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How to Predict, Prevent, and Overcome Knee Pain

Knee pain affects one in three people in parts of Australia.1 When walking makes the knee pain flare up, people often begin avoiding physical activity for fear of worsening their knee. Consequently, this barrier to physical activity contributes to physical disability.2

Knee Pain in Australia

After studying healthcare data from 4,060 Australians, Charlotte Blacketer (Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia) and her research colleagues concluded that we have an underuse of non-pharmacological treatments.1 Their study identified age, weight, and higher waist circumference as risk factors in developing knee pain.

Knee Pain Worsened by Walking

A separate group of researchers in China focused on how not just knee pain, but knee pain exacerbated by walking, creates barriers to physical activity that lead to physical disability.3 They studied a public research data set covering nearly 5,000 people in the United States. Their data shows that lower quadriceps muscle strength, severe changes visible on x-ray, and previous injury each, independently predict knee pain that worsens when walking.

Quadriceps Strength and Knee Pain Worsened by Walking

Researchers found two different measures of quadricep strength affecting knee pain. One was strength asymmetry. When one quadricep was 4% weaker than the other or more, the risk of knee pain was higher. They also measured absolute knee strength in newtons. The risk of knee pain rose with knee strength lower than 100 newtons, but greater knee strength up to 500 newtons showed an increasing protective effect against knee pain. Calculating newton meters is a very good measure, but fairly complex. Here’s an explanation of measuring knee extension torque.  

Preventing and Overcoming Knee Pain

The Chinese research team point out that both knee injury and quadriceps strength are “modifiable” risk factors (meaning risk factors over which we have some control). Structured strength training programs strengthen quadriceps and prevent knee injury.4,5

At Advanced Physiotherapy the combination of physiotherapy and exercise physiology helps with the treatment of knee pain. Exercise physiology can help with exercise and nutrition plans that affect weight and waist circumference to improve joint health. Both physiotherapy and exercise physiology can assist with structured exercise plans to prevent knee injury or overcome existing knee pain. If you have knee pain and want an exercise plan with assurances that you are helping your knee without making it worse, we can help.



  1. Blacketer C, Gill T, Taylor A, Hill C. Prevalence and healthcare usage of knee pain in South Australia: a population‐based study. Internal Medicine Journal. 2019 Sep;49(9):1105-10.
  2. Somers TJ, Keefe FJ, Pells JJ, et al. Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability. J Pain Symptom Manage. 2009;37:863-872.
  3. Liu Q, Li Z, Ferreira M, Wise B, Hunter DJ, Tao K, Lin J, Zhang Y. Recent injury, severe radiographic change, and lower Quadriceps strength increase risk of knee pain Exacerbation during walking: a within-person knee-matched study. Journal of Orthopaedic & Sports Physical Therapy. 2021 Jun;51(6):298-304.
  4. Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490-498.
  5. Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. PM R. 2012;4:S45-S52.


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