Dealing with knee pain

Welcome to the directory for CrossFit-Related knee pain!

Now, some ground rules!

  • This is, first and foremost, a piece to help with the niggles, aches and pains that we ALL experience from time to time with training. This is not a manual or something to be taken and applied 100% of the time. This approach forsakes your individual tendencies and  nuance. Use any advice by firstly using your brain!
  • Secondly, you’re an individual little snow-flake! You’re going to present differently to the person next to you and also to the person you were yesterday and tomorrow. That’s the beauty of being human
  • A complex, dynamic system! This does, however, create difficulty in making broad, sweeping statements and any attempt to do so will miss people along the bell-curve. – This piece revolves around considerations for pain located around the kneecap (the anterior knee). This does not include previous or current trauma, surgery or anything else of that nature. Please have this assessed by a professional and get a plan for YOU and YOUR needs.
  • Please get your knee pain assessed… Please don’t blindly stumble down into the cavernous rabbit-hole of YouTube tutorials and Instagram models for advice. This is will lead to ongoing pain, frustration and ultimately end up costing more in time and money. A few sessions with a practitioner will have you full bottle on everything you need to know and arm you with a training plan that is going to keep you on track and doing what you actually want to do, as well as feeling better in the process!

Knee pain can sometimes seem very simple. I mean, it’s mostly just a modified hinge joint, right? I would beg to differ. So, here’s a quick guide on a select few of the common knee pain presentations we encounter weekly at Roar Physio;

As it is hopefully becoming apparent, there is a huge amount of diagnostic variance in knee pain. When you combine this with the enormous variety between individuals, it begins to become increasingly difficult to make generalisations about all types of anterior knee pain.

This isn’t to say that there are not factors that most of the above types of knee pain will have in common though. As such, you can apply most of these considerations and exercise advice to a variety of pain presentations and disorders, but it certainly won’t be a perfect fit.

Here are some key considerations when you have anterior knee pain;

Consideration One: What’s your training load like?

One of the key questions that all clients at Roar Physiotherapy will be asked is about their training history and current training loads. This provides pivotal information as to what may be the primary pain driver and at times guides a rehabilitation plan and program.

Increasing training intensity/volume/frequency/ modality will push you up and beyond your current physical capability. In the right dose, this leads to supercompensation, adaptation and building resilience – the good stuff!

When we push the boundary further, we move outside our ‘envelope of function’ and this can result in pain and dysfunction. This is demonstrated in the following image.

In summary, when increasing your training, be smart and understand that this comes with risk and reward – it’s up to you or your coach to decide the balance!

To learn more about training load and its impact on training and injury, check out these previous blog posts, HERE and HERE.

Consideration Two: Pain Patterns

More often than not, knee-pain sufferers tend to not find every activity painful, but rather a select few. There are some broad patterns I have observed in practice;

  • Positional pain
    • For example; deep squats or end range leg extension
  • Load-related pain
    • For example; pain onset at a threshold of weight through the knee – i.e. heavy squats
  • Force-related pain
    • For example; high force activity such as explosive movements (jumping/landing/cutting)

These can also be present in combination with one another. Accurately identifying the category, or categories, you fall in to can enable effective training modification, whilst recovering.

Consideration Three: Sleep, Stress & Mood

It can be broadly considered that adaptation occurs between the balance of fitness and fatigue. We develop fitness over time through training; depletion of energy; and recovery. This process is known as supercompensation (as illustrated in the diagram below).

If we interrupt the recovery process prematurely (prior to achieving supercompensation), then we accumulate fatigue, instead of positive adaptation.

Essential components for recovery are time, diet and sleep.

In fact, one study found that adolescent athletes who sleep, on average, less than eight hours have 1.7 times greater risk of being injured than those who sleep longer than eight hours.

By interfering with our sleep and recovery time, we potentially steer ourselves to developing pain. To learn more about sleep and its impact on training and injury, check out a previous blog post, HERE.

Furthermore, our mood & stress levels have been shown to be associated with the development/resolution of anterior knee pain. In one study, an individual’s beliefs surrounding their pain and activity levels were the strongest predictor of recovery from their knee pain.

So, when things don’t tend to make sense in regard to training itself, step back and consider how you have been recovering and what your stress has been like in recent times. This can start to build a clearer picture of why knee pain may have developed in the first place and what needs to be considered for optimal recovery.

Times they need a changin’..?

Ok, now we’ve established WHY you’re probably in pain, but what do we do about it?

Firstly, don’t freak out! Remember, pain is normal and is UNDOUBTABLY going to happen sometime in your training career.

If we look back to ‘Consideration Two,’ try to figure out what your sensitising features are;

  • Do you find certain positions painful? – i.e. below parallel/max depth while squatting
  • Do you find high load’s most painful? – i.e. squatting heavy weights
  • Do you find particular activities painful? – i.e. landing from box jumps
  • Do you find your knee painful when you hit the fatigue barrier?

The easiest method to begin managing this is to regress the aggravating activity. Perhaps for you this means reducing the weight, volume or depth of the movement. This is the option we promote most at Roar Physio and tends to be the most effective, whilst still keeping you very active.

If this doesn’t achieve our goal of pain reduction or functional improvement, then removing the aggravating activity should be considered. Seems like a no-brainer. The awesome thing about CrossFit is how ‘constantly varied’ it is. Take advantage of that and take a break from the one or two activities that’s are causing you pain for a week. It won’t kill you!

What Next?

After implementing the above considerations and relevant activity modifications, there is usually a role for exercise rehabilitation to get you back into optimal function.

Here are a few favourites from Roar Physiotherapy to assist you in getting back to it!

Exercise One: Spanish Squats

Spanish Squats are very useful for warming up tendon-related pain and to practice a more ‘hip-dominant’ style squat, which reduces anterior knee force.

Exercise Two: Single Leg Movements

CrossFit is massively bilateral, until it’s not… Just ask the recent Games Day 2019 competitors how their 100 pistols for time went!

As such, I think it’s important to regularly include and practice single leg movements. A simple regression/progression ladder may be;

  • Split squats
  • Bulgarian split squats
  • TRX/ring-assisted pistols
  • Lateral box step downs
  • Pistols to a box/ball
  • Full pistols


Exercise Three: Banded Walks

For some knee-pain sufferers, training the gluteal muscle group has an effect on pain reduction and functional improvement. Have a go at this example of a banded glute 


I hope this has provided some assistance for anyone suffering from knee pain. As a long-term knee pain sufferer myself, I understand how difficult and frustrating it can be to be limited by a cranky knee.

To learn a little more about knee pain, HERE is a previous blog piece I have written on common sources of knee pain.

If anyone is struggling to get on top of their pain or regain their function and performance, get in touch with us on the details below and get a plan in place!


Jack Connelly

Roar Physiotherapy

Principal Physiotherapist

FIFO life MEETS CrossFit life

In the words of Katrina Naylor

Before CrossFit, I was looking to improve my overall fitness and I was bored of going to the gym and doing my own thing on the machines. I watched the CrossFit Games on Netflix and was in awe of the strength and endurance of the athletes. RFX CrossFit had just opened their new box in Canning Vale, and so I started peeking through the window when I’d walk past, and thought it looked like good fun. I joined in October 2016 and have never looked back. I remember during one of my classes, Coach Corey had me push an empty sled and I thought I was going to die. Safe to say that it was the start of this crazy ride into the world of CrossFit.

Today, CrossFit has given me something to aim for in terms of my performance and overall fitness. It started out with wanting to lose weight but it soon became much, much more. Every time I would perfect a new movement or PB a lift (achieve a personal best) it would drive me to do better. I injured myself pretty badly early on in my CrossFit journey, mostly due to not listening to the coaches when they told me to slow down or reduce my weights. Basically, pushing my body beyond what it was capable of at the time, my muscles couldn’t support what I was trying to throw around.

I took 10 months off to recover from my injury, and when I decided to come back, I made sure this time I’d do things properly. I was working FIFO at the time and so I approached our Head Coach Clint to see what I could do to integrate my FIFO roster in with the regular classes. This was the start of me getting serious with my training. I set a goal and that was to do my first competition by the end of that year (2018). I attended 1-2 classes a week when I was home and started following extra programming provided by Clint while away on site in the gym. I checked in with Clint daily and would video my progress to obtain advice and tips on my technique.

I said to Clint one day that I had figured out the definition of insanity – “Doing burpees late at night in an empty gym in the Pilbara with no one encouraging you or yelling at you, other than the voice in your own head telling you to push harder, knowing your coach would know if you cheated!”

Working away in isolation from friends and family can be tough, however having this training regime and setting a goal ensured my mindset remained positive and focused. Last time I worked FIFO was 2006/2007 and it was an unhealthy experience for me. I was carrying an extra 30kg and had not stepped into a gym before. But I turned things around and now had a FIFO/CrossFit friendly routine, and was even meal prepping food to take to site with me to ensure I hit my macros and got those gains.

My mental well-being became the focus of my training. When I started working FIFO and wasn’t training, my mind would wander and I’d start over thinking everything and wishing I was at home and not stuck on site. I would feel myself slipping into depressive states and that’s when food would become my best friend. CrossFit kept life interesting and my mind occupied. I would look forward to finishing my 12-hour shift and getting ready to hit the gym and grind as hard as I could. This training, while away from home, set me up to have a kick ass time in the Saturday partner WODs when home, as I was still progressing and hitting PBs like everyone else despite not being able to go to class every day like everyone else.

Today, CrossFit has allowed me to push my body to places I never thought possible. It challenges my mental capabilities every single day. I used to talk myself out of training when I’d look at a class and think there was no way I would be able to do that. Now, I can’t wait to see what else I am capable of. If I’m not at work I am usually in the box, and my life is so much sweeter for it. I get to train with one of my oldest friends of 23 years (and counting), have met some of the most amazing people who I call my best mates, and even found a little love along the way. I absolutely love walking into the box and witnessing everyone’s PBs and embracing the overwhelming support from everyone, including the coaches, to grind harder every day. It’s become my happy place, that’s for sure.

My attitude toward my training, my mindset, and my focus on my routine and hitting goals only grew more positive on the daily. In October 2018, I stood on the podium with my best mate of 23 years as we took out 2nd place at my first competition, Festivus Games. Today, my next goal is to get a Bar Muscle-up and be able to Handstand Walk. I’d also like to stand on the podium once again at my next comp!

To anyone out there thinking of trying CrossFit, remember this – It’s you, against yourself, no one else. Your biggest fan club is the people throwing down with you every day in class. These are the people that will cheer you on to achieve things you never thought you’d be able to do. I promise, you will get stronger and fitter both in your body and mind.


What made you decide to try CrossFit?

I was a member at my local globogym and the training I was doing started to get really mundane and repetitive. My husband was attending CrossFit classes and coming home a lot more exhausted and satisfied than I was. I am not a fan of change but knew I needed something more, so I went and found my local box. I have never looked back

In what way has CrossFit improved your quality of life?

I had a pretty unfriendly relationship with snacks and alcohol and it caught up to me in my late 20s. The improvement in my mental and physical health has been invaluable. Going to CrossFit each day gives me an outlet to shut down for an hour, switch off and de-stress

What do you enjoy most about CrossFit at RFX?

It’s really hard to say what I most enjoy, everything is pretty awesome at RFX! The coaching staff are amazing, the programming is forever changing and challenging, and the vibe is always uplifting and positive

What advice would you give to someone thinking about trying CrossFit?

I know it can be a bit overwhelming to try something new and to step out of your comfort zone, but do you know what will eventually become more overwhelming – poor health. You won’t regret making a positive change in your life, I am yet to meet anyone who has

How long have you been doing CrossFit for now, and what are your goals for the future?

I’ve been doing CrossFit since 2012 and have been at RFX since 2015. My time at RFX has been the most rewarding. Some of my current goals are to place top 10 in an individual RX competition and to have a 100kg Back Squat

Phases 2 -How to build strength for the Strict Pull-up

Once we have spent 4-6 weeks progressively loading the phase 1 of this program you will find that your body starts to become accustomed to the movements and will no longer allow you to increase in load the way you may have over the first 3-4 weeks. This is the point which you need to change exercises or vary what you are doing to some extent to give your body the stimulus it needs to keep adapting and getting stronger.

At this point you need to start to incorporate some form of pull-up. It can takes some months to get to the strength needed to support you own weight over the bar so the 2 options are eccentric pull-ups and assisted eccentric pull-ups. By working the eccentric portion of the pull-up which is the lowering part only you are able to overload your muscle with good stimulus even though you might not be able to pull your own chin over the bar. I would set up boxes to a height that allows you to stand with your chin over the bar, get a good pull-up grip and try to lower yourself over 6 seconds; repeat this for 4-8 reps; 3-4 sets. A good way to tell when you have done enough reps is if you can no longer control the eccentric.

We will be doing eccentrics twice per week plus the extra support exercises. If you are feeling strong at any day feel free to try a strict pull-up at the beginning of the session. You can measure your progress by how high you can pull your chin to the bar. You will see each time you will get a little higher until you can finally do a pull-up!

With the other movements to keep progressing, we can adjust the rep range and remove the tempos to allow you to continue to lift more weight over the coming weeks. This way we have changed the stimulus and allowed you to continue to increase load!

The next 4-6 weeks will look like this:

Day 1:

A: Eccentric Pull-up; 4 x 4-8@60A0; rest 120s

Or Assisted Machine Eccentric Pull-ups

B: Lat pull-down; 4 x 8-10; rest 90-120s

C: Cable Row; 4 x 10-12; rest 90-120s

Day 2:

A: Eccentric Pull-up; 4 x 4-8@60A0; rest 120s

Or Assisted Machine Eccentric Pull-ups

B: DB Row; 4 x 10; rest 90s

C: Inverted Bar or Ring Row; 4 x 10-12; rest 90-120s


Watch the video’s provided for each movement, to help break down each exercise and show correct technique!

Phases 1 – How to build strength for the Strict Pull-up

Getting pull-ups can seem to be an impossible task for many of you. I’m here to tell you that anyone can achieve them! With a structured program and some coaching guidance, you will be well on your way to developing Strict Pull-ups.

First Step

The first step is to build the requisite strength and movement pattern a pull-up requires. A lot of people think if they just grab a band and start pulling their chin up to the bar, they will develop strength in the end. This kind of approach will develop bad movement patterns and you will likely develop a strength curve that does not put enough emphasis on the initial pull, as this is where the band has the most amount of tension.

This program is aimed at beginner – intermediate strength levels, however I have come across many seemingly strong athletes who have little or no control over there back musculature that could really benefit from taking the time to reduce load and develop control and strength in the right areas to bust through plateaus.

How to start

To start off, you should consider including machine-based strength movements into your program. Why? Because you can incrementally adjust load which will allow you to make small progression week to week, and your movement pattern will remain high quality as you won’t be forced to lift something too heavy. You will also use time under tension and higher volume, as the overall load will be lighter, and athletes with this weakness will benefit from the higher volume without it affecting their nervous system.

Most people have trouble activating their lats, rhomboids, and lower trap musculature. So, for the first 4 weeks of strength building, we will select some specific exercises with the focus to maintain perfect activation through these muscles by performing low loads and more time under tension to strengthen weaker positions. If you were to overload too early, you would end up reinforcing bad movement patterns by overusing the chest, biceps, and upper traps. The key is patience and quality, until you can feel the muscles activating. When you have good activation and control, you can increase load accordingly. It is a good idea to have an experienced coach present to watch your movement so they can correct if necessary. If you don’t have a coach present, video yourself for review! It will be easy to feel if you are performing them correctly or not, because if done incorrectly, you won’t feel the burn in the rhomboids and lats. Instead, you would feel it in the upper traps and biceps.

Movements to include in your first phase would be the following:

*Active Bar Hang – to develop grip and active shoulder strength

*Lat Pull-down – with tempo to emphasise pause and eccentric

*Cable Row – tempo to emphasise pause and eccentric

*RNT DB Banded Row – band to help develop natural arc and to assist with lat activation

*Inverted Bar or Ring Row – help to incorporate bodyweight movements to get used to pulling your own weight under load

*Banded Straight Arm Kneeling Lat Pull – higher volume, focus on engaging lats and disengaging biceps to develop the straight arm pull

We will split this program over 2 days with at least 2 days rest between, and you can fit this almost anywhere into the week of a standard CrossFit or Fitness Program.

Day 1:

Day 2:

Watch the video’s provided for each movement, to help break down each exercise and show correct technique!

To start off, we suggest sticking with this program for 4 weeks prior to moving to Stage 2, however if you are still progressing on week 4, stay on this program incrementally adding load each week until form starts to break or you are no longer getting any benefit from this structure.

Then, keep your eye’s peeled for Phase 2!

– Coach Clinton Hodgkins