Pilates and Knee Pain: How to Keep Moving Safely

Knee pain is something I see often in class, especially for women over 45. It’s one of the most common reasons people hesitate to exercise, but the good news is that the right movement can help manage and even improve knee pain.

What Causes Knee Pain?

The knee is a hard-working joint that takes a lot of strain. Pain can happen for several reasons:

• Muscle imbalances: Weak glutes, tight hamstrings or quads, and underactive inner thighs can all affect knee alignment.

• Poor movement patterns: Everyday habits or incorrect technique in exercises can overload the knee.

• Lack of mobility: Stiff hips or ankles can force the knee to work harder than it should.

• Injury or wear and tear: Past injuries, meniscus tears, ligament damage, or arthritis.

• Overuse: Repetitive high-impact activities, too much jumping, or sudden changes in exercise levels.

Why Knee Pain Is So Common

The knee works as a hinge joint and relies on the hips and ankles to work well. Weak glutes, tight hip flexors, poor posture, and a more inactive lifestyle (or simply getting older) can all lead to knee discomfort and stiffness.

How Pilates Can Help

Pilates is a brilliant way to strengthen and support the knee joint without putting unnecessary strain on it. My classes focus on:

• Improving hip and ankle mobility

• Strengthening the glutes, hamstrings, and core

• Encouraging good knee tracking and alignment

• Building safe and functional movement patterns

Pilates Exercises That Can Help Knee Pain

Here are some of my favourites for clients with knee issues:

• Glute bridges to strengthen hips and glutes

• Clamshells and side-lying leg lifts to help with knee tracking

• Standing balance exercises to improve lower body control

• Short wall sits for controlled quad strength

• Seated leg extensions (without weights) to regain control

• Hamstring work with a ball or band to build strength in the back of the legs

• Gentle stretching for hips, hamstrings, calves, and quads

• Breathwork and pelvic stability to support overall posture

Exercises to Avoid or Modify

Some movements can aggravate knee pain and are best left out or adjusted:

• Deep squats and unsupported lunges

• Repetitive jumping or hopping

• High-impact drills

• Quick directional changes

• Prolonged kneeling without support

• Strongly bent knee positions if you have arthritis or meniscus problems

Top Tips for Safe Movement

• Always check knee alignment: knees should track over the second or third toe.

• Offer seated or lying-down alternatives when pain flares up.

• Use small props like balls or bands to build strength gently.

• Activate the glutes before starting leg exercises.

• Move slowly and with control for better body awareness.

• Always speak to a physiotherapist if pain is severe or persistent.

How Common Is Knee Pain?

You’re not alone if you’ve struggled with knee discomfort.

• Around 1 in 4 adults will experience ongoing knee pain at some point.

• Women and adults over 50 are more likely to develop knee problems.

• Causes include arthritis, past injuries, poor form in exercise, or general stiffness.

When Might a Knee Replacement Be Needed?

For some, a knee replacement is the next step when:

• Severe arthritis or joint damage limits daily life

• Pain doesn’t improve with physiotherapy or lifestyle changes

• Movement becomes difficult (walking, stairs, standing)

• Pain interferes with sleep or independence

• There are visible changes like swelling or joint deformity

A Final Word

You don’t have to give up exercise because of knee pain. Pilates offers a safe and structured way to build strength, improve mobility, and reduce discomfort. In my classes, we work together to find what feels good for you – no pressure, no jumping, and always with options to suit your needs.

If you want to feel stronger and move better, join my face-to-face classes in Oxfordshire or take part in my online classes from anywhere, anytime.

Get in touch to find out more about our Pilates classes or click here to see the timetable for a class near you and info on our Online Classes.