Last week, I wrote about someone who was seeking advice on Reddit regarding their knee pain.  


This person had surgery for a medial meniscus tear two years ago, but was still struggling with knee pain.  



If you missed this, read more here.

Here’s what else they posted:

“Short term pain killers” for knee pain?

Since they specified “short term,” I think they probably know about the harm of taking anti-inflammatory medication – over-the-counter or prescription – long term.  



Even though millions of people take anti-inflammatories every day, like ibuprofen and naproxen, research has shown again and again how problematic it is for people trying to treat their knee pain.  


Taking this type of medication for more than a few weeks has been shown to advance the progression of knee osteoarthritis and accelerate deterioration (decrease the space between the knee bones on X-rays). (source, source, source) 



For more insights regarding the effects of anti-inflammatory medication, watch this video:

Does “strengthening the quads” fix knee pain?

Strengthening the four muscles on the front of the thighs has long been promoted as a solution for knee pain.  


This is likely because scientific research indicates that people with weaker quadriceps are more likely to have painful knees. (source, source) 



Many physicians, physical therapists, and trainers continue to believe that stronger muscles will take pressure off the knees. 


However, a 2021 randomized control trial published in The Journal of the American Medical Association debunked this belief. (source)

Strengthening muscles requires achieving a lot of fatigue by completing a challenging exercise several times in a row.  


And since the muscles on the front of your thighs cross over the front of your knees (see below illustration), this places force on your knees, essentially “squishing” everything inside your knees, including your cartilage.


This is why it’s critical to strengthen the inside of your knees – improving your knee fluid and cartilage surfaces – so that your knees won’t be harmed when you strengthen your leg muscles.

Will “quad activation exercises” help your knees?

The person who posted on Reddit clearly has done some research because they acknowledge that it’s not possible to strengthen only one of the four muscles on the front of your thighs. (source, source) 


Strengthening the VMO (the Vastus Medialis Oblique muscle) alone isn’t possible because it doesn’t have its own nerve supply.  


The nerve that tells the VMO to contract and get stronger simultaneously tells the other three quadriceps muscles to do the same.  


This is something my friend and colleague, 

Doug Kelsey, PT, PhD, has written about. 

Learn more here. 



If the mention of “quad activation” refers to isometric exercises like Quad Sets, there is good evidence that turning “on” the muscles on the front of your thighs will decrease knee pain and improve the quality of the fluid inside your knees. (source) 



Thicker, more viscous synovial fluid inside your knees will provide better lubrication and shock-absorption during your daily activities. 


This will improve how your knees feel. 


And it will prepare you for more challenging exercises and activities.

When are your knees ready for “squats/lunges”?

Frequently people with knee pain are told to avoid squats.  


But squatting is much more than an exercise completed at the gym.  



Anytime you bend or straighten your knee with your foot on the floor, you’re performing a type of squat.  


This includes standing up from sitting on a couch, crouching down to pick something up, as well as getting on or off the floor.  



Lunges are a variation of squatting that involve one leg at a time.  


Many activities involve a type of lunge, including ascending or descending stairs, playing tennis or pickleball, and gardening or practicing yoga.  



If you try to avoid all forms of squatting and lunges, your life will feel limited. 


So the question becomes when to reintroduce squats or lunges.  


And this may be sooner than you think.



Most people try stretching, foam rolling, generic exercises, medication, injections, or even stopping activity altogether. 


But those things don’t address the one factor that determines how well your knees function: Load Tolerance.



Load Tolerance is the amount of pain-free force your knee can produce or absorb for a specific movement, over a certain period of time, while still controlling that movement. 


Learn more about starting to measure your knees’ Load Tolerance here.

Key Takeaways:

  • Long-term use of anti-inflammatory medication can worsen your knees.

  • Strengthening your thigh muscles increases force on your knees, which can worsen pain and symptoms if your knee joints aren’t able to withstand this force. 

  • Gentle isometric exercises like Quad Sets can improve your knee fluid and reduce pain, creating the foundation for future strengthening.

  • Everyday movements like standing up, walking stairs, or picking something up from the floor are all forms of squatting and lunging. 

  • The key is to build Load Tolerance – your knees’ ability to handle and control movement without pain – so you can enjoy your active life without harming your knees.

Related Articles

For Inside Out Knee Health,

here's a guide to get started:

You can access it here. 


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Schedule a free 20-minute Strategy Session.  (Find your best time here.)


Disclaimer: The information in this blog post is for educational and informational purposes only and is not intended as medical advice. It should not be used to diagnose, treat, or prevent any health issue or disease without consulting with a qualified healthcare professional. The author of this blog and the website do not bear any responsibility for any actions taken based on the information provided in this blog.