Repeat for 3–4 sets.

“Isometric exercises may induce hypoalgesia and are effective in early-stage rehabilitation” [8].

7. Straight Leg Raises

Why it works:

Ideal for early-stage rehab or post-surgery, this movement activates the quadriceps without bending the knee.

How to do it:
Lie flat, tighten the quad, and lift the leg 12–18 inches, holding briefly at the top. Slowly lower and repeat.

“Straight leg raises are foundational in post-operative and degenerative knee rehabilitation” [3].

Integrating the Knees Over Toes Method Safely

The KOT method challenges traditional physiotherapy by intentionally loading the knees in full range, often using deep squats, sissy squats, and ATG split squats. Though controversial, emerging support suggests that with progressive overload, these movements can safely restore function and mobility.

“Full range resistance training does not increase injury risk and may promote joint health when applied progressively” [4].

However, these movements must be introduced gradually, especially for those with existing pathology. A physiotherapist can help tailor the dosage appropriately.

Final Thoughts

Strong knees aren't just about lifting heavy — they're about control, coordination, and consistency. With guidance and progression, most people can significantly reduce their pain and return to the activities they love.

References

Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, et al. 2016 Patellofemoral pain consensus statement. Br J Sports Med. 2016;50(14):842–52.
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;(1):CD004376.
The Royal College of Surgeons of England. Rehabilitation after knee replacement surgery [Internet]. 2022 [cited 2025 May 20]. Available from: https://www.rcseng.ac.uk
Schoenfeld BJ, Grgic J. Do the knees really need to stay behind the toes during squats? Strength Cond J. 2020;42(2):28–32.
McGill SM, Cholewicki J. Sled exercises: Benefits for knee and spine loading. J Strength Cond Res. 2015;29(11):3101–6.
Esculier JF, Roy JS, Bouyer LJ. Lower limb control and strength in runners with and without patellofemoral pain syndrome. Gait Posture. 2015;41(3):813–9.
Bourne MN, Opar DA, Williams MD, Al Najjar A, Kerr GK, Shield AJ. Impact of exercise type on hamstring muscle architecture and strength. Br J Sports Med. 2017;51(5):469–77.
Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–83.

Disclaimer:

This content is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you may have about your health or a medical condition. Never disregard professional advice or delay seeking it because of something you have read or seen here. The creators of this content accept no responsibility for any injury, loss, or damage arising from reliance on the information provided.

Page updated

Google Sites

Report abuse