New Year’s Resolution… and Now My Knee Hurts!

A new year brings fresh motivation.

Perhaps you’ve decided to start running, return to the gym, ride your bike more regularly or simply become more active after a busy year.

You’ve downloaded a running app, signed up for a fitness challenge or committed to exercising several times each week.

And then, a couple of weeks into your New Year’s resolution, something unexpected happens.

Your knee starts hurting.

Perhaps it aches when you walk downstairs. Maybe your first few squats feel uncomfortable. Or the knee feels stiff in the morning, warms up during exercise and becomes sore again afterwards.

It’s frustrating, particularly when you’ve finally found the motivation to make a positive change.

But here’s something worth considering: the problem may not be that you’ve started exercising. It may be how much your exercise demands have changed.

At RHP Physiotherapy in Kelvin Grove, Brisbane, we regularly work with people whose knee pain has appeared after returning to exercise, increasing their training or taking on a new physical challenge.

Understanding the relationship between loading, adaptation and symptoms can help you make more informed decisions without abandoning your New Year’s resolution.

Why Does My Knee Hurt After Starting Exercise?

Our bodies are remarkably adaptable.

Muscles, tendons, bones and joints respond to physical activity. Appropriate exercise helps develop strength, fitness and the ability to tolerate increasing demands.

But adaptation takes time.

Imagine you’ve spent the past several months doing relatively little running.

Then January arrives, and you begin running four times each week because you’ve entered a race or want to get fit.

Your motivation may be ready for four runs per week, but your body’s current capacity might be better suited to a smaller starting dose.

Something similar can happen when returning to the gym.

After several weeks or months away, you may attempt the same exercises, weights and repetitions that you previously completed comfortably.

However, your current tolerance for those demands may have changed.

It’s often the difference between what your body has recently been doing and what you’re now asking it to do that deserves attention.

This doesn’t mean every increase in exercise causes injury.

Increasing physical demands is also how we become fitter and stronger.

The important consideration is whether the new demands are appropriate for your current capacity and whether you’ve allowed sufficient opportunity to adapt.

Understanding Exercise Load: It’s More Than How Much You Do

When we talk about exercise load, people often think only about distance or the amount of weight lifted.

But physical loading involves several different variables.

A change in any of these can alter the demands placed on your knee.

1. Training Volume

Volume describes the total amount of exercise completed.

For example:

• Increasing weekly running distance.
• Completing more sets or repetitions at the gym.
• Walking much further than usual.
• Spending longer on the bike.

Even when exercise intensity remains relatively low, a substantial increase in total volume can change how your knee responds.

2. Training Intensity

Intensity describes how demanding an activity is.

Examples include:

• Running faster.
• Adding hill sprints.
• Lifting heavier weights.
• Increasing resistance during cycling.
• Introducing jumping or high-intensity classes.

A short, demanding session may place different loads on the knee from a longer, easier session.

Neither is automatically better or worse. They simply involve different physical demands.

3. Training Frequency

Frequency refers to how often you’re exercising.

Moving from one gym session per week to five changes more than the number of sessions.

It also changes how much opportunity exists between sessions for recovery and adaptation.

That matters particularly when several sessions involve similar exercises or repeated loading of the same tissues.

4. The Type of Exercise

A new activity can introduce unfamiliar loading, even for someone who is already quite fit.

For example, a strong cyclist may have excellent cardiovascular fitness but relatively little recent experience with running impact.

Likewise, someone who regularly walks might find their knees uncomfortable after starting a gym program involving repeated deep squats, lunges and jumping.

Being fit for one activity doesn’t automatically mean you’re fully prepared for another.

5. Recovery and Everything Else You’re Doing

Your exercise program is only one part of your physical workload.

Consider the person who decides to start running three days per week while also returning to weekend sport, completing physically demanding work and spending their holidays renovating the house.

Each activity contributes to the wider demands being placed on the body.

Sleep, recovery and other health factors may also influence how someone responds.

Looking at the entire week is often more informative than examining one training session in isolation.

Does Knee Pain Mean You’ve Damaged Something?

Not necessarily.

Pain is an important experience, but it is not a direct measurement of tissue damage.

For example, a person may develop discomfort around the kneecap after substantially increasing their running.

That does not automatically mean their cartilage has been worn away or that running has caused permanent harm.

The knee may be experiencing symptoms associated with a physical demand that currently exceeds its tolerance.

However, it’s equally important not to assume that every episode of knee pain is simply caused by a training increase.

Some knee injuries involve significant tissue damage, and other medical conditions can produce pain with or without a change in exercise.

Understanding how symptoms started, where the pain is located, whether swelling is present and how the knee responds to activity helps determine what might be happening.

Common Types of Knee Pain After Returning to Exercise

Several knee conditions may become symptomatic when people increase physical activity.

The diagnosis depends on the individual, and these conditions are not restricted to particular ages or genders.

Patellofemoral Pain: Pain Around or Behind the Kneecap

Patellofemoral pain is common in runners and active people.

Symptoms are often felt around or behind the kneecap and may be aggravated by:

• Running.
• Squatting.
• Walking up or downstairs.
• Repeated lunges.
• Other activities involving loaded knee bending.

A change in training demands may be relevant, particularly if symptoms appeared after increasing running, gym or other physical activity.

Exercise therapy, particularly progressive knee strengthening with hip exercises where appropriate, is a recommended part of management.

Patellar Tendinopathy: Pain Just Below the Kneecap

Patellar tendinopathy is another condition that may become noticeable after an increase in jumping, running or high-load knee exercises.

Symptoms typically involve localised pain around the patellar tendon near the lower part of the kneecap.

The tendon needs to tolerate and adapt to repeated loading.

Management often involves modifying aggravating activity and progressively developing tendon loading capacity.

Importantly, patellar tendinopathy does not always require complete rest, but simply continuing the same aggravating workload may not be the best approach either.

Knee Osteoarthritis: Pain When Returning to Activity

For some adults, a return to exercise may make previously quiet knee osteoarthritis symptoms more noticeable.

These symptoms can include stiffness, pain and sometimes swelling.

However, having knee osteoarthritis does not mean exercise is damaging the joint.

The Australian Osteoarthritis of the Knee Clinical Care Standard recommends physical activity and exercise as important components of management.

Exercise can improve function, physical capacity and symptoms when appropriately tailored.

Some discomfort during activity does not necessarily indicate that the arthritis is progressing.

For people managing knee osteoarthritis, our GLA:D Program offers structured education and exercise-based management.

Osgood-Schlatter Disease in Active Adolescents

Young athletes may also develop pain around the upper shin just below the kneecap, particularly during periods of growth and increased sporting demands.

Osgood-Schlatter disease is a growth-related condition affecting the tibial tuberosity.

It is relevant in children and adolescents participating in running, jumping and field or court sports.

Management considers symptoms, growth, sporting workload and progressive physical capacity.

Our Kids Sports Physiotherapy service works with young athletes experiencing growth-related and sporting injuries.

These are only examples. Knee pain can also arise from meniscus injuries, ligament injuries and other conditions, particularly when there has been a distinct twisting event, fall or trauma.

For a broader discussion of assessment and treatment, visit our Knee Physiotherapy page.

What Should You Do if Your New Exercise Routine Causes Knee Pain?

The first response doesn’t necessarily need to be abandoning the gym, throwing away your running shoes or cancelling your New Year’s resolution.

It may be more useful to look carefully at what has changed.

Step 1: Review Your Recent Exercise History

Think about the previous two to six weeks.

Ask yourself:

• How much exercise was I doing before January?
• Have I increased the number of sessions?
• Have I started running further or faster?
• Have I added heavier weights or new exercises?
• Have I changed several things at once?
• Am I doing more activity outside my formal exercise sessions?

It can be surprisingly easy to overlook the total change in activity when each new session feels manageable on its own.

Step 2: Identify Which Activities Provoke Symptoms

Different exercises create different demands.

Someone might tolerate walking and cycling comfortably but experience discomfort during running.

Another person may find flat running manageable but struggle with repeated hills or stairs.

Understanding these patterns can help identify which parts of your exercise program might need temporary adjustment.

You don’t necessarily need to stop every activity simply because one is uncomfortable.

Step 3: Reduce the Most Aggravating Loads

If your knee has become uncomfortable following a substantial increase in activity, consider temporarily reducing the exercise demands that appear to be contributing.

This might involve:

• Shortening a run.
• Reducing the number of running sessions.
• Temporarily removing hill sprints or intervals.
• Reducing squat or lunge volume.
• Adjusting gym resistance.
• Allowing more recovery between demanding sessions.

The appropriate modification depends on the presentation.

For some people, reducing one aspect of the program is enough.

Others may need a more substantial change while symptoms settle or the knee is assessed.

The goal is to find a manageable starting point from which you can progress again.

Step 4: Pay Attention to Your Knee’s Response

This is perhaps the most important part of the process.

When introducing or increasing exercise, consider how your knee responds at different times.

• During exercise: Does discomfort remain manageable, or does it progressively increase?
• Immediately afterwards: Are you walking and moving comfortably, or are symptoms noticeably worse?
• Later that day: Does the knee become more irritable or swollen?
• The next morning: Is there more stiffness or pain than usual?
• Across the week: Is your activity tolerance improving, stable or progressively deteriorating?

A small amount of discomfort during exercise does not always mean you’re causing harm.

But repeatedly provoking symptoms that become substantially worse or take longer to settle may suggest the current exercise dose needs reconsideration.

Some rehabilitation programs use pain scores or a 24-hour symptom response to help guide progression.

These can be useful tools, but they are not universal safety tests for every knee condition.

New swelling, significant loss of function or a suspected structural injury requires a different approach.

Step 5: Progress Gradually and Change One Thing at a Time

Once you’re tolerating your current activity well, begin progressing again.

For example, you might first increase the duration of your easy runs before introducing faster running.

Or you might establish a consistent number of gym sessions before progressively increasing the weights.

Changing one major variable at a time also makes it easier to understand how your body is responding.

There is no universal rule that increasing your exercise by exactly ten per cent each week will prevent pain or injury.

The appropriate progression depends on your history, current fitness, age, health, goals and the type of exercise involved.

What matters is creating enough of a training stimulus to improve while paying attention to the response.

Can You Keep Exercising When Your Knee Hurts?

Often, yes, depending on the diagnosis and severity of symptoms.

For many common gradual-onset knee pain presentations, continuing a modified amount of exercise may be appropriate.

Examples could include:

• Replacing a demanding run with a comfortable walk.
• Using a shorter running session.
• Reducing gym resistance temporarily.
• Choosing a different exercise that is better tolerated.
• Continuing upper-body training while reducing painful lower-limb exercises.

These are examples, not universal recommendations.

Some acute injuries or medical conditions require more protection or further investigation.

The important principle is that adjusting exercise is not the same thing as giving up exercise.

Strength Training Can Help Build Knee Capacity

When we reduce an activity because it is painful, we also need to consider how to develop the capacity required to return to it.

This is where progressive strength training can be useful.

Depending on the presentation, an exercise program may include:

• Squats or sit-to-stand exercises.
• Leg press.
• Split squats.
• Step-ups.
• Calf raises.
• Hip strengthening.
• Other exercises specific to your goals.

There isn’t one perfect set of exercises for every painful knee.

For patellofemoral pain, contemporary best-practice guidance supports knee-targeted exercise therapy, with hip exercises added where appropriate, alongside education and individualised load management.

For knee osteoarthritis, tailored strength and physical activity are central components of recommended care.

For patellar tendinopathy, progressive tendon loading is often important.

The specific exercises may differ, but the wider goal is similar: improve the physical capacity required for the activities you want to perform.

How Do You Make a New Year’s Exercise Resolution Sustainable?

One of the challenges with New Year’s resolutions is that motivation can encourage us to pursue the end goal before we’ve developed the routine needed to reach it.

If your goal is to run five kilometres comfortably, you don’t necessarily need to run five kilometres immediately.

If your goal is to train at the gym four times each week, there is no requirement to begin with four demanding sessions.

A more sustainable approach is to consider where you’re starting and create a progression.

Think in Months, Not Just the First Two Weeks of January

Physical adaptation takes time.

You do not need every exercise session to be difficult for it to be worthwhile.

Consistency and progressive loading can provide opportunities for your muscles, tendons and joints to adapt.

And if you experience a setback, that doesn’t necessarily mean the resolution has failed.

It might simply mean the current program needs to be reconsidered.

A plan that can be adjusted is often more useful than one that only works when everything goes perfectly.

When Should You See a Physiotherapist for Knee Pain?

Not every episode of knee discomfort requires a physiotherapy appointment.

But assessment can be useful when symptoms are not progressing as expected or when you’re uncertain about how to continue exercising.

Consider seeking advice when:

• Knee pain is repeatedly limiting exercise.
• Symptoms are becoming progressively worse.
• The knee remains swollen or becomes swollen after activity.
• You’ve had previous knee injuries or surgery.
• You’re unsure whether to continue, reduce or stop a particular activity.
• Pain is affecting walking, stairs, work or normal daily activities.
• Symptoms are not improving after appropriate changes to your exercise routine.

Frequently Asked Questions About Knee Pain After Starting Exercise

Knee Physiotherapy and Exercise Advice in Kelvin Grove, Brisbane

At RHP Physiotherapy, we encourage people to be active and develop the physical capacity to participate in activities they enjoy.

Our approach to new or recurring knee pain considers the person’s symptoms, current physical capacity, recent training changes and wider goals.

Depending on the presentation, assessment and management may include:

• Understanding the likely diagnosis.
• Reviewing recent changes in exercise load.
• Identifying activities that are currently difficult.
• Strength and physical capacity assessment.
• Advice about modifying training.
• Individualised progressive strengthening.
• Guidance returning to running, gym training or sport.

Our Knee Physiotherapy service provides assessment and management for a wide range of knee conditions.

Our Running Physiotherapy and Sports Physiotherapy services may also be relevant when your goal involves running or a return to sport.

For people looking to build a longer-term exercise routine, our Exercise Physiology service can support structured physical activity and strength development.

This article provides general education and does not replace an individual assessment by a qualified healthcare professional. Seek appropriate medical care for significant injury, marked swelling, systemic illness or other concerning symptoms.

Author in the know

Sam Donaldson

Director, APA titled Sports and Exercise Physiotherapist. Sam loves to treat athletes with lower limb injuries and has a special interest in knees of all ages; adolescent knee pain, athlete with knee pain, ACL injuries, ACL rehabilitation, Knee Osteoarthritis and Knee Replacement recovery. He is a Dad, Football enthusiast and loves to move. BAppSci (HMS), MPhtyStudies, MPHTY (Sports)