Knee and joint pain training in Surat, and what a gym can honestly do

What training can and cannot do for a painful knee

Start with what the guidance says, because it is stronger than most people expect. The NICE osteoarthritis guideline NG226, published in 2022, tells clinicians to offer therapeutic exercise to every person with osteoarthritis, and names exercise and weight management as the core treatments. That is mainstream clinical advice rather than something a gym owner invented to sell memberships.

The size of the benefit deserves stating honestly. A Cochrane review by Fransen and colleagues in 2015 pooled 44 trials and found exercise reduced knee pain by about 12 points out of 100 immediately after a programme, with function improving by about 10. At two to six months those figures had fallen to roughly 6 points and 3 points. That is a small to moderate average effect, it matters to a lot of people, and it fades once the training stops, which is why I treat this as something you keep doing rather than a course you finish.

For pain around and under the kneecap, the 2019 patellofemoral pain guideline in the Journal of Orthopaedic and Sports Physical Therapy gives exercise targeting both the hip and the knee its strongest grade of recommendation, and prefers that over knee work alone. This is why a member who arrives complaining about a knee spends a surprising amount of time working the hip.

Two things training will not do. It will not repair worn cartilage and it will not reverse arthritis, whatever the internet has told you. My own coaching judgement, formed on the floor since 1999 rather than from any trial, is that most people who stay with it end up doing considerably more with the same knee. The guidelines are careful about mechanism too, recommending the exercise while stopping short of claiming that stronger muscles around the joint are the reason it helps.

Can I squat with knee pain

Usually yes, in some form, and almost never in the form you were doing before you came in. The belief that squatting wrecks knees has less behind it than its popularity suggests. A scoping review by Rojas-Jaramillo and colleagues in Frontiers in Sports and Active Living, 2024, found 13 of 15 studies supporting the safety of the deep squat for knee joint health, provided proper technique is maintained.

Read the limitations before carrying that further. Most of those interventions ran only 6 to 10 weeks, several carried a moderate to high risk of bias, and the people studied largely did not have painful knees. That weakens the case against the squat for healthy knees, and it gives me no permission to load depth on a member whose knee already hurts. What it does support is starting from the position that a squat of some kind probably belongs in your programme, and then finding out which one.

So the squat gets modified rather than banned. The order below is my own preference from coaching rather than anything a trial established.

• Depth changes first, because most people find a range where the knee stays quiet, often well above parallel, and we widen it over the following weeks.
• The variation changes next, since a box squat, a goblet squat held in front of the chest, or a leg press with the feet placed higher often feels like a different exercise altogether.
• Tempo and load change after that, and slower repetitions with less weight is where I usually start a sore knee.
• Hip and hamstring strengthening goes in early and carries more of the job than anything done to the knee itself, following what the patellofemoral guideline points at.

Sharp pain at one specific point, a knee that gives way, or pain that climbs a little further every session means we stop that exercise and you get assessed.

Knee pain after the gym, and what it usually means

An ache arriving some hours after a session, spread across the joint rather than sitting at one point, with no swelling, and settling within 2 to 3 days, is the ordinary response of a tissue asked to do more than it was used to. It is commonest in the first month and after any jump in load.

NICE says something here that I wish more people knew. NG226 tells clinicians to warn people that joint pain may increase when they start therapeutic exercise, and to explain that regular and consistent exercise will benefit their joints even though it may initially cause pain or discomfort. Being sore at the start is expected, and it is written into national guidance rather than being gym folklore.

Be careful how far you carry that. A review by Smith and colleagues in the British Journal of Sports Medicine, 2017, found painful exercise slightly ahead of pain-free exercise for short-term pain, with no difference in the medium or long term. When the question was revisited in the Journal of Orthopaedic and Sports Physical Therapy in 2025, the effect was unclear, and the only conclusion those authors would stand behind was that pain during exercise may not need to be avoided. Mild discomfort is a poor reason to stop, and there is no solid evidence that pain is doing you any good either.

A knee still sore beyond the fourth day, or hurting a little more after every session rather than a little less, tells me the load went up too fast. When a member says the pain arrives after training and never during it, my first move is to cut the volume by about a third and hold it there for a fortnight, which is a judgement formed on the floor rather than one I can cite a paper for.

How a member with knee pain is coached here

Every session at both branches opens with yoga and the twelve positions of Surya Namaskar before anybody touches a weight, and that has been the house rule since I opened in 1999. For a stiff knee it buys a few minutes of controlled movement through the hips, ankles and knees before load arrives, and it tells me how the joint is behaving that morning. The honest version of what the research does and does not show is in my longer guide on Surya Namaskar before weight training.

After that the shape of the work is deliberately unremarkable.

• I ask what your doctor or physiotherapist told you, and if you were given exercises I build around them rather than over the top of them.
• We find the ranges, machines and foot positions where the knee stays quiet, and start considerably lighter than your pride would like.
• Hip and hamstring work carries much of the early load, for the reason the patellofemoral guideline gives.
• Weight goes up in small steps and gets held wherever the knee objects, so progress here is measured in months.
• The rest of your body keeps training normally, because one sore knee is no reason to stop pressing, rowing or carrying things.

I hold an advance fitness personal trainer certificate and a special population training certificate, both from Dr Mahesh Kumar's Medical Institute, and both are photographed on the credentials page. Neither of them makes me a clinician. My yoga training is a one-month foundation course at Surat's district yoga wellness centre, scanned and on that page too, and it is where the mobility work in these sessions comes from.

Members arriving with sore joints are usually better served by personal training than by a floor membership for the first few months, because somebody has to watch the joint under load. Much of this sits inside the wider picture on training after 40.