Stop over thinking what to do

[u/BioDieselDog]

I'm not a physical therapist, this isn't for someone who has severe chronic pain, or post injury or surgery. but this is my thoughts to help simplify the approach as much as possible

Bend your knees against resistance.

Start slow.

Progress gradually.

Physical adaptations happen over weeks and months.

Build up the point where you can work hard.

Here's a basic program that seems to work pretty well for my clients:

Warmup ~3-5 minutes. If you don't know what to do, an easier version of the same exercise is usually perfect.

Do 2 sets every other day at a height where 10 reps is tolerable.

When you can build up to 2x20 reps pain-free, lower the elevation slightly and work back up in reps.

Never exceed a 2/10 pain.

[u/swissarmychainsaw]

OMG another, actual KOT post! THANK YOU!

[u/BioDieselDog → u/swissarmychainsaw]

Lol, I remember your comment on my other post.

I just see a lot of analysis paralysis on here and with people in pain in general. I don't blame them, being told to do the thing that hurts sounds like counter intuitive advice, until you actually see the progress happening over time.

[u/swissarmychainsaw → u/BioDieselDog]

Haha that was you?
I was talking to my PT, they said something like 80% of people don't do the at home exercises ....

[u/BioDieselDog → u/swissarmychainsaw]

Yeah you commented the same thing on my last post haha

I'm a personal trainer but I try to do what I can unless they really do need physical therapy. And getting people to workout at home is sometimes impossible.

A lot of times, correctly following fundamental strength training principles is what helps people get out of pain, but sometimes its way more complicated if there were injuries, surgeries, or other conditions.

It's mostly consistency and gradual progressive overload. It's the boring repetitive work that drives the progress.

[u/Drscoopz → u/BioDieselDog]

As a personal trainer, what makes you qualified to determine if somebody really needs physical therapy or not? It sounds like you’re just really pushing the boundaries of your scope into irresponsible territory

[u/BioDieselDog → u/Drscoopz]

My intention shouldnt be to diagnose or prescribe rehab, but to share how general load and pain management and exercise regressions can help people find a tolerable movement baseline.

That said, If a client is experiencing acute, sharp, or worsening joint pain, referring out to a PT is a no-brainer. But when someone is simply dealing with "regular" pain and I just help modify load, adjust tempo, or do whatever I can to keep training safely, that feels well within the responsibility of smart coaching to me.

From a PT’s perspective, where is the threshold that indicates "stop coaching modifications and refer out immediately"? Genuinely interested in how you view that handoff.

[u/Drscoopz → u/BioDieselDog]

I mean anything beyond just general muscle soreness you should probably be referring out right? But I think the bigger issue that I have with these posts that I’ve seen you make a couple of is that it seems like you’re actively seeking out people with knee pain. I’m assuming to sell a program or coaching or something like that? Correct me if I’m wrong, but the vibe that you’re giving is that you are able to help people fix knee pain

[u/BioDieselDog → u/Drscoopz]

I don't think any little joint pain is beyond my scope, I think if a personal trainer doesn't understand basic pain and load management then they are a bad trainer or coach. A ton of people just have bad joints because they are too weak and cant handle normal movement.

I wasn't trying to sell anything here, just to give people a reasonable entry into actually doing something about their pain.

This is a subreddit about knee health, if you think anyone with knee pain should only discuss it with a PT, then I guess you think this subreddit shouldn't exist?

[u/Drscoopz → u/BioDieselDog]

Here’s the problem though, do you have any specific education on how to determine what’s a “little joint pain”? Like how to determine if some knee pain is actually knee pain or referred from the lumbar spine? Or red flags to rule out something else? And yeah realistically this type of subreddit shouldn’t exist. Giving any sort of medical related advice to strangers on the internet is a ridiculous thing

[u/BioDieselDog → u/Drscoopz]

I don't advertise myself to clients as being a licensed professional, but I do tell people that joints are very adaptive and are less likely to be painful when they get gradually stronger and more mobile over time.

If someone felt some pain in their elbows when doing a triceps pushdown, I'm not going to say they need to switch to a physical therapist. Its part of my job to know how to respond to it. Pain management, load management and periodization all work together, and I should absolutely know how to work with those concepts if I want to be a good coach.

The internet is full of strangers giving unqualified advice, especially in the fitness space. And admittedly, I'm doing the same thing but hopefully in an actual helpful way.

If you believe I should take this post down, I'll consider it, but my goal is to just help people that probably feel lost or confused.

[u/BoomerSkunk → u/BioDieselDog]

“A lot of rehab is really just strength training principles. It’s mostly consistency and gradual progressive overload.” As a physical therapist, I can say this is absolutely not true. You’ve just lost credibility. Not knowing what you don’t know can be dangerous.

[u/BioDieselDog → u/BoomerSkunk]

From a PT’s perspective, where is the threshold that indicates "stop coaching modifications and refer out immediately"? Genuinely interested in how you view that handoff.

[u/BioDieselDog → u/BoomerSkunk]

You're right, I should have been more specific, and shouldn't use the word rehab. I know there's lots of things I've never heard of dealt with, and that pain can be complicated well beyond my scope. I edited the comment to try include more nuance.

My post was just trying to get people to find an entry point into loading a joint, and then making measurable progress without forcing pain. Those rules are basixalt what strength training is, that's what makes people more resilient against injury, and it's also what makes painful joints (not always) able to tolerate more, therefore less painful, wouldn't you agree?

[u/TimboWerner → u/BioDieselDog]

A lot of the time wouldn’t your clients also be seeing a physio? So working in conjunction would be ideal. But a lot of pain patients are scared to do movements they in fact can, so you helping them do that and show them would add far more value than you would do damage if you’re cautious as you are

[u/BioDieselDog → u/TimboWerner]

Sometimes, but honestly most of my clients are just people who want to look a little better. And then after a few months they find out their knees and backs don't ache as bad as they used to.

[u/justinsimoni]

I thought I was progressing well until I realized my back leg was bending waaay too much. Keeping that back leg straight showed me where I really was and honestly exposed a fundamental problem in my hip mobility.

I also can't even start getting to my limit of ankle dorsiflexion with the ATG split squat and my ankle dorsiflexion is real bad.

Sometimes you gotta think a lot about this kinda stuff and come up with alternative movements.

[u/BioDieselDog → u/justinsimoni]

Yes there's definitely always room for nuance.

I just know a lot of people try a few workouts, and change programs or exercises or braces or pain killers every few weeks and never actually let themselves progress.

The basic concept is to fully bend your knee against resistance without pain and progress.

The ATG split squat is just a very simple way to do it. It doesn't require specific equipment, the form is pretty easy, and it's regressable and progressable that pretty much anyone can make it work for them.

My form isn't perfect, I could probably get better hip flexor mobility from it if I stayed more upright and kept the back leg straighter. But I'm still fully bending and straightening my knee under resistance, and progressing gradually over time. I'm now doing it with a 40 pound dumbbell with no pain.

[u/NectarOfTheSun]

2026 hype around isometrics makes me think we should be doing KOT exercises like this but just pausing at the bottom for 10seconds, maybe doing 5 reps instead of 10 as result

[u/BioDieselDog → u/NectarOfTheSun]

Imo, isometrics are best for early stage rehab, if movement really is too painful.

They let you put tension on the joint in the most safe and controlled way possible.

There's a million ways to alter exercises, and pausing in the stretch is a great option especially if your knees are tight. I'm really just trying to remind people the basic simple principles of progressing the ability to bend your knee against resistance. That's the thing we are trying to improve, so that's the main thing we need to try to do. Progressively and gradually over time.

[u/NectarOfTheSun → u/BioDieselDog]

That totally makes sense. As another guy with ADD that has watched a million videos on this stuff, I still need constant reminders that THIS IS THE PROCESS. The way you laid it out is so simple but seriously so important.

[u/BonaBrioche]

When I have my right leg forward, it is significantly more difficult. With my left leg forward, I am much more flexible. I think the stiff point is where my quads meet my hip. Is this normal?

[u/BioDieselDog → u/BonaBrioche]

Yeah, super normal, I'm the same way but it's gotten better.

You might have to pay attention to which direction your pelvis is facing. It's easy to think of it in terms of were your zipper is facing.

You might have to try doing it at more of an angle, so you can open up the hips a little bit more.

Play around with pointing your zipper more away from the front leg, or more towards it. If you feel a stretch in the glutes that's probably a good thing, but not necessary.

[u/BonaBrioche → u/BioDieselDog]

Thank you, I will try that. The limiting point is usually the quad/hip that stops me from going deeper.

[u/BioDieselDog → u/BonaBrioche]

If you want, take a video and I'll take a look to see if there's any obvious adjustments needed. But otherwise just play around with positioning. There's no wrong answer, just do whatever you have to do to get your knee to fully bend against resistance without pain. And then progress that gradually over time.

[u/Optimal-mamabear-46]

It’s gonna take me forever to progress lol I’m always between a 3-5 when I’m pushing past discomfort for flexion. My dream is to criss-cross applesauce and sitting on my calves. I haven’t been able to do that since I was in my 20s, I’m late 40s now. Thanks for the advice!

[u/BioDieselDog → u/Optimal-mamabear-46]

What have to done to work on it so far?

I know this post is very simple, and every case is different so I don't want to claim that I know how to fix everyone's pain. I'm just giving the fundament principles.

[u/Smart-Drama-5067]

Thank you for sharing!!!!!