Knee pain when doing burpees: the squat, the jump and landing, kneeling and the swaps that help

What a burpee asks of the knee, and what no study has measuredEmerging evidence

A burpee is a squat down to put your hands on the floor, a jump or step back to a straight plank, a jump or step back in, and a stand or jump up with the arms overhead, often with a push-up and sometimes with the chest and thighs touching the floor. The knee bends deeply twice (squatting down and landing the feet back in under the chest), works hardest as you drive up and jump, brakes the landing, and in some versions meets the floor.

We found no lab study of knee angles, forces or loads in a burpee or squat thrust, and none comparing a jump-back with a step-back burpee or a burpee onto a raised surface. What is measured is how hard burpees are: in 10 young adults, they gave the highest heart rate, lactate and energy cost of seven bodyweight exercises, about 32 calories a minute over 30-second bouts against about 20 for squats. Fit students averaged about 57 (men) and 49 (women) burpees in a 3-minute test. So the knee meets the burpee tired, which is our reading of why pain shows up late in a set.

Sources 1, 2

The squat and the floor: depth and kneeling load the front of the kneeMixed evidence

In lab studies of healthy knees, the forces behind the kneecap rose as the knee bent, peaking around 90 degrees in 15 adults, and a squat from about 45 degrees to straight kept kneecap stress low in 10. A review suggests a range of 0 to 50 degrees for many people in knee rehabilitation, while another found deep squats with good technique didn't raise the risk of injury to the knee's passive tissues. Rising from a full squat or from kneeling put about 4,500 newtons through 16 healthy knees (several times body weight), within what the cartilage tolerated in that study, while a cadaver study found deep bending concentrated stress to the limits of cartilage. So the evidence on deep bending is mixed, and none of it comes from people doing burpees.

When you kneel, most of the pressure goes through the tendon and the bump just below the kneecap, and pads spread it but don't remove it, in two small lab studies of static kneeling. Pressure on the front of the knee can bring on a swollen bursa (housemaid's knee), and about a third of such cases are infected in a review; the NHS advises padding when kneeling.

Sources 3, 4, 5, 6, 7, 8, 13, 14, 15, 16

The landingEmerging evidence

In 8 female athletes dropping from 59 cm, soft landings bent the knee to 117 degrees and stiff landings to 77, and stiff landings gave bigger impact forces, while the knee and hip muscles absorbed more of the energy in soft ones. Telling adult women athletes to land softly lowered the peak landing force and bent the knee more straight away, and soft single-leg landings lowered modelled load on the anterior cruciate ligament (ACL).

In 10 filmed ACL injuries in handball and basketball, the knee was bent only 23 degrees at landing and caved inwards within about 40 milliseconds, at about 3 times body weight. So a soft landing shifts work onto the thigh and hip muscles rather than removing it (our reading), which is why the jump comes back last for a sore tendon.

Sources 9, 10, 11, 12

How common it is, and who gets itEmerging evidence

No study counts knee pain from burpees. In CrossFit surveys, knees were 13% to 16% of injuries (11 of 84 in 386 people, 10 of 62 in 191, and 15% of the injured among 3,049), behind the shoulder and the back, and people in their first year and training fewer than three times a week were injured more. Burpees weren't counted separately. A review of three cohort studies found CrossFit injury rates comparable to many other sports, with low certainty.

In 100 adults in 6-week trainer-led group strength-endurance classes, 18 were injured; the knees were the commonest injured region (7 injuries) and the back next (6), and burpees and squats were the commonest movements causing injury. We read that study's abstract only, which gives no count per movement. US emergency department data linked to exercises such as burpees rose as high-intensity interval training (HIIT) grew, mostly leg injuries, but with no count of people taking part, the risk per session is unknown. So knee pain with burpees is most likely in newcomers, after a break, in big or timed sets and in people with a sore kneecap or tendon already (our reading).

Sources 17, 18, 19, 20, 21, 22

How the causes are told apartStrong evidence

Kneecap pain (patellofemoral pain) is defined by pain around or behind the kneecap brought on by at least one activity that loads the bent knee, such as squatting, stairs, running, hopping or jumping, and a squat that brings on pain at the front of the knee is the best single test. A sore patellar tendon hurts at the lower tip of the kneecap and gets worse with activities that store and release energy in the tendon, such as jumping and landing; the NHS describes pain between the kneecap and shin from repeated running or jumping.

A meniscus tear can come from a minor twist, even standing up, the NHS says, and when catching or locking, pain at full straightening and full bending, tenderness on the joint line and a positive clinical test are all present, a consensus found it predicted a tear 92% of the time. From mid-life, a stiff ache is often arthritis, which the National Institute for Health and Care Excellence (NICE) diagnoses without imaging. In growing children, pain at the bump below the knee or the lower tip of the kneecap hurts with jumping and kneeling.

Sources 23, 24, 25, 26, 27, 28, 29, 30

When a scan or test mattersStrong evidence

Kneecap and tendon pain are diagnosed by examination, and NICE says don't routinely image knee arthritis. For a wear-and-tear meniscus tear, a European consensus says magnetic resonance imaging (MRI) is typically not needed first; for a tear after an injury, a scan matters mainly when keyhole surgery is being considered. After a fall or a bad landing, the Ottawa knee rule decides who needs an X-ray: across 6 studies of 4,249 adults it picked up 98.5% of fractures.

Tests that change things: an X-ray when the Ottawa rule says so, an MRI after a pop with fast swelling, locking or giving way, or catching that hasn't settled after about 3 months, and blood tests and joint fluid for a hot, swollen knee, which the NHS says needs checking straight away.

Sources 29, 31, 28, 32, 33

How it usually goesEmerging evidence

No study follows knee pain from burpees. In a kneecap pain trial of 40 young women, 85% were doing sport without pain at 12 months, but a consensus warns that kneecap pain can persist for years. NHS inform says to see a professional if knee pain hasn't improved within 6 weeks of its exercises. A meniscus tear can get better on its own, though it can take a while, the NHS says.

Jumper's knee is often slow: in the largest trial, 43% were back at their usual level of sport at 24 weeks with staged loading. In growing knees, some children need to stop the activity completely for 2 to 4 weeks, and most carry on with less running and jumping. No one can promise a date.

Sources 34, 23, 36, 27, 35, 30

Kneecap pain: hip and knee strength is the treatmentStrong evidence

An international consensus recommends exercise for kneecap pain, and hip and knee exercises together in preference to knee exercises alone. A Cochrane review of 31 trials (1,690 people) found consistent but very low quality evidence that exercise reduces kneecap pain by a clinically worthwhile amount, about 1.5 points out of 10 during activity against no exercise in the short term (5 trials, 375 people). NHS inform's knee exercises build from 2 or 3 repetitions to sets, up to 2 sets of 15, and say a gradual return to normal activities gives the best results.

None of these trials was in people with knee pain from burpees: the evidence is borrowed from kneecap pain in general.

Sources 37, 24, 36, 38

Patellar tendon pain: staged loading, with the jumps lastEmerging evidence

In 76 athletes with patellar tendon pain, a staged programme of daily holds, then slow heavy strength, then springy jumps such as jump squats and box jumps every third day, then sport, did better than painful decline squats at 24 weeks: 28 against 18 points on a 100-point tendon score, an adjusted difference of 9. Load was set by pain, kept at 3 out of 10 or less, and the jumping stage started at 3 sets of 10 on two legs. An expert review says treatment should build the tendon's tolerance to load step by step. That is the template for bringing the burpee's jump back.

Sources 35, 25

Changing the burpee: lab readings, untested against painEmerging evidence

No trial has tested a changed burpee for knee pain, and no study has measured the knee in one. Stepping back removes the landing; a bench or box at hand height means you squat less deeply, and kneecap stress was lowest above about 45 degrees of bend in lab studies, so that it eases kneecap pain is our reading, inferred from squat studies. A cue to land softly lowered landing forces straight away in women athletes, and kneeling on a mat spreads the pressure on the front of the knee.

A burpee without the jump is still a standard, hard exercise: the 3-minute burpee test uses a squat thrust that ends standing, with no jump.

Sources 4, 5, 6, 10, 13, 14, 2

Meniscus tears and arthritis: exercise before surgeryStrong evidence

In 140 middle-aged adults with a wear-and-tear meniscus tear, 12 weeks of supervised exercise did as well as keyhole surgery at 2 years. A European consensus says keyhole trimming shouldn't be the first treatment for such tears, a guideline makes a strong recommendation against keyhole surgery in nearly all degenerative knee disease, and NICE offers exercise to everyone with osteoarthritis, saying joint pain may rise a little at first.

Sources 39, 31, 40, 29

Some pain during exercise is fineEmerging evidence

In 7 trials of 385 people with long-lasting muscle and joint pain, exercise that allowed some pain gave a small short-term benefit over pain-free exercise and did no worse later. In 38 people with Achilles tendon pain, carrying on running and jumping under a pain-monitoring model did as well as resting. A kneecap pain trial built its programme around a pain-monitoring system. So staying active within a pain rule, rather than stopping, is the approach here.

Sources 42, 41, 34

Your burpee for now (written steps)

Our 3D figure shows the full burpee, not the scaled versions, how far you step or jump, or the floor under you. These steps come from lab studies of squats, landings and kneeling, our burpee technique and HIIT guides and coaching practice; where a step is our suggestion or our reading, it says so. No trial has tested a change to the burpee for knee pain.

• 1. Step, don't jump: step your feet back to the plank and back in, one at a time. Our burpee technique guide teaches the step-back version first, and removing the jump removes the landing, the part that loads the patellar tendon most.
• 2. Hands on a bench or box: a sturdy bench, box or step about knee height means you squat less deeply to reach it. Kneecap stress peaks around 90 degrees of bend in lab studies, so that this eases kneecap pain is our reading, untested in burpees. Lower the box over the weeks.
• 3. Squat down, don't fold or drop: only as deep as stays comfortable, with your heels down, as our squat move page says.
• 4. Land softly, or leave the jump out: land quietly with your knees bent and pointing over your toes, not caving in, and drop the jump when you're tired, as our HIIT guide says.
• 5. No knees on a hard floor: step a foot through to get up rather than dropping onto your knees, or kneel on a folded mat. Pads spread kneeling pressure but don't remove it, and the NHS advises padding when kneeling. Chest-to-floor burpees and burpee broad jumps wait until stage 3 (editorial).
• 6. Fewer, slower reps with more rest: for example 20 to 30 seconds of work with 30 to 40 seconds of rest before 40 on and 20 off (editorial, as in our burpee back guide). No timed challenges, as many rounds as possible (AMRAP) or burpee penalties for now: newcomers and big, unaccustomed sessions go with more injury and with muscle breakdown.
• 7. Low-impact cardio while it settles: step jacks, a bike, an elliptical or brisk walking keep the heart-rate part going (our HIIT guide's no-jump swaps; editorial).
• 8. Tell the coach and scale: more trainer involvement went with fewer injuries in a CrossFit survey.

Sources 4, 5, 6, 10, 11, 13, 14, 16, 19, 43, 17

Back to classes, HYROX and sport (written steps)

No study has tested how burpees come back after knee pain, so these steps are our suggestion unless a source is named.

• 1. Classes, boot camps and CrossFit: scale to your stage, tell the coach, and leave out burpee penalties, timed challenges and AMRAPs until stage 3 passes the pain rule.
• 2. Chest-to-floor burpees and HYROX burpee broad jumps: last, after full burpees pass for 2 weeks, with a mat under your knees if you put one down.
• 3. Coming back after a break: about half your old volume in the first session, adding a little each week. People in their first year and training fewer than three times a week were injured more in a large survey.
• 4. Jumping sports: landings and springy jumps come back by our jumping knee guide's stages, which follow the tendon trial's order.
• 5. Daily life: keep walking, use stairs within the pain rule, and kneel on a cushion for floor jobs.
• 6. Keep two strength sessions a week with knee and hip work.

Sources 19, 43, 35