Q: I am 31 years old and an on/off again treadmill runner/jogger. I tried to start running outside but it made my knees hurt too bad so I have to resume treadmill running. I know the importance of strength training and actually love lifting weights and body weight exercises. My question is this: I love how lunges make my thighs get firm but lately they are hurting my knees and now when I walk down stairs my knees speak to me. Yes, I am a bit heavy but I don’t want to give up exercise! I want to save my knees as I hope to get many more years out of them. I don’t have consistent exercise to a pool so can you suggest any leg strengthening exercises that won’t hurt my knees? Any suggestions (other than lose weight) on how to save/strengthen my knees? Thanks Erika-this has really perplexed me and I’ve skipped working out because I’m scared for my knees. 

I always hate to hear someone say that they’re skipping a workout, especially out of “fear,” mainly because in a lot of instances, activity is what you need the most… just the right kind of activity.

Whenever you’re experiencing joint pain, nine times out of ten it has to do with the way you’re moving, usually in either the thigh or the calves (or both.) As you move, all of your joints are supported by the adjacent muscles. When it comes to your major joints – shoulders, chest, pants, shoes…. uhh, I mean hips, knees, ankles (purposefully leaving out shoulders, fingers, toes, and wrists for the intentions of this post, but they are/have joints as well) – they tend to take quite a beating, and the beating only gets worse as you age particularly because many people are so sedentary throughout the day.

“Creaky” joints are only a major concern when there is pain involved with the cracking. It’s usually a result of the same kind of mechanism that allows you to painlessly crack your knuckles, neck, or back. A sedentary person that would otherwise be less active, all of a sudden starts moving (or moving in new and different ways), and it’s safe to bet that your joints are going to protest a little bit.

If you do experience pain, however, go see a joint specialist – it’s likely due to a loss of connective tissue, and that is where permanent damage can occur.

When it comes to identifying knee pain, take a long, hard look at your knee – is the pain directly on the joint, or is it just above or below? If it’s above or below, it’s related to the muscle groups responsible for the joint, not the joint itself, and it’s an easy fix.

Treadmills aren’t quite the salve we think they are. They’re human hamster wheels – the terrain never changes, there’s never any opportunity for you to increase your own pace naturally, they have their times where they’re potentially dangerous, and they actually can de-condition your body for running outdoors. Treadmills allow you to get away with running on your heels and conditions you to be comfortable with that and, once you try to do that outdoors, you struggle. In other words, consistent treadmill running can make it harder for you to run outdoors.

Long time runners will tell you – hell, I told you years ago – that you have to pick one: outdoors or treadmill. You cannot train equally on both, and outdoor running – regardless of the terrain – is infinitely better. Because the treadmill essentially bends to your movement, designed to make it easier for you to run no matter how you run, it enables you to run with poor form. When you’re outdoors, however, Mother Nature isn’t interested in your tomfoolery. The Earth does not cave to your heel striking – you land on that heel and, like a shockwave, the force moves up through all of your joints, through all of your muscle groups, eventually dissipating somewhere around your core. This is where that hip pain comes from. This is where that plantar fasciitis comes from. And, this is where that knee pain comes from.

At the same time, that outdoor terrain is how your body changes – your legs get leaner because your muscles have to grow and change and move differently to support you better. As your muscles are more active, your calorie burn increases and improves. Your heart rate gets higher faster, and your heart gets stronger. Your time outdoors is more effective. You get the job done faster.

So, when it comes to your strength training, you should still be doing those lunges and squats (preferably squats, so you can train both legs in the same way at the same time, alleviating the pain you might feel training one leg in one way at a time), but do them supported. Use an exercise ball to help you do your squats and lunges (be sure to place a blanket or a pillow on the ground for your kneeling leg, so that you’re not grinding your kneecaps into the ground when you lower your back knee.)

Also, check out your running form. Kiss the treadmill goodbye – or, at least, no more running on it (walk/speed walk in intervals instead!) and definitely no training for events on it – and focus your genuine running outside, and use this as an opportunity to tighten up that form. It might mean you have to go slower, but that’s okay. Fast runners were slow runners (and, even walkers) once upon a time, too, so you don’t have to feel like you’ll never pick up speed or endurance.

I’d also recommend a knee brace for the time being. Something is going awry in your legs, and it could be temporary or permanent. While you work to strengthen the muscles that support those joints and tighten that running form up, the knee brace will help you remain mindful of your movement – focusing your movement in the right direction, no knees going outward to the side instead of forward – and help you feel supported in your knee, thereby better strengthening your muscle groups.

You don’t have to give up anything, but you do have to go slowly and take your time. When it comes to those sounds in your knee, pay close attention. I had this issue in the beginning, and it went away after a couple of months of consistent, but mindful training. If yours doesn’t, don’t be afraid to go see a specialist to get some insight – unattended knee pain can quickly turn into hip pain (because you’ll eventually start walking differently to avoid the knee pain, only aggravating the hips) and then you’ll really be up a creek.

Stay consistent, stay conscious of your needs, and don’t be afraid to slow down or stop when your body fights it… and I promise, your knees will go back to giving you the silent treatment!