Understanding Knee Damage: Exercise vs Rest

This year is great because we are starting to see lots of lovely research being published on knee pain.

These papers cut-through all the broscience. It is NOT true that running “wears” your knees out. It’s definitely bad advice if you have been told to stop lifting weights because you have knee degeneration or knee pain.

Yes, you are right that I am bias. I do run a predominantly exercise-based practice. However, past and new research published are validating what I am already doing – keeping patients with pain active.

It’s a nice feeling to know we have taken the right bet. That our analysis of data is accurate and that more and more data is starting to support good clinical practice for pain management = active recovery. Not getting your knees adjusted. Definitely not stretching out your “tight” muscles.

If you are a client of ours, please also share our joy. We are privileged to have your trust. We are happy to report your trust is not misplaced!

Can marathon running improve knee damage of middle-aged adults

kingsley tay, tendinitis, knee pain, chiropractor singapore
Singapore national volleyball player works with chiropractor Jesse Cai for his knee pain. What took other doctors and physiotherapists 9 months – with minimal improvement – took Jesse three visits across a ten-day period. While such results are rare, an evidence-based approach yields the best clinical outcomes!

My guess is that this is the most controversial paper pertaining to knee pain this year.

This paper was published in October this year and looked at 82 volunteers with knee “damage” before and after a 4-month marathon training.

The first thing to note that all of these volunteers had signs of knee damage but no pain. The damages include: meniscus tear, subchondral bone marrow oedema (fluid build up), injury to the articular cartilage of the knee cap.

After 4-months of training and completely the marathon (that is 42.195km), there was no significant chances to their knee pain and daily activity!

What is more remarkable was that the meniscus tears did not worsen and the oedema findings IMPROVED. I think that’s mind-blowing cool!

Please stop telling people running is bad for their knees.

Please stop telling people running is gonna wear-and-tear their joints out.

Please stop asking people with knee degeneration to stop running or that they will never run again!

Knee Osteoarthritis Patients Are Prescribed With Too Little Aerobic Exercise

There is a small chance that I may also be guilty of prescribing too little aerobic exercises when it comes to knee pain.

Our focus at Square One is indeed targeted at function and strength training.

I do admit this is one of our shortcomings but don’t worry, we will work on it! This is the beauty of evidence-based practice and why we always deliver superior outcomes. We take the time to keep ourselves up to date with the latest research.

When research tells us something that is different from what we are currently doing, we take it onboard. We adapt and better ourselves so you have better treatment outcomes!

Regardless, the important thing to note is that arthritic knee pain patients are not getting enough aerobic exercise.

To rephrase, the paper is saying you should be doing more cardio! Patients with knee osteoarthritis are not exercising enough!

Weight Training Dosing For Knee Pain

By far my favourite paper: Resistance training improves pain and physical function in knee osteoarthritis.

This means weight training is good for you.

If you’re having knee pain and some one told you can never squat again … my suggestion is to STOP seeking clinical advice from them.

Strength training doesn’t just make you stronger. It increases your quality of life, by virtue of improving your capacity for daily function, and also helps with your pain!

Of course resistance training is no easy feat. It takes time and effort. According to the authors, 24 total sessions and spread across 2 to 3 months seem provide the best outcomes.

As far as weight, sets, or reps go, it doesn’t seem to better. In short, as long as you lift some weights on a regular basis for 2-3 months, you are good.

This is exactly what we aim to do with all of our knee pain clients. Yes, we may start slow at the beginning but we look for gradual and progressive improvements.

With our current exercise programming (both in-person visits and home exercises program), all of our clients who follow through with us would have easily met at least 24 session across 2 to 3 months.

I don’t know what to do, please send help

knee pain, weight training, chiropractor singapore
We work with people from all walks of life. While most of our photos show athletic patients, only 10% of our patients are national or elite athletes. 90% of our knee pain clients live sedentary lifestyles and achieve full recovery in 4-7 visits. Our evidence-based approach is one-of-a-kind in Singapore and we deliver results our competitors cannot match.

Unfortunately, we do not have the perfect solution to share with you.

Quite often people ask me what should they do. The answer? I don’t know.

I follow an evidence-based test-retest approach. I test and re-test your knees. Based on what we can observe, we prescribe exercises to help you get better.

Trust me, there is no one-size-fit-all magic solution.

Read more about why Instagram rehabilitation doesn’t work.

Sure, there are tons of videos and social media content with the magic four or seven must-do exercises for knee pain or back pain. Well, they are all compiled based on assumptions and – for most parts – would not work for most patients.

Even with professional supervision, recovery is not easy. We previously blogged about our experience with the unsuccessful patient. The truth is people do get worse with treatment because we do not have a perfect solution.

This is what our clients pay us for. To provide expertise to guide you through the recovery process. Our treatment approach works even for patients with A LOT of pain. It’s just not always smooth sailing but don’t miss the forest for the trees. Focus on the process!

If you are currently living with knee and you are looking to seek professional help from a chiropractor or a physiotherapist, do drop us a message. We’d love to walk you through this journey. We can’t promise that there won’t be setbacks but we will help you through this!


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.