The physio room is full, and the air is thick with antiseptic and anger. A retired runner in his 50s holds his knee while looking at his phone on one table. A young office worker in leggings next to him shows the therapist a screenshot that says, “Look, it says swimming and Pilates are the best.” Low impact, right? The therapist lets out a breath, half a sigh and half a laugh, and says softly, “That’s not what we’re doing anymore.”
She tells him to go to the corner, not to a mat or a pool, but to something that looks a lot like a squat rack.
The patient is unsure. Knee pain with weight? In spite of everything he’s read.
But this time, the experts are going the other way.
And it’s starting a war in medicine.
Why doctors are suddenly telling people with knee pain to load up instead of back off
This new trend is both strange and unsettling: a growing number of experts are recommending a weight-bearing exercise for people with chronic knee pain, which goes against the “protect your knees” mantra.
Instead of long stretches or gentle swims, they tell patients to bend, hold, and carry their own body weight in a very specific way.
Not floating in the water. Not rolling around on a Pilates ball. Standing on solid ground and working right into the joint that everyone has been taking care of for years.
A 63-year-old woman with osteoarthritis walks into a sports medicine clinic thinking she’ll get a pool program and soft Pilates. Her MRI shows that her cartilage is wearing down, and her doctor told her to “avoid stairs” and “take it easy.”
The specialist listens, nods, and then walks her to a wall. She slides down into a slow, shaky half-squat with her back against the wall and her knees bent at about 90 degrees.
Her legs are shaking and her face is red thirty seconds later. She is scared that she is hurting someone. The doctor smiles and says, “That’s the point.” We’re not teaching your knee to go away; we’re teaching it how to work.
There is a bigger change behind this simple scene. More and more studies are showing that progressive loading, which means doing exercises like slow squats, wall sits, and step-downs that put calculated stress on the knee, is good for people with knee osteoarthritis and patellofemoral pain.
It’s very easy to understand: the muscles around the knee act like shock absorbers, and they only grow when they are put to the test.
Swimming and Pilates can help, but they don’t always come close to the stress your knee feels when you climb stairs, carry groceries, or just get up from a chair. *Your rehab has to be weight-bearing, just like your real life.
The “forbidden” move: wall sits and slow squats for knees that feel broken
The main part of this quiet revolution is a painfully simple exercise: a controlled squat or wall sit with weight, done slower than you would at the gym.
The person lowers themselves as if sitting in a chair, with their feet about hip-width apart and their weight evenly distributed over the whole foot. They stop before they feel sharp pain and then hold or rise just as slowly.
Some doctors call it “time-under-tension” training for the knee. It looks kind of boring. It doesn’t feel that way very often.
For years, most people with knee pain have been told to avoid bending too much, protect the joint, switch to swimming, do Pilates or cycling, and stick to “gentle” movement.
When they are told to sit against a wall for 45 seconds with their quads on fire, their first reaction is almost always fear: “Won’t this grind the cartilage?” “Don’t squats hurt your knees?”
We’ve all been there: your body screams “danger,” but the expert in front of you calmly counts down, “Ten more seconds, you’re safe, keep breathing.”
More and more of those professionals are going in the same direction.
Orthopedic surgeons are on one side of the debate, saying that “overloading damaged joints” is bad and showing pictures of worn cartilage and bone spurs.
On the other hand, sports doctors and physical therapists are waving studies that show that *properly dosed* squats can help with knee arthritis by reducing pain, improving function, and even slowing down disability.
A sports doctor from Lyon told me:
“I don’t just tell people to swim anymore for most knee pain. People feel better when they’re in the pool, but their life hurts again when they’re on land. We need to teach them how to walk in the world they live in.
The debate isn’t about whether movement is good for you, but how much, how often, and when during the disease.
That nuance is messy and doesn’t fit on a poster, and that’s where patients get stuck watching the experts argue.
How to do this safely without hurting your knees or your nerves
For those who are curious and maybe a little scared, the first step is usually a wall sit or a “supported squat.”
With your back against a wall and your feet about 40 to 50 cm in front of you, slowly slide down until your knees are between 45 and 90 degrees and your toes and knees are pointing in the same direction.
First, you hold for 10 to 20 seconds, and then you push back up through your heels. Not brave, not worth posting on Instagram. Just work that is controlled, repeatable, and a little uncomfortable.
Ego is the biggest trap. People read about weight-bearing rehab, say they want to “fix it once and for all,” and then go right into heavy leg presses or deep squats.
As a result, there was a flare of swelling, three nights of throbbing pain, and a panicked “See?” Squats are bad for your knees.
Let’s be honest: no one really does this every day at the right level and pace that their physio suggests.
Progress looks more like doing two or three sets of 20 to 30 seconds three times a week, with an extra set added only when the last level feels too easy.
Most of the experts I talked to agreed on a few basic rules: it’s okay to feel a little pain during the exercise, but not sharp or lasting pain afterward.
A rehab expert put it this way:
“If pain is a volume knob, we want it to go up just a little bit during the exercise, not blast your ears for hours afterward.” That’s when you’ve gone too far.
A lot of doctors now give their patients a small checklist to help them stay on track with this new trend:
Use only your body weight at first, and use a wall or chair for support.
- On your own scale, keep pain during or after exercise to less than 4 out of 10.
- If your knee feels hot, swollen, or unstable, take a full day off.
- Don’t make big jumps in depth or weight; instead, make small changes every few seconds or reps.
- Pair “kind” days with “loading” days. This could mean walking, light cycling, or even a gentle swim.
- The trend is bold, but the best versions of it are not at all reckless.
Between fear and progress: where this leaves you and your sore knees
Some readers will be immediately drawn to this new way of thinking, as if they have finally been given permission to fight for their strength instead of giving in to the “wear and tear” story.
Just reading the words “squat” and “knee pain” in the same sentence will make some people feel sick. Both responses are true and valid.
The medical argument going on in the background doesn’t change one basic fact: your knees have to carry you and your full weight through the life you actually live.
For some, that will mean working with a therapist who knows how to change angles, ranges, and tempos to slowly increase the weight they lift.
For some, it might just mean not being afraid of a gentle wall sit anymore or giving up the idea that the only safe place is a pool.
There isn’t one exercise that works for all joints on all X-rays.
What is coming out instead is a simple, but uncomfortable truth: avoiding all load is not usually the way to get rid of pain, but brave, well-planned experiments with weight-bearing might be.
There is a narrow, human path between the advice to “don’t bend your knees” and the Instagram videos of people doing 100-kilo squats.
It looks like shaky legs, short holds, half-sits, and small steps that feel almost too small to be true.
It sounds like you asking questions, your doctor answering, and both of you watching what happens over days and weeks, not minutes.
Maybe that’s the real story here: not the medical war, not the shocking headline exercise, but the quiet moment when you decide your knees can still work for you.
Main pointDetail: What the reader gets out of it
Weight-bearing isn’t badWhen done carefully, slow squats and wall sits can make the muscles around the knee stronger.Gives you a real way out of the “only gentle exercise forever” way of thinking
Pain vs. damageAccept mild pain that doesn’t last long; stay away from sharp pain and long flares.Gives a simple rule to tell if an exercise is good or bad for you
Not heroics, but progress. Small, steady increases in time and depth are better than big jumps or heavy weights.Lessens fear, lowers the risk of injury, and makes the routine last.
| Key point | Detail | Value for the reader |
|---|---|---|
| Weight-bearing isn’t the enemy | Slow squats and wall sits can strengthen muscles around the knee when introduced carefully | Offers a realistic path out of the “only gentle exercise forever” mindset |
| Discomfort vs. damage | Accept mild, short-lived discomfort; avoid sharp pain and long flares | Gives a simple rule to judge whether an exercise is helping or harming |
| Progress, not heroics | Small, gradual increases in time and depth beat big jumps or heavy weights | Reduces fear, lowers injury risk and makes the routine sustainable |
Questions and Answers:
Isn’t squatting bad for knees that are already hurt?Squats are usually safe if you have good form and a controlled range. Problems happen when you go too deep, use bad form, or put a lot of weight on an irritated joint all of a sudden.
What if my knee gets bigger after I try wall sits?That’s a sign that you did too much too quickly. Cut back on the hold time, range of motion, or frequency and let the swelling go down before trying again.
If I start doing weight-bearing work, should I stop swimming or doing Pilates?No, both can still be helpful; they just shouldn’t be the only type of exercise if you want to get better at moving around on land.
Can this be used instead of surgery for knee osteoarthritis?Not always, but for a lot of people it makes surgery less necessary or puts it off by making them stronger, more stable, and more confident.
Do I need a physical therapist to get started?Yes, if your pain is bad or complicated, but a lot of people start with very easy wall sits at home and then ask for help as they get better.
