Pain guide · Knee pain

Knee pain on the elliptical: the kneecap, stride and resistance, foot position and what helps

Knee pain on the elliptical (cross trainer) usually comes from the kneecap. The machine takes away the impact of walking and running, but it bends your knee more and works the front of your thigh harder, thousands of times a session, and inside the knee it loaded the joint about as much as walking and twice as much as a bike in small studies. Where it hurts is the best clue: around or behind the kneecap is usually kneecap pain (runner's knee), one point just below or above it a tendon, the outside the iliotibial (IT) band, and a stiff ache in both knees from mid-life arthritis. Shorter sessions, moderate resistance, a low ramp, a steady pedal rate, feet pointing forwards and soft knees may help, though no study has tested them against pain, and the elliptical isn't bad for knees.

This guide starts with the signs that need help, from accident and emergency (A&E) for a knee that changed shape or swelled fast after a pop, to a same-day check through the National Health Service's 111 line (NHS 111) or a general practitioner (GP) for a knee that locks, gives way or can't take your weight, a hot, swollen knee, or a swollen, painful calf. It then maps the causes by where it hurts, explains what the studies show, and don't, about resistance, the ramp, stride, foot position and pedalling backwards, shows how to change your sessions today, and gives a three-stage plan with a 3D demo of every move, back to your usual workouts.

3-stage exercise plan When to get help 34 sourcesUpdated 28 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Go to A&E if you've injured your knee and it has changed shape, it becomes very swollen very quickly, you felt a pop or snap, you can see bone sticking out, or it's bleeding heavily. Don't drive yourself: ask someone to take you, or call 999 if the pain means you can't move your leg to get there.
Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape.
Get advice from NHS 111 now: the knee locks, gives way or clicks painfully. Painless clicking is normal.
Get advice from NHS 111 now: after a twist, your knee won't go fully straight, or something blocks the last part of straightening, even if you can still walk on it. A torn piece of meniscus caught in the joint can do this, and it needs checking promptly.
Same day: a pop or tearing feeling at the front of the knee after a fall, stumble, jump, landing or a heavy squat, then you can't straighten the knee or lift the straight leg off the bed, there's a dent above or below the kneecap, or the kneecap sits higher or lower than on the other side. Go to A&E or an urgent treatment centre, or get help from NHS 111. A torn quadriceps or patellar tendon does best when it's repaired soon.
You hurt your knee and cannot take 4 steps, or you are 55 or over and have injured it: get it checked the same day for a broken bone.
Get advice from NHS 111 now: a hot, red or swollen knee with sudden severe pain, a very high temperature (although not everyone has one), or feeling hot, cold or shivery. This can be a joint infection.
Call 999 or go to A&E if your child gets sudden pain in their hip, knee or thigh (hip problems can sometimes be felt in the thigh or knee) or cannot put any weight on their leg. If your child is limping, ask for an urgent GP appointment or get help from NHS 111 the same day. This applies to teenagers too, and in some children knee pain is the only sign.
Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin; or swollen veins; or sudden worse pain and swelling around a lump at the back of the knee (a possible clot or a burst Baker's cyst).
Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out. Do not drive yourself. It can be a blood clot that has reached the lungs.
Call 999: chest pain that started suddenly, or spreads to your arm, neck or jaw, or your chest feels tight. This could be a heart attack. Do not drive yourself to A&E.
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
Same day (call NHS 111, or go to A&E if you feel very unwell): after a big or unusual session, such as a first spin class, a workout of 100 back squats, or intervals of wall sits, squats, lunges and jumps, a challenge or a new class, muscle pain, swelling or weakness far worse than the session explains, and dark pee (red, brown, tea or cola coloured), sometimes starting hours or days later. Dark pee isn't always there, so muscles far sorer, more swollen or weaker than the session explains still need the same-day check. It can be rhabdomyolysis, a breakdown of muscle that can harm the kidneys.
Call 999 or go to A&E: back or leg symptoms with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or severe or worsening weakness or numbness in both legs.

See a doctor or physiotherapist if

Knee pain that has not improved within a few weeks of looking after it at home. Many areas offer NHS physiotherapy without a GP referral.
Kneecap pain that hasn't improved within 6 weeks of changing your activities and doing the exercises, or that gets worse: talk to a GP or physiotherapist.
The knee gives way, the whole knee swells, or it catches or locks: that isn't typical of kneecap or tendon pain. Get it checked for a ligament or meniscus injury (our suggestion).
Catching, locking or swelling at the joint line that hasn't settled after about 3 months of exercise and other non-surgical care: ask your GP or physiotherapist about a specialist review. A magnetic resonance imaging (MRI) scan may be considered then.
Tendon pain above or below the kneecap and you take steroid tablets or have steroid injections, use anabolic steroids, have kidney disease, gout, rheumatoid arthritis, lupus or diabetes, or have recently taken a fluoroquinolone antibiotic: tell your GP or physiotherapist and build up more gradually. These can weaken the tendon. If you're taking a fluoroquinolone now, stop taking it and contact your doctor straight away, as the UK medicines regulator advises.
A child or teenager with pain at a bump just below the kneecap or at its lower tip, worse with squats, jumps and kneeling: see our Osgood-Schlatter and Sinding-Larsen-Johansson guides, and get it checked if it is getting worse.
A child or teenager whose knee pain is there at rest or worse at night, or comes with a limp, swelling, a high temperature, unusual tiredness or weight loss: see a GP.
Numbness, tingling or weakness that travels down the leg from the back. That points to a nerve (sciatica) rather than the knee.
Swelling in several joints, or morning stiffness that lasts more than 30 minutes: see a GP. It can be an inflammatory arthritis such as rheumatoid arthritis rather than osteoarthritis.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

Around or behind the kneecap, hard to point to, building through a session, worse with high resistance or a steep ramp, and off the machine on stairs, squats and after sitting

Usually kneecap pain (patellofemoral pain), often called runner's knee: by far the commonest pattern. Painless clicking is normal.

Read: Runner's knee →One point at the lower tip of the kneecap, worse with hard efforts and, off the machine, jumping

Patellar tendon pain (jumper's knee).

Read: Jumper's knee →One point at the top edge of the kneecap, worse at the deepest bend

Quadriceps tendon pain. A pop with a dent and a knee you can't straighten is a tear: see the warning signs.

Read: Quadriceps tendinopathy →Below the kneecap, either side of the tendon, worst as the knee snaps straight as each pedal goes back

Possibly fat pad impingement. Keeping your knees soft at the back of the stride usually helps.

Read: Fat pad impingement →The outside of the knee, coming on at the same point in each session

Usually iliotibial (IT) band syndrome.

Read: IT band syndrome →The inside of the knee: a stiff ache from mid-life, a tender spot a few centimetres below the joint, or after a twist

Arthritis on the inner side, pes anserine pain, the inner ligament or the meniscus. Our inner knee guide maps the exact spot.

Read: Inner knee pain →The joint line, with catching, locking or swelling later that day

Often a meniscus tear.

Read: Meniscus tear →Both knees, a stiff ache from your mid-40s, with morning stiffness of 30 minutes or less

Often knee arthritis, which is diagnosed without an X-ray.

Read: Knee arthritis →Behind the knee, tightness or a soft lump

Often a Baker's cyst or a tendon. A throbbing, swollen calf in one leg needs a same-day check for a clot: see the warning signs.

Read: Pain behind the knee →Achy thighs or the area just above the kneecap a day or two after a new or longer session, easing day by day

Usually muscle soreness.

Read: Knee pain after a workout →The same pain on the bike, on stairs or on a step machine

Our cycling and stairs knee guides cover those.

Read: Knee pain when cycling →Using the elliptical after a knee replacement

Your surgical team's timing comes first; our knee replacement guide covers the return to exercise.

Read: Knee replacement →A teenager with a tender bump just below the kneecap

Worse with sport and kneeling in a growing teenager: Osgood-Schlatter disease.

Read: Osgood-Schlatter →Pins and needles or numbness down the leg

Points to a nerve in the lower back rather than the knee: sciatica.

Read: Sciatica →

Understand it

What the elliptical asks of the knee: less impact, not much less knee loadEmerging evidence

Your feet stay on two pedals that travel in long ovals, so there is no landing. In 75 adults aged 19 to 72, the load under the foot averaged 73% of body weight on an elliptical, against 112% walking, 175% jogging on a treadmill and 201% jogging outside, and in 30 adults it stayed at 70% to 81% across resistance and incline settings. But the knee works through more bend: compared with walking, the hip, knee and ankle bent further and the knee's straightening effort was greater in 15 men, the knee bent more and part of the front of the thigh (the quadriceps) worked harder in 20 adults, and the front of the thigh worked harder than in cycling or walking in 10 adults.

Inside 3 knee replacements fitted with force sensors, the elliptical put 2.24 times body weight through the knee, unchanged as the machine got harder, against 2.05 for treadmill walking, 1.03 for a stationary bike and more than 4 for jogging; the authors concluded that for reducing knee forces it was no better than treadmill walking. In 12 young men, knee forces were higher on an elliptical than on a bike and rose with a faster pedal rate, and in 20 adults cycling gave the lowest knee loads and walking the highest, with the elliptical between. These are small studies of different measures, but they agree.

Sources 1, 2, 3, 4, 5, 6, 7, 8

What no study has countedEmerging evidence

No study counts knee pain caused by the elliptical, measures the load behind the kneecap on one, or links stride length, the ramp or foot position to knee load or pain. So the map on this page is built from what each condition is known to do. That kneecap pain on the elliptical comes from more bend and more thigh work repeated thousands of times, a jump in time or resistance, or a sudden switch from other training, is our reading, not a counted fact.

Sources 6, 7, 9

Kneecap pain, and 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 or hopping; a squat that brings on pain at the front of the knee is the best single test. An NHS leaflet says about a quarter of people have it at some point.

A tendon is one point you can press, just below or above the kneecap. The fat pad pinches below the kneecap as the knee snaps straight. Arthritis is a stiff ache from mid-life with morning stiffness of 30 minutes or less, which the National Institute for Health and Care Excellence (NICE) diagnoses without an X-ray. Catching, locking or swelling after a twist points to the meniscus or a ligament, and a throbbing, swollen calf to a possible blood clot.

Sources 9, 10, 11, 12

When a scan helps, and what it can't tell youStrong evidence

Not usually: an international consensus calls the clinical examination the cornerstone of diagnosing kneecap pain, NHS services say X-rays and scans are not routinely used for it, and NICE says diagnose osteoarthritis without imaging in people 45 or over with activity-related joint pain and short morning stiffness. Scans of knees that don't hurt show cartilage defects in 11% of adults under 40 and 43% from 40, and meniscus tears in 4% and 19%, so a report has to match your symptoms.

Tests matter after an injury with a pop, fast swelling, a knee that locks or gives way, or one you can't walk on, and for catching or swelling at the joint line that hasn't settled after about 3 months of non-surgical care. A US orthopaedic page says X-rays are often taken for kneecap pain; UK practice is not to.

Sources 9, 13, 14, 11, 15, 16

How it usually goesEmerging evidence

No study follows knee pain from the elliptical. In a kneecap pain trial in 40 young women, 85% were doing sport without pain at 12 months. But in a long-term follow-up, 34 of the 60 people who replied (57%) reported an unfavourable recovery 5 to 8 years later, and pain for more than a year at the start predicted a poorer outcome; the consensus calls kneecap pain a condition that can persist for years.

NHS inform says many knee problems begin to settle within 6 weeks; NHS leaflets for kneecap pain say it can take around 12 weeks to notice a great improvement, or 3 to 6 months. No one can promise a date, which is why the plan keeps strength work going after the sessions come back.

Sources 17, 18, 9, 19, 13, 14

What helps, and how strong the evidence is

Changing the machine: lab readings, never tested against painEmerging evidence

The settings on this page are our reading of lab studies of joint angles and loads in healthy people; none has been tested against knee pain. In 12 men, the vertical force at the knee was about 0.94 times body weight at 50 pedal strokes a minute and 1.20 at 70, so racing the pedals adds load. In 30 adults, more resistance raised the load under the foot while more ramp didn't, and the authors, who didn't measure the joints, warn that high shear forces may exist on the leg joints at high resistance. Raising the ramp changed how far the knee bent in 24 adults, and turning the toes out gave the greatest inward knee angle in 16 men.

Sources 7, 2, 20, 21

Pedalling backwards isn't a kneecap fixMixed evidence

In 24 young adults on a modified elliptical, pedalling backwards bent the knee less at every ramp angle but let it fall inwards slightly more at the two lowest ramps, and the authors suggested it for people with knee arthritis or pain around the kneecap. That study measured joint angles only. In a computer model of cycling, pedalling backwards raised the load behind the kneecap, and its authors advised against it for kneecap pain. So use backwards pedalling for variety once the knee is settled, not as a treatment.

Sources 20, 22

Strength work is the treatment for kneecap painStrong evidence

In a Cochrane review of 31 trials (1,690 people), exercise reduced kneecap pain during activity by about 1.5 points out of 10 against no exercise in the short term (5 trials, 375 people), on very low quality evidence. An international consensus recommends exercise, and hip and knee exercises together in preference to knee exercises alone; it says foot orthoses can reduce pain in the short term, and was uncertain about taping and bracing.

An NHS leaflet for kneecap pain gives 3 sets of 8 to 12 of bridging, straight-leg raises, mini squats to less than 30 degrees, heel raises, knee extensions, sit to stand, hamstring curls and clams, and names the cross trainer, with swimming and stationary biking, as gentler alternatives to high-impact exercise. None of these trials was on an elliptical: the evidence is borrowed from kneecap pain in general.

Sources 23, 24, 25

Knee arthritis: exercise helps, and most rate the cross trainer knee friendlyEmerging evidence

NICE recommends exercise for everyone with osteoarthritis, such as local muscle strengthening and general aerobic fitness, and says joint pain may rise when you start. In 415 overweight adults followed for 4 years, those who used ellipticals had the smallest rise in knee damage on MRI (magnetic resonance imaging), an association that can't show cause. In an international survey, about 6 in 10 of the people with knee arthritis who rated it called cross-training knee friendly (read from a chart in the paper), against 82% for indoor biking.

In 15 people with severe arthritis waiting for a hip or knee replacement, an all-out elliptical test raised pain by a median of 3 out of 10, against 2 on a treadmill and 3 on a bike.

Sources 11, 26, 27, 28

The elliptical as a treatment: one small study of a special machineEmerging evidence

The only elliptical treatment study we found used a robotic off-axis machine, whose footplates twist and slide, in 12 people with kneecap pain: 18 sessions of 30 minutes over 6 to 8 weeks, with knee pain scores rising from 69 to 81 out of 100 (higher is better) and no control group. Ordinary gym ellipticals haven't been tested as a treatment. For runners, a standard elliptical cost less energy than running in 16 runners, so it keeps fitness ticking over while running hurts.

Sources 29, 30

How much pain is OK while you exercise?

0 to 2 is safe, up to 5 is acceptable, back to usual by the next morningEmerging evidence

This guide uses the knee hub's pain rule, for the exercises and for the machine. Rate your knee pain from 0 to 10 during and after exercise. In the pain-monitoring model used in knee trials, 0 to 2 counts as safe, up to 5 as acceptable and above 5 as too much. Aim for 0 to 3 most of the time. By the next morning your knee should be back to its usual level. If it is not, drop back one step next time (fewer sets, a shallower range, a lower step), not to nothing.

The model comes from a kneecap pain trial in 40 young women. NHS inform's kneecap exercises use the same bands (0 to 3 minimal, 4 to 5 acceptable, 6 to 10 excessive) and want pain no worse the morning after. One NHS service is more precise: pain back to its usual level within 30 minutes, and no extra pain or stiffness the next morning lasting longer than an hour; another says if pain rises for more than 24 hours, do fewer exercises next time. In 7 trials of long-lasting muscle and joint pain, exercise that allowed some pain did no worse than pain-free exercise. With pain at one point just below or above the kneecap, our knee tendon guides keep it to 3 out of 10 or less.

On the elliptical (our suggestion, built on the same rule): judge each session by its last few minutes and the next morning, and use the time, resistance, ramp and pedal rate where your knee stays at 5 out of 10 or less, aiming for 0 to 3. Pain that builds steadily through a session rather than holding steady is a sign to end it there and go shorter or lighter next time, not to stop altogether. Sharp, catching or giving-way pain, new swelling, a swollen calf, or chest pain or breathlessness isn't a pain-rule question: see the warning signs.

Sources 17, 31, 13, 14, 32

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle: change the machine, start loading

About weeks 0 to 2, strength work 2 to 3 days a week: keep your fitness on the elliptical only within the pain rule, with the changes in the written steps below, or on a bike instead, and start the hip and knee strength work recommended for kneecap pain. With a diagnosed condition (a tendon problem, a meniscus tear, an arthritis flare, a knee replacement), that guide's plan comes first.

Elliptical trainer demonstrated on the 3D figure

3D demoElliptical trainerBeginner · Cardio machine

Only if it passes the pain rule: 10 to 20 minutes at a moderate effort to start, building towards 30, with moderate resistance, the ramp low, a steady pedal rate, heels down and knees soft · The move page's dose, an editorial starting point; the settings are our reading of lab studies. If it hurts more than 5 out of 10, use the recumbent bike instead at its move page's dose, the same 10 to 20 minutes building towards 30 (an editorial starting point)

Harder: Stair-stepper machine

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

3 sets of 8 to 12 · An NHS leaflet's dose for kneecap pain

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

3D demoClamshellBeginner · No equipment

3 sets of 8 to 12 each side · An NHS leaflet's dose for kneecap pain

Easier: Supine isometric hip abduction (belt press) · Harder: Lateral band walk

Sit squat (partial squat) demonstrated on the 3D figure

3D demoSit squat (partial squat)Beginner · No equipment

3 sets of 8 to 12, to less than 30 degrees of knee bend at first · An NHS leaflet's dose and depth for mini squats

Harder: Bodyweight squat

Seated knee extension (chair) demonstrated on the 3D figure

3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight

3 sets of 10 to 15 each leg, 2 to 3 days a week · The move page's dose. If the full range hurts, work only from 90 to about 45 degrees of bend, as the move page says

Easier: Quad set (static quads) · Harder: Leg extension

Spanish squat (band squat hold) demonstrated on the 3D figure

3D demoSpanish squat (band squat hold)Intermediate · A band + An anchor point

Only for pain at one point just below or above the kneecap: 4 to 5 holds of 30 to 45 s with 1 to 2 min rest, once a day, at 3 out of 10 or less · The move page's dose

Easier: Straight-leg raise · Harder: Pistol squat

Move on when: Daily life and these exercises stay within the pain rule, and 20 minutes on the elliptical (or the bike) leaves the knee no worse the next morning, for about a week (editorial, as in our cycling knee guide).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build hip and knee strength, and time on the machine

About weeks 2 to 6, strength work 2 to 3 days a week and the elliptical 3 to 5: the combined hip and knee work recommended for kneecap pain, with sessions built up by time first.

3D demoElliptical trainerBeginner · Cardio machine

Build to 20 to 30 minutes at a moderate effort, adding about 5 minutes every session or two, time before resistance · Editorial, as in our elliptical guide. Moderate means you can talk but not sing, as the NHS describes it

Harder: Stair-stepper machine

3D demoStep-upBeginner · A step

3 sets of 10 each leg, a low step, then medium · Editorial, as in our cycling knee guide

Easier: Low step-up · Harder: Dumbbell step-up

Patrick step-down demonstrated on the 3D figure

3D demoPatrick step-downIntermediate · A step

3 sets of 8 to 10 each leg, low step first · Editorial, as in our cycling knee guide

Easier: Bodyweight squat · Harder: Skater squat

Lateral band walk demonstrated on the 3D figure

3D demoLateral band walkBeginner · A band

3 sets of 12 steps each way · Editorial, as in our cycling knee guide

Easier: Hip abduction machine · Harder: Lateral band walk, band at the feet

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 8 to 10 each leg, to a depth within the pain rule · Editorial, as in our cycling knee guide

Easier: Bodyweight squat · Harder: Reverse lunge

Single-leg glute bridge demonstrated on the 3D figure

3D demoSingle-leg glute bridgeIntermediate · No equipment

3 sets of 10 each leg · Editorial, as in our cycling knee guide

Easier: Glute bridge · Harder: Barbell hip thrust

Move on when: Ten slow step-downs from a low step on the sore leg stay within the pain rule, and 30 minutes on the elliptical leaves the knee no worse the next morning (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Back to your usual sessions, and keep strong

From about week 6, then ongoing: your usual sessions, then harder ones, one change at a time by the written steps below, with strength work kept once or twice a week, because kneecap pain often comes back. No study has tested a return to the elliptical after knee pain, so the order is editorial.

3D demoElliptical trainerBeginner · Cardio machine

Your usual sessions; then add resistance a level at a time, then the ramp, then intervals (1 minute harder, 2 minutes easy, 4 rounds building to 8), then backwards if you want it · Editorial, as in our elliptical and cardio intervals guides

Harder: Stair-stepper machine

3D demoLeg pressBeginner · Strength machine

3 sets of 6 to 10 each leg, one leg at a time, in a range that passes the pain rule · As in our cycling knee guide (editorial)

Harder: Bodyweight squat

Rear-foot-elevated split squat (Bulgarian split squat) demonstrated on the 3D figure

3D demoRear-foot-elevated split squat (Bulgarian split squat)Intermediate · A bench or box

3 sets of 6 to 8 each leg · As in our cycling knee guide (editorial)

Easier: Reverse lunge · Harder: Split squat jump

Single-leg Romanian deadlift demonstrated on the 3D figure

3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell

3 sets of 8 each leg, fingertips on a wall at first · As in our cycling knee guide (editorial)

Easier: Dumbbell Romanian deadlift

Side plank with leg lift demonstrated on the 3D figure

3D demoSide plank with leg liftAdvanced · No equipment

3 sets of 8 to 10 each side · As in our cycling knee guide (editorial), for outer knee pain

Easier: Side plank · Harder: Copenhagen plank

Single-leg calf raise from a step demonstrated on the 3D figure

3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall

3 sets of 15 each leg · As in our cycling knee guide (editorial)

Easier: Slow calf raise · Harder: Single-leg pogo hops

Move on when: Your usual sessions pass the pain rule for 2 weeks. If the knee flares, drop back to the last step that was fine; if it keeps coming back, see a physiotherapist (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

What to change on the elliptical today (written steps)

Our 3D figure can't show the machine's settings. These steps are our reading of lab studies of joint angles and loads in healthy people, plus our move page and NHS leaflets; none has been tested against knee pain, and the pedal-rate finding comes from 12 men. Keep what passes the pain rule.

1. Time first: shorter sessions while it's sore, at a moderate effort (you can talk but not sing, as the NHS describes it), building by about 5 minutes every session or two, towards the move page's 10 to 20 minutes, then 30.
2. Resistance: moderate, enough that you don't bounce, never a grind. More resistance raised the load under the foot in a lab study, and its authors warn of high shear forces on the leg joints at high resistance, though they didn't measure them.
3. Pedal rate: steady and unhurried rather than racing; knee force rose with a faster pedal rate in a study of 12 men. Make sessions harder with time first, then a little resistance.
4. The ramp: low while the kneecap is sore. Raising it changes how far the knee bends; no study has measured the load behind the kneecap at different ramps.
5. Stride: if your machine lets you set it, a length that feels like your natural walking stride, neither overreaching nor choppy. No study links stride length to knee load or pain.
6. Feet and knees: heels down and the whole foot on the pedal, as our move page says; feet pointing forwards rather than turned out, since toe-out gave the greatest inward knee angle in a lab study; knees in line with your feet and soft, not locked, as each pedal goes back.
7. Stand tall and drive with your legs rather than leaning on the handles, as our move page says.
8. Backwards: leave it out with kneecap pain unless it clearly feels better. The elliptical study measured angles only, and a cycling model found more load behind the kneecap going backwards.
9. A different machine for now: if the elliptical keeps hurting, a recumbent or upright bike loaded the knee about half as much in two small studies; an NHS leaflet also suggests swimming.
10. Keep moving: an NHS leaflet says keep moving within your pain limits, and NHS inform says use your leg more after the first 48 hours.
11. Clicks: painless clicking is normal, the NHS says; a knee that clicks painfully, locks or gives way needs checking.

Sources 7, 2, 20, 21, 22, 6, 25, 19, 33, 34

Stairs, sitting, running and classes

While it settles, lead with your good leg going upstairs and your sore leg going down, as NHS inform suggests, and stretch the leg out or get up every half hour on long sits (editorial). If you use the elliptical while running hurts, a standard machine costs a little less energy than running, so add a few minutes; bring running back by our running knee guide. In classes and on home machines, set the stride and resistance before you start, and don't add time and resistance in the same week (editorial).

Sources 19, 30

Positions to swap, and why

Habit or position	Why it matters	Instead
Long, hard sessions while the kneecap is sore	A sudden jump in time or effort is the usual story (our reading), and knee load didn't fall as the machine got harder in the knee replacement study.	10 to 20 minutes at a moderate effort, building by about 5 minutes; the recumbent bike if it keeps hurting.Try: Recumbent exercise bike
Grinding at a high resistance	More resistance raised the load under the foot, and the authors warn of high shear forces on the leg joints at high resistance, though they didn't measure them.	Moderate resistance; add time first.
Racing the pedals	Knee force rose with a faster pedal rate in a study of 12 men.	A steady rate you could talk at.
A steep ramp with kneecap pain	It changes how far the knee bends; no study has measured the load behind the kneecap (our suggestion).	The ramp low.
Feet turned out or wide on the pedals with inner knee pain	Toe-out gave the greatest inward knee angle in a lab study.	Feet pointing forwards, knees in line with your feet.
Locking the knees as each pedal goes back	The move page's own caution; it can pinch the fat pad, as our fat pad guide explains.	Keep the knees soft.
Up on your toes, or leaning on the handles	Our move page says heels down and drive with the legs.	The whole foot on the pedal; stand tall.
Pedalling backwards "to protect the kneecap"	The elliptical study measured angles only, and a cycling model found more load behind the kneecap going backwards.	Forwards, lower and shorter.
Resting the knee completely	Exercise is the treatment for kneecap pain, and NHS sources say keep moving within your limits.	The stage 1 moves.Try: Glute bridge
A brace or sleeve to push through it	An international consensus was uncertain about bracing for kneecap pain.	The machine changes and the strength plan.
Training on through a swollen calf, a locking knee or new swelling	These need checking: see the warning signs.	Stop and get it checked.

Routines to follow

Elliptical workout for beginners: set-up, steady rounds and first intervals on the cross trainer

A first elliptical (cross trainer) workout: step on safely, ride steady at a talk-but-not-sing effort, then add 1-minute pushes once 20 minutes is easy.

30 minBeginner4 movesCardio machine, A wall

Knee strengthening workout: from first steps to full range

A 25-minute session for knees that don't currently hurt: thigh and hamstring strength, single-leg control, then an optional full-range block with knees over toes.

25 minBeginner13 movesA bench or box, A wall

Knee control warm-up

A 20-minute warm-up that trains your knees to track over your toes: side-hip strength, squats and lunges with alignment practice, balance and quiet landings.

20 minBeginner10 movesA wall, A band

Low-impact leg workout (no jumping)

A gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.

20 minBeginner7 movesA bench or box, A step

Glute workout at home

A 25-minute glute workout with bodyweight and a mini band: bridges, clamshells, band walks, kickbacks and lunges.

25 minBeginner9 movesA wall, A band

Cardio machines for beginners: treadmill, cross-trainer, rower and bike

A first tour of the gym's cardio machines: a few minutes each on the bike, treadmill, cross-trainer and rower, set up safely, at a talk-but-not-sing pace.

40 minBeginner7 movesCardio machine, A wall

More moves for this area

Questions people ask

Why does my knee hurt on the elliptical?

The elliptical takes away impact but bends your knee more and works the front of your thigh harder than walking, thousands of times a session, so kneecap pain is the usual story, often after a jump in time or resistance. Where it hurts points to the cause: around the kneecap, a tendon just below or above it, the outside, the inside or behind the knee.

Is the elliptical bad for your knees?

No: it's a good, low-impact way to keep fit, and elliptical users didn't show more knee damage over time in one study. But it isn't the gentlest machine for the knee joint itself: in small studies it loaded the knee about as much as walking and more than a bike.

Is the elliptical or the treadmill better for bad knees?

The elliptical cuts the load under your feet to well below walking and jogging, but inside the knee it was no gentler than treadmill walking in a small study. If walking is comfortable, either is fine; if impact hurts, choose the elliptical; if bending under load hurts, try a bike.

Is the elliptical or a bike better for knee pain?

The bike loaded the knee about half as much as the elliptical in two small studies, so it's the gentler choice while a sore knee settles. Many people move back to the elliptical once the pain rule holds.

Can I use the elliptical with runner's knee?

Usually, yes, in shorter sessions with moderate resistance, a low ramp and a steady pace, keeping pain at 5 out of 10 or less and no worse the next morning. An NHS leaflet suggests the cross trainer as a gentler option, alongside hip and knee strength work.

Is the elliptical good for knee arthritis?

It can be: NICE recommends aerobic fitness and strengthening for everyone with osteoarthritis, and about 6 in 10 people with knee arthritis in a survey rated cross-training knee friendly. Joint pain may rise a little when you start; if it builds through a session, try a bike.

Does pedalling backwards help sore knees?

Not reliably. It bent the knee a little less but let it fall inwards more in a lab study of angles, and in a computer model of cycling, going backwards raised the load behind the kneecap. Use it for variety once your knee has settled.

What resistance, incline and stride should I use?

Moderate resistance, a low ramp and a stride that feels like walking, with a steady pedal rate. That is our reading of lab studies in healthy people, not a tested treatment, so keep the settings that pass the pain rule.

Why does the back of my knee hurt after the elliptical?

Often a hamstring or calf tendon working hard, or a Baker's cyst if there's a soft lump. A throbbing, swollen calf in one leg needs a same-day check for a clot, and with breathlessness or chest pain, call 999.

Why does the inside of my knee hurt on the elliptical?

From mid-life it's often arthritis on the inner side, and a tender spot a few centimetres below the joint is often pes anserine pain. Point your feet forwards rather than out, which reduced the inward knee angle in a lab study, and see our inner knee pain guide.

Do I need a scan?

Rarely: kneecap pain and knee arthritis are diagnosed by examination, and knees without pain often show changes on scans. After an injury, or a knee that locks, gives way or swells fast, get it checked.

When should I see a doctor?

Go to A&E for a knee that has changed shape or swelled fast after a pop, get advice from NHS 111 now for a knee you can't put weight on, that locks or gives way, or that is hot and swollen with a fever, and get a same-day check for a swollen, painful calf. See a GP or physiotherapist if it hasn't improved within a few weeks. In the US, call 911 where this page says 999.

Related exercise guides

Elliptical guide

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.