Chronic knee pain in adult lifters is almost never the knee. It's usually the hip, the ankle, the foot, or the loading pattern. The knee is just the loudest joint in a chain that's compensating. That's why most people who try to "train around" knee pain by doing leg extensions and avoiding squats end up exactly where they started after six months.
The work here is different. We figure out what's actually driving the pattern — usually a combination of two or three things — and we build a strength program that addresses the chain, not the symptom.
What chronic knee pain training actually looks like
The most common drivers I see in mid-career lifters:
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A stiff ankle. If your ankle can't dorsiflex (can't get your knee out over your toes), your knee absorbs the work the ankle should have done. We rebuild ankle range first, then re-load.
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A weak hip. Specifically, weak glute medius. If the hip can't stabilize the femur, the knee drifts in under load and the inside of the knee gets angry. We rebuild hip strength with single-leg work — split squats, step-ups, walking lunges.
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A foot that collapses. Less common but real. If the arch collapses under load, the tibia rotates, the knee tracks badly. We rebuild foot strength with barefoot work and specific cueing.
Almost no one needs to avoid squatting. They need to squat correctly, at the right load, with the right setup. The squat is the answer to chronic knee pain about 80% of the time — it's just not the squat they were doing.
Who I'm not the right coach for
If you have an acute injury — meniscus tear within the last 6-8 weeks, ligament damage, anything that requires imaging — see a physical therapist first. I don't do early-stage rehab. I do the part that comes after, when you're cleared and the gym world hands you a program written for a healthy 22-year-old.
If you've had knee surgery, I want to see you at least four months post-op with a clean handoff from your PT.
The 12-week consult
Coaching starts with a 12-week consult. Free. About thirty minutes. Bring whatever imaging or PT notes you have if you have them. If your situation needs more rehab before strength, I'll tell you and refer you out.
FAQ
Will I be able to squat heavy again? Almost always, yes. Usually within the first three months. Often heavier than you were squatting before the pain started, because we'll have rebuilt the position underneath it.
What if my knee hurts during the session? The cue is "no pain during, no pain after." If something hurts, we change it on the spot. The work is supposed to feel hard, not painful.
Do you work with runners who have knee pain? Yes — running-related knee pain is one of the most common patterns I see. The work usually focuses on hip strength and foot mechanics.
The next step is the consult.