How to Train Clients With Knee Injuries (Step-by-Step Guide)

How to Train Clients With Knee Injuries (Step-by-Step Guide)

Training clients with knee injuries can open up a new client base for a personal trainer. But, it’s important that you have the proper tools to train someone with knee injuries effectively. Using certain personal training software features can help you learn how to train clients with bad knees. Find out how to train clients with knee problems and learn about what tools you’ll need to train someone with knee injuries in this guide by Exercise.com.

  • Training someone with knee injuries requires a comprehensive assessment to determine the mechanism of injury and contraindicated exercises.
  • Most clients with knee injuries experience pain on the anterior (front) side of their knee and will need to temporarily remove things like jumping, running, and lunging forward from their training program.
  • Incorporating workout and assessment software can help prioritize your client’s safety while helping them reach their goals with fewer setbacks.

Breaking into training special populations, like training clients with knee injuries, can be a rewarding way for personal trainers to add a new stream of revenue to their fitness businesses.

To train clients with knee injuries, it’s important that you’re not only well-versed in knee injuries, but that you have the tools in place to make your training as effective as possible; that’s where personal training software comes into play.

By taking advantage of the features that the best online personal training software has to offer, you can train clients with knee injuries in a way that works for them, not against them.

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Learning How to Train Clients With Knee Injuries

To learn how to train clients with knee injuries, it’s imperative that you have a thorough understanding of common knee injuries and why it’s important to follow certain procedures with these clients.

What are common knee injuries?

The knee is an oft-injured joint that absorbs a large percentage of the impact that we experience day to day. Many of the common knee injuries affect the anterior (front) portion of the knee, according to MedLine. Some of these injuries include:

  • Osteoarthritis
  • Patellofemoral Pain Syndrome (Runner’s Knee)
  • Patellar Tendonitis (Jumper’s Knee)
  • Anterior Cruciate Ligament (ACL) Tears
  • Meniscus Tears

These are common injuries that might cause pain somewhere around the patella, whether it be superior, inferior, or deep to the patella. Anterior knee pain is the most common, but there are some other injuries that occur regularly, including medial collateral ligament (MCL) tears.

ACL and MCL tears are more common in athletes, while most other sources of anterior knee pain are common to the general population. It’s important to know the difference between anterior, medial, or lateral knee pain. While each type of pain might impact the same joint, procedures differ when determining how to remain active with a knee injury depending on the type.

Do you need to be certified to train clients with knee injuries?

Becoming a certified personal trainer (CPT) often provides you with a foundational knowledge of the body and how to train most normal clients. Where those certifications lack is providing applicable modifications and procedures when training clients with a knee injury or other condition.

To better prepare yourself to work with clients with knee injuries, there are some desirable certifications, listed below.

  • NASM Corrective Exercise Specialist (CES)
  • ACSM Certified Exercise Physiologist (ACSM-EP)
  • NSCA Special Populations Specialist (CSPS)

The aforementioned certifications will help trainers better prepare for common conditions that will need some accommodation. While a CPT might teach you the fundamentals of flexibility and strength, these certifications can help you learn some knee-friendly exercises to help with knee pain.

Training Clients After a Knee Injury

Working around exercise and knee pain isn’t always easy. Knee pain presents itself with different locations and limitations from person to person. For starters, you typically want to stay within a pain-free range of motion. It always helps to start with adequate warm-ups to prepare the affected knee for exercise.

Some theories suggest that knee pain is driven by other limitations in the kinetic chain, more specifically, the ankle or the hip. In short, if someone is experiencing anterior knee pain, the problem might stem from weakness or stiffness that causes an excessive force on the knee joint instead of a more even distribution of weight between all three joints.

If this were to be the case, your client may need to emphasize stretching of the direct and surrounding joints. Most notably, they would want to stretch the quadriceps, hip flexors, gluteal muscles, and calves (soleus and gastrocnemius).

Depending on the knee injury, you may need to emphasize knee stability exercises or knee strengthening exercises. Some good exercises for starters are terminal knee extensions (TKEs) and bridges. TKEs help to stabilize the anterior portion of the knee while bridges help posteriorly.

TKEs and bridges are just two examples of available knee strengthening exercises at home. If you’re trying to learn how to strengthen knee ligaments, you can perform these exercises while exaggerating the eccentric (lengthening) phase or by performing them isometrically. This basically means you would produce a full contraction and hold that position for 20 to 30 seconds.

There are a considerable number of clients that will exercise with bad knees to lose weight. Virtually anyone can lose weight, but there are some exercises to avoid if you have bad knees, especially if you have anterior knee pain. You’ll want to avoid exercises that require a great deal of shear force on the knee.

Some examples of exercises to avoid with knee injuries include:

  • Forward Lunges
  • Stair-Climbing
  • Pistol Squats
  • Heavy Knee Extensions (Machine-based)
  • Jumping

Over time, these exercises may be able to be implemented back into a training regimen. During the initial stages of recovery, you’ll want to re-establish movement patterns to alleviate some of the stress on the knee joint. Most commonly, this means developing the posterior chain with exercises like Romanian deadlifts (RDLs), good mornings, or bridges.

Knee injuries are a common concern for many individuals, especially those who engage in physical activities or sports. As a trainer, it is essential to have a comprehensive understanding of knee injuries and how to effectively train clients who experience them. This article aims to provide you with a detailed guide on training clients with knee injuries, offering insights into the common causes of these injuries, the different types clients may experience, and the importance of proper assessment and diagnosis.

Understanding the Common Causes of Knee Injuries

Knee injuries can occur due to various factors, including sudden trauma, overuse, or degenerative conditions. Understanding the common causes of knee injuries can help trainers tailor training programs to address specific factors contributing to the injury. Sudden trauma, such as a fall, collision, or awkward landing, can cause significant knee damage. Overuse injuries, on the other hand, result from repetitive stress placed on the knee joint, leading to inflammation and discomfort. Degenerative conditions, like osteoarthritis, can also contribute to knee injuries, as the joint’s cartilage wears down over time.

It is important to note that certain sports and activities can increase the risk of knee injuries. Sports that involve jumping, pivoting, or sudden changes in direction, such as basketball, soccer, and skiing, put a significant amount of stress on the knee joint. Additionally, individuals who have poor biomechanics, such as improper alignment or muscle imbalances, may be more prone to knee injuries. Therefore, it is crucial for athletes and trainers to be aware of these risk factors and take appropriate measures to prevent knee injuries.

Identifying the Different Types of Knee Injuries

Knee injuries can encompass various types, each requiring a tailored approach to treatment and rehabilitation. Some of the most common knee injuries trainers may encounter include ligament sprains and tears, meniscus tears, patellar tendinitis, and patellofemoral pain syndrome. Ligament sprains and tears involve damage to the knee’s ligaments, such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL). Meniscus tears refer to tears in the cartilage cushioning the knee joint. Patellar tendinitis is characterized by inflammation of the tendon connecting the kneecap to the shinbone, while patellofemoral pain syndrome involves pain around the kneecap and its surrounding structures.

It is important for trainers to be able to identify these different types of knee injuries in order to provide appropriate care and guidance to their clients. Ligament sprains and tears can occur during activities that involve sudden changes in direction or impact, such as sports like basketball or soccer. Meniscus tears are often caused by twisting or rotating the knee while bearing weight, and can also occur as a result of degenerative changes in the knee joint. Patellar tendinitis is commonly seen in athletes who participate in activities that involve repetitive jumping or running, such as basketball or track and field. Patellofemoral pain syndrome can be caused by factors such as muscle imbalances, overuse, or abnormal tracking of the kneecap.

The Importance of Proper Assessment and Diagnosis for Clients with Knee Injuries

Proper assessment and diagnosis are crucial for designing an effective training plan for clients with knee injuries. Trainers should work closely with healthcare professionals, such as orthopedic specialists or physical therapists, to ensure accurate diagnosis and understanding of the injury’s severity. This assessment helps identify any underlying factors contributing to the knee injury, such as muscle imbalances, joint instability, or poor movement patterns. By conducting a thorough assessment, trainers can create individualized training plans that address specific weaknesses and imbalances, advancing their clients’ rehabilitation progress.

Furthermore, proper assessment and diagnosis also play a significant role in preventing further damage or complications. By accurately identifying the nature and extent of the knee injury, trainers can implement appropriate modifications and precautions during training sessions. This ensures that clients with knee injuries are not subjected to exercises or movements that may exacerbate their condition. Additionally, a thorough assessment allows trainers to monitor the progress of their clients’ rehabilitation and make necessary adjustments to the training plan as needed. Overall, proper assessment and diagnosis are essential for both effective rehabilitation and injury prevention in clients with knee injuries.

Preparing a Safe and Effective Training Plan for Clients with Knee Injuries

When developing a training plan for clients with knee injuries, trainers must prioritize safety and effectiveness. The plan should begin with a focus on reducing pain and inflammation, improving range of motion, and gradually increasing strength and stability. Initially, exercises should be low impact and non-weight-bearing, such as range-of-motion exercises and gentle stretching. As clients progress, emphasis can shift towards strengthening exercises that target the muscles supporting the knee, including the quadriceps, hamstrings, and glutes. It is essential to start with light resistance and controlled movements, gradually increasing intensity based on the client’s tolerance and progress.

In addition to exercise selection, trainers should also consider incorporating other modalities into the training plan for clients with knee injuries. These may include modalities such as heat or cold therapy, which can help reduce pain and inflammation. Additionally, manual therapy techniques, such as soft tissue mobilization or joint mobilization, can be beneficial in improving joint mobility and reducing muscle tension. Trainers should work closely with healthcare professionals, such as physical therapists or orthopedic specialists, to ensure a comprehensive and individualized approach to training.

Strengthening Exercises to Rehabilitate the Knee after an Injury

Strengthening exercises play a pivotal role in the rehabilitation of clients with knee injuries. However, it is essential to choose exercises that are safe and appropriate for each individual’s specific injury and fitness level. Some effective exercises for knee rehabilitation include leg presses, step-ups, hamstring curls, and glute bridges. These exercises help target the muscles around the knee joint, enhancing stability and reducing the risk of future injuries. It is crucial to ensure proper form and technique while performing these exercises to avoid any undue stress on the knee joint.

In addition to these exercises, incorporating balance and proprioception training can also be beneficial for knee rehabilitation. Balance exercises such as single-leg stands, heel-to-toe walks, and stability ball exercises can help improve proprioception, which is the body’s ability to sense its position in space. By enhancing proprioception, individuals can better control their movements and reduce the risk of re-injury. It is important to progress gradually with these exercises and consult with a healthcare professional or physical therapist for guidance on the appropriate level of difficulty.

Strategies for Reducing Pain and Inflammation in Clients with Knee Injuries

Pain and inflammation are common symptoms clients with knee injuries experience. Trainers can implement several strategies to help alleviate pain and reduce inflammation in their clients. These may include ice therapy, compression techniques, and elevation to reduce swelling. Additionally, using non-steroidal anti-inflammatory drugs (NSAIDs) or recommending specific supplements like fish oil or turmeric can aid in managing inflammation. Moreover, ensuring clients are properly warmed up before training sessions and incorporating gentle stretching exercises can help increase blood flow and reduce pain sensitivity.

Another strategy that can be effective in reducing pain and inflammation in clients with knee injuries is the use of physical therapy modalities. Modalities such as ultrasound, electrical stimulation, and laser therapy can help promote healing, reduce pain, and decrease inflammation in the affected area.

In addition to modalities, implementing a comprehensive rehabilitation program can also be beneficial. This may include exercises to strengthen the muscles surrounding the knee, such as quadriceps and hamstring exercises. Strengthening these muscles can provide stability and support to the knee joint, reducing pain and inflammation.

Modifications and Adaptations for Cardiovascular Training with Knee Injuries

While knee injuries may limit some cardiovascular activities, trainers can still develop cardiovascular training programs that minimize strain on the knee joint. Low-impact exercises like swimming, cycling, or using an elliptical machine are suitable alternatives. These activities provide cardiovascular benefits without subjecting the knee joint to excessive stress or impact. If impact exercises are preferred, trainers can modify them by using equipment like knee braces or selecting exercises that have less impact on the knees, such as walking on grass or a rebounder trampoline.

Building Stability and Balance in Clients with Knee Injuries

Improving stability and balance is crucial for clients with knee injuries as it helps enhance joint stability and prevent future injuries. Trainers can incorporate exercises that challenge balance, such as single-leg stands or Bosu ball exercises. Additionally, exercises that target the stabilizing muscles of the knee, such as lateral step-ups or lateral band walks, can significantly contribute to improving stability. Progressing from stable to unstable surfaces can further challenge the client’s balance and engage the core muscles, promoting overall stability.

Incorporating Functional Movements into Training Programs for Clients with Knee Injuries

Functional movements are actions that simulate real-life activities and are essential for clients with knee injuries to regain confidence and functionality. Integrating exercises that mimic daily tasks, such as squats, lunges, or step-ups, can help clients reintegrate into their daily routines. These exercises focus on enhancing strength, flexibility, and coordination, allowing clients to perform movements with more ease and safety. By gradually progressing these functional movements, trainers can assist clients in restoring their range of motion and overall functionality.

Effective Rehabilitation Techniques for Clients Recovering from Knee Surgery

For clients recovering from knee surgery, rehabilitation plays a vital role in their overall recovery and successful return to normal activities. Trainers should collaborate closely with the client’s healthcare team to develop a comprehensive rehabilitation plan that addresses the specific surgical procedure and the expected recovery timeline. The plan may include a combination of mobility exercises, strength training, and targeted stretching to improve range of motion and muscle function. Additionally, trainers can incorporate modalities such as electrical stimulation or ultrasound therapy, under the guidance of a healthcare professional, to aid in the rehabilitation process.

Understanding the Role of Nutrition in Promoting Recovery from Knee Injuries

Nutrition is a vital component in the recovery process for clients with knee injuries. Adequate nutrition promotes tissue healing, reduces inflammation, and supports overall joint health. Trainers can educate their clients on the importance of consuming a well-balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and healthy fats. Encouraging clients to stay hydrated and ensuring they consume enough protein to support muscle recovery and tissue repair are also essential considerations for optimizing recovery from knee injuries.

Tips for Managing and Preventing Overuse Injuries in Clients with Weak Knees

Overuse injuries are a common concern for clients with weak knees. Trainers can provide guidance to their clients on managing and preventing overuse injuries by incorporating appropriate rest and recovery periods into their training programs. Emphasizing the importance of listening to their bodies and gradually increasing training intensity can help clients avoid pushing themselves beyond their limitations. Implementing cross-training routines that engage different muscle groups and joints can also help alleviate strain on the knees and prevent overuse injuries.

Motivating and Supporting Clients During their Journey to Recovery from Knee Injuries

Recovery from a knee injury requires patience, commitment, and motivation. Trainers play a crucial role in motivating and supporting their clients throughout their rehabilitation process. By setting achievable goals, celebrating milestones, and providing positive reinforcement, trainers can create a supportive environment that fosters clients’ optimism and determination. Additionally, regularly monitoring progress and adjusting training plans accordingly can help clients stay engaged and motivated, ensuring they remain dedicated to their recovery journey.

Working Collaboratively with Healthcare Professionals to Optimize Training for Clients with Knee Injuries

Collaboration with healthcare professionals is essential when training clients with knee injuries. Trainers should maintain open communication with orthopedic surgeons, physical therapists, or other relevant healthcare providers involved in their clients’ care. This collaboration allows trainers to gain valuable insights into their clients’ specific circumstances, any recent changes in their treatment plans, or adjustments required for their training programs. By working collaboratively, trainers can ensure their approaches align with the clients’ overall treatment goals, optimizing their training outcomes and minimizing the risk of further complications.

Training clients with knee issues requires a comprehensive understanding of the common causes, types, and characteristics of these injuries. Through proper assessment and diagnosis, trainers can tailor training programs to meet their clients’ specific needs and promote successful rehabilitation. By incorporating a combination of strengthening exercises, pain management strategies, and functional movements, trainers can effectively guide clients through their journey to recovery. Moreover, understanding the essential role of nutrition, providing injury prevention guidance, and offering ongoing support and motivation are key aspects of training clients with knee injuries. By collaborating with healthcare professionals, trainers can ensure coordinated care and promote optimal outcomes for their clients’ overall well-being.

How do you train someone with a knee injury?

Training someone with a knee injury requires a personalized and careful approach. Exercises should be low-impact and should focus on strengthening the muscles around the knee, such as the quadriceps and hamstrings. Balance and flexibility exercises are also important. Always ensure the client is in minimal pain during the workout and that movements are performed with proper form.

What exercises are safe for knee injury?

Safe exercises for a knee injury include leg lifts, hamstring curls, step-ups, and wall squats. Other low-impact exercises like swimming or cycling on a stationary bike can also be beneficial. It’s crucial to progress slowly and not push through pain.

How do you train someone with a torn ACL?

Training someone with a torn ACL should be done under the guidance of a physical therapist. The focus is usually on restoring range of motion, strength, balance, and stability. This can involve exercises like quad sets, straight leg raises, and heel slides.

Can you still train with knee pain?

Yes, but it depends on the cause and severity of the knee pain. Certain exercises can actually help alleviate knee pain by strengthening the muscles that support the knee. However, high-impact activities or exercises that cause pain should be avoided. Always consult a healthcare provider or a physical therapist for guidance.

What exercises to avoid after knee injury?

Exercises to avoid after a knee injury usually include high-impact activities like running, jumping, or any exercise that involves sudden twists or turns. Deep squats, lunges, and full arc knee extensions should also be avoided until the knee has healed and these exercises have been approved by a healthcare provider.

What gym equipment can I use with bad knees?

Gym equipment that is generally safe to use with bad knees includes stationary bikes, elliptical machines, and rowing machines. These are all low-impact options that can help strengthen the muscles around the knee without putting excessive stress on the joint.

How can I exercise with a torn meniscus?

Exercising with a torn meniscus should be done under the guidance of a healthcare provider or a physical therapist. Generally, you’ll start with gentle range of motion exercises, then gradually add in strengthening exercises for the muscles around the knee. Low-impact activities like swimming or using a stationary bike can also be beneficial.

Can you lift weights with a knee injury?

Yes, you can lift weights with a knee injury, but it’s important to do so safely. Avoid exercises that put a lot of stress on the knee, like deep squats or lunges, and focus instead on exercises that strengthen the muscles supporting the knee. Always ensure that movements are performed with proper form to avoid further injury.

What activities should be avoided with knee injury?

Activities to avoid with a knee injury include high-impact sports like running, basketball, or soccer, and exercises that involve deep knee bends, jumping, or twisting. Always consult with a healthcare provider for a personalized list of activities to avoid.

Software Tools for Training Clients With a Knee Replacement

When you’re learning how to train someone with a knee injury, you’ll need to be consistent with check-ins for exercise tolerance and progression. If you’re managing a full clientele, this can be a time-consuming task. Thankfully, there are resources that can help manage exercise and knee pain.

Workout Software for Clients With Knee Injuries

Knee injuries can be complex and cover a gamut of potential limitations. Most of your clients won’t have much background in biomechanics and resultantly might not recall exactly which exercises to avoid for knee injuries. If that client wants to fit in a workout on their own time with no real plan, there’s a risk that they might exacerbate their knee injury.

By incorporating Exercise.com’s workout software, you’ll be able to provide your clients with customized and structured workouts for knee injuries of any type. Depending on the severity of their knee injury, you can provide them with accessible workouts with custom-designed volume, intensity, rest intervals, and more.

On top of customized workouts, you and your clients will also benefit from workout analytics. These reports will help simplify and display progression for your clients, maximizing their satisfaction and retention without any additional work for you.

Fitness Assessments for Clients With Knee Injuries

It’s hard to provide your clients with adequate fitness programs if you don’t know what they’re capable of. Exercise.com offers functional fitness assessment software that affords trainers the ability to develop customized fitness assessments that can also be conveniently tracked to monitor progression.

To train clients with knee injuries, you might want to include range of motion assessments, functional mobility screens, balance assessments, and even test their strength. Don’t forget, your clients will likely still want an upper body workout with a knee injury, so you can still include those assessments and performance metrics.

As a trainer, you can even distribute your assessments to clients’ assessments virtually so that they can perform the assessments on their own, if applicable. This way, your client will know when they should be assessed and they can still see if their training program is as effective as it should be. Happy clients are long-term clients which means stable income for you.

Customizable Exercise Library for Clients With a Knee Injury

There are a limited number of hours in a day. This means that you’ll have a limit on how many clients you can see face-to-face each day. That doesn’t have to limit your revenue. To help retain clients, you’ll want top-level resources to assure they will be pursuant to their goals whether you’re present or not.

Exercise.com’s customizable exercise library offers clients the luxury of seeing and reading details related to any exercise you include in your training program. For example, if you wanted to include a Romanian deadlift for your injured client, they could quickly see that the movement is hip-driven and doesn’t include a great amount of knee flexion or extension.

On the contrary, if you simply provided them a sheet of paper that included a Romanian deadlift, your client might misinterpret the exercise and perform something along the lines of a squat, further aggravating their injured knee. In essence, an online exercise library is an effective way to assure your client’s understanding for desirable safety and performance outcomes.

Your clients will have access to your exercise library from a custom-branded fitness app 24/7. Improved accessibility and functionality helps to maintain a presence with your clients, even if you aren’t physically there. Accountability is one of the most important roles for personal trainers. Adding features like an exercise library helps eliminate excuses.

Training Clients With a Knee Injury: The Bottom Line

Training clients with a knee injury requires a lot more than just general knowledge. It requires education, empathy, and a host of software tools built with customization and adaptation in mind.

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To learn more about how Exercise.com can help you train senior clients, book a demo today!


  1. https://medlineplus.gov/ency/article/000452.htm
Thomas Barnett is a writer for Exercise.com and a Professor of Exercise Science at Keiser University. He has over eight years of experience working in rehabilitation, personal training, and strength and conditioning. Additionally, Thomas holds a Master's Degree in Human Performance, a Bachelor's Degree in Exercise Science, is an NSCA Certified Strength and Conditioning Specialist (CSCS), a Certified USA Weightlifting Coach, and holds the ACSM Exercise is Medicine Credential. When he isn't working or training, he enjoys a good game of rugby or can be found fishing and/or exploring the Florida coast.
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