Pain guide · Knee pain

Knee pain when kneeling: the kneecap, bursitis, knee replacements, knee pads and how to build back

Kneeling puts your weight through the front of the knee, mostly through the tendon below the kneecap and the bump at the top of the shin, so it shows up problems there first: bursitis (housemaid's knee), kneecap pain, tendon pain and, in growing children, Osgood-Schlatter disease. Everyday kneeling hasn't been shown to damage knees; the links with arthritis and cartilage tears are with years of kneeling at work.

A swelling over the kneecap that turns hot and red, with a high temperature, can be infected and needs a general practitioner (GP) or National Health Service (NHS) 111 the same day, and spreading redness with feeling very unwell needs a 999 call or accident and emergency (A&E). This guide covers those warning signs, how to tell the causes apart from where it hurts, what knee pads can and can't do, how kneeling goes after a knee replacement, how to kneel less and better at work and at home, and a three-stage plan with a 3D demo of every move that ends with kneeling for floor jobs.

3-stage exercise plan When to get help 33 sourcesUpdated 23 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

Call 999 or go to A&E if redness spreads through the skin around the knee (cellulitis) and you have a very high temperature or feel hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on the skin, feel dizzy or faint, are confused, or have cold, clammy or pale skin. These can be signs of a serious infection. Don't drive yourself.
Same day: the swelling over or below the kneecap becomes hot, red or more painful, the skin over it is broken, or you have a high temperature or feel shivery, sick or unwell. Ask for an urgent GP appointment or call NHS 111: it may be infected and need antibiotics.
Same day: a pop or tearing feeling at the front of the knee after a fall, stumble, jump or landing, 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 cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape.
The knee locks, gives way or clicks painfully. Painless clicking is normal.
A hot, red or swollen knee with sudden severe pain, a very high temperature, or feeling hot, cold or shivery. This can be a joint infection.
You hurt your knee and cannot take 4 steps, or you are 55 or over and hurt it in a fall: get it checked the same day for a broken bone.
Your knee swelled up straight away after a twisting injury: get advice from NHS 111.
Throbbing pain and swelling in one calf or thigh with 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).
Leg pain or swelling with breathlessness or chest pain: call 999 or go to A&E, and do not drive yourself. It can be a blood clot that has reached the lungs.
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.
Numbness, tingling or weakness that travels down the leg from the back. That points to a nerve (sciatica) rather than the knee.
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.
Bursitis that hasn't improved, or is getting worse, after 1 to 2 weeks of looking after it yourself, a knee you can't move, or very severe, sharp or shooting pains: see a GP.
Swelling that keeps coming back, or a lump that stays for months: see a GP. Draining it, an injection or, rarely, surgery may be discussed, and other causes ruled out.
Bursitis when you have diabetes, kidney disease, gout or rheumatoid arthritis, or take medicines that weaken the immune system, such as steroids or chemotherapy: see a GP sooner, because infection is more likely and the cause may need treating.
After a knee replacement, don't kneel on the new knee until your surgeon or physiotherapist says you can. If kneeling is still very hard months later, ask your physiotherapist to show you how; numbness or pain by the scar is common and is often the reason.
Kneeling keeps getting harder week after week despite pads, breaks and the plan, or your job means kneeling most of the day and your knee is getting worse: see a GP or physiotherapist, and talk to your employer or occupational health about tools and job rotation (our suggestion).

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

A soft, squashy swelling on the front of the kneecap after kneeling

Tender to kneel on: bursitis, often called housemaid's knee.

Read: Knee bursitis →The same swelling, now hot and red, with broken skin over it, a high temperature or feeling unwell

Possibly an infected bursa: get help the same day, as the warning signs say.

Read: Knee bursitis →A tender point just below the kneecap, over the tendon

Possibly patellar tendon pain. A soft swelling there after kneeling upright can be bursitis below the kneecap (clergyman's knee).

Read: Jumper's knee →Either side of the tendon below the kneecap, worse as the knee straightens fully

Possibly the fat pad behind the tendon.

Read: Fat pad impingement →Around or behind the kneecap, also on stairs, squatting and after sitting with bent knees

Kneecap (patellofemoral) pain.

Read: Runner's knee →Just above the kneecap, worse with deep squats, kneeling and jumping

Possibly quadriceps tendon pain.

Read: Quadriceps tendinopathy →A tender bump below the kneecap in an active child or teenager going through a growth spurt

Often Osgood-Schlatter disease, which usually settles as growth finishes.

Read: Osgood-Schlatter →The lower tip of the kneecap in a sporty child or teenager after a growth spurt

Possibly Sinding-Larsen-Johansson syndrome.

Read: Sinding-Larsen-Johansson →An achy, stiff knee from mid-life, with kneeling and getting up from the floor hard

Possibly knee arthritis.

Read: Knee arthritis →The joint line, with catching, locking or swelling after deep kneeling, squatting or a twist

Possibly a meniscus tear. A knee that locks or gives way needs checking, as the warning signs say.

Read: Meniscus tear →Kneeling hurts or feels numb after a knee replacement

Common, and not a sign of harm. Your surgical team's advice comes first.

Read: Knee replacement →Kneeling hurts after anterior cruciate ligament (ACL) surgery with a kneecap tendon graft

Our ACL surgery guide covers getting back to kneeling.

Read: ACL surgery recovery →Kneeling in the first months after a meniscus repair

Our meniscus surgery guide covers when deep kneeling can come back.

Read: Meniscus surgery →Kneecap pain when you squat or lunge in the gym

Our squatting guide covers depth and load.

Read: Knee pain when squatting →Knee pain on stairs

Our stairs guide covers the technique and a plan.

Read: Knee pain on stairs →A lump at the back of the knee that makes deep kneeling tight

Often a Baker's cyst. If the calf becomes painful, red or swollen too, get it checked the same day.

Read: Baker's cyst →A fall straight onto the kneecap, tender over the bone, or you can't straighten the knee

Possibly a broken kneecap or a torn tendon: get it checked the same day.

Read: Broken kneecap →A child or teenager with knee or thigh pain and a limp, with the knee itself looking normal

It can come from the hip: get it checked the same day.

Read: SUFE (slipped hip growth plate) →

Understand it

Why kneeling hurts at the front of the kneeEmerging evidence

Kneeling puts your weight through the front of the knee. In a lab study of 10 people kneeling in the postures used in low mines, most of the pressure went through the tendon below the kneecap and the bump at the top of the shin, rather than through the kneecap itself. That's why problems there show up first when you kneel.

The NHS describes bursitis as warm and red, with kneeling or bending making the pain and swelling worse. NHS inform lists kneeling among the things that bring on pain around or behind the kneecap, along with stairs, squatting and sitting for a while.

Sources 1, 2, 3, 4

Bursitis: housemaid's kneeStrong evidence

Bursitis is a painful, swollen bursa, a fluid-filled sac that cushions a joint. Over the front of the kneecap it's often called housemaid's knee. The American Academy of Orthopaedic Surgeons says it's often caused by pressure from constant kneeling, and that plumbers, roofers, carpet layers, coal miners and gardeners are at greater risk. The NHS says it usually goes away in a few weeks with rest from pressure, ice and painkillers.

Some bursitis is infected, usually after germs get in through a cut, scrape or bite over the knee, and it "must be treated more urgently". Heat, redness, broken skin over the swelling or a high temperature need a same-day check. In the UK, bursitis from kneeling a lot at work is a prescribed industrial disease.

Sources 3, 5, 2, 6

Kneecap painStrong evidence

Patellofemoral pain is pain behind or around the kneecap, "especially on climbing up and down stairs, kneeling and squatting", and after sitting for a while, NHS inform says. Repeated kneeling or bending of the knee is one of the things that can contribute, along with weak buttock and thigh muscles, tight hamstrings and calves, and sudden changes in activity.

Source 4

Growing children: Osgood-Schlatter and Sinding-Larsen-JohanssonEmerging evidence

Osgood-Schlatter disease causes pain at the bump just below the kneecap during growth spurts in active children, and an NHS trust says the bump "can hurt when touched or when kneeling". The American Academy of Orthopaedic Surgeons says symptoms usually go when growth finishes, around 14 in girls and 16 in boys, and that "continued participation in activity will not cause long-term damage to the knee". At the lower tip of the kneecap, Sinding-Larsen-Johansson syndrome affects sporty children after a growth spurt, and "kneeling is painful", an NHS trust says.

Kneeling can stay uncomfortable for years. In 50 people followed up after untreated Osgood-Schlatter disease, 60% still couldn't kneel without discomfort; of 107 young men who had surgery for it, 38% had no pain kneeling about 10 years later; and in 43 people followed for a median of nearly 4 years, 60.5% still had knee pain. These are follow-ups of selected groups, so they may overstate how often it lingers.

Sources 7, 8, 9, 10, 11, 12

Kneeling at work and your kneesEmerging evidence

Everyday kneeling hasn't been shown to damage knees. What's linked with knee arthritis is kneeling or squatting at work for years: in a review of 15 studies, which pooled the 5 with enough data, the odds rose by about 26% for every 5,000 hours of kneeling, on moderate-quality evidence. A review of 80 studies found physically demanding jobs, including floor laying, linked with higher odds of knee arthritis, and an earlier review found moderate evidence for kneeling and heavy lifting. Kneeling and squatting at work were also linked with meniscus tears, on moderate to low quality evidence.

The Health and Safety Executive (HSE) lists repetitive kneeling and squatting as a cause of problems in the legs at work, including knee arthritis (floor layers and cleaners are at higher risk), bursitis and meniscus damage. The Health and Safety Executive for Northern Ireland says the risk of knee osteoarthritis is significantly increased among miners, floor layers and cleaners. In the UK, knee arthritis after 20 or more years of carpet or floor laying is a prescribed industrial disease.

Sources 13, 14, 15, 16, 17, 18, 6

When a scan helpsStrong evidence

Usually not for kneeling pain. The NHS says a GP examines the knee to check for bursitis, and may take fluid with a needle to test for infection or gout. The National Institute for Health and Care Excellence (NICE) diagnoses osteoarthritis without a scan in people aged 45 or over with typical symptoms. A knee that locks or gives way, or that swelled straight away after a twisting injury, needs checking, as the warning signs say.

Sources 3, 19, 20

How it usually goesEmerging evidence

Bursitis "should go away in a few weeks", the NHS says, and NHS inform expects a new knee problem or a flare to begin to settle within 6 weeks. Osgood-Schlatter disease usually settles when growth finishes, though for some, kneeling stays uncomfortable for years. After a knee replacement, the share of people who can kneel rises over the years. No one can promise a date.

Sources 3, 20, 7, 12, 21

What helps, and how strong the evidence is

Pads, breaks and kneeling less: guidance and lab studiesEmerging evidence

The NHS advises padding when you put a lot of pressure on your knees, for example when kneeling, and taking regular breaks. The American Academy of Orthopaedic Surgeons says wear kneepads if you work on your knees, rest your knees by stopping to stretch your legs, and switch activities regularly. The HSE's controls for kneeling work are changing working methods, mechanical aids, rotating people between jobs, regular breaks, seating where possible, and knee pads or anti-fatigue matting.

Pads help, but they don't make kneeling all day harmless. In the lab study of 10 people, pads lowered the peak pressure, but high-pressure spots remained over structures such as the bursa; in 11 men simulating tile laying, the design of the pad changed how force spread over the knee, and reaching far while kneeling raised the forces. The Health and Safety Executive for Northern Ireland says knee pads "provide useful protection while kneeling on hard floor surfaces, but they do not mitigate the risks of extreme flexion of the knee", that "their benefit is largely in respect of preventing lacerations and penetrating injuries and improving comfort", and that it is not known whether they reduce the risk of osteoarthritis.

Sources 3, 5, 17, 1, 22, 18

Kneeling after a knee replacement: what the advice rests onEmerging evidence

Kneeling is the activity people most often struggle with after a total knee replacement: a narrative review says 60 to 80% report difficulty kneeling or can't kneel, and across 36 studies, 36.8% could kneel at least a year after surgery and 47.6% after 3 years. The review found "no evidence that there is any clinical reason why patients should not kneel", and that people often can kneel but choose not to, because of pain, numbness, fear of harming the joint, other health problems or advice from health professionals.

An NHS trust's leaflet says "you will not do any harm to the knee replacement by kneeling on it": once the scar is comfortable, start on a soft surface such as the bed, then try a firmer surface with a cushion or kneeling pad. In a trial of 60 people after a partial knee replacement, one physiotherapy session of kneeling advice and instruction at 6 weeks improved how well people said they could kneel a year later, and the authors say the result applies only to partial replacements. The NHS says don't kneel on your new knee until your doctor says you can. So the advice rests on a narrative review, an NHS trust leaflet and one trial of 60 people with partial replacements.

Sources 23, 21, 24, 25, 26

Strength for the kneeStrong evidence

In a review of 139 trials in knee osteoarthritis, the trials that compared exercise with a placebo or attention found it improved function by about 11 points out of 100 (moderate certainty) and may have eased pain by about 9 points (low certainty). For kneecap pain, an international consensus recommends exercise, especially hip and knee exercises together, and NHS inform says strengthening weak muscles is very important. No trial has tested an exercise plan for kneeling pain itself, so this plan borrows from our knee pain and knee bursitis guides.

Sources 27, 28, 4

Osgood-Schlatter disease: keep active, and pace itEmerging evidence

The American Academy of Orthopaedic Surgeons says continued activity won't cause long-term damage and that it's safe for children to stay active as they can tolerate, with stretches for the front and back of the thigh. An NHS trust's leaflet paces it by pain, "try not to go over 5" out of 10, with exercises in three levels (lying or sitting, then standing, then sport moves), going back to the first level after a flare in a growth spurt. For Sinding-Larsen-Johansson syndrome, an NHS trust says there's no evidence that playing sport with pain causes damage, though the pain may take longer to settle.

Sources 7, 8, 9

Bursitis: draining, injections and antibioticsStrong evidence

The NHS says a GP may draw off fluid with a needle to test for infection and gout, which may also ease it; a steroid injection may be given if it isn't infected; infected bursitis needs antibiotics, usually for at least 7 days; and surgery is rare. Exercise doesn't treat the bursa itself, as our knee bursitis guide explains; it keeps the leg strong while the bursa settles.

Sources 3, 5

How much pain is OK while you exercise?

0 to 2 is safe, up to 5 is acceptable, and no bigger swelling the next morningEmerging evidence

For the exercises, this guide uses the knee hub's rule. 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. Over the weeks pain should hold steady or ease; that last check is our suggestion rather than a tested rule.

Some knee programmes say you should feel no pain at all. The trials allowed some, and a meta-analysis found exercising into some pain did no worse than pain-free exercise. NICE says joint pain may rise when you start exercising with arthritis, and that regular exercise still helps in the long run. Sharp, catching or giving-way pain, or new swelling, is a reason to stop and get it checked.

With a swelling over the kneecap, our knee bursitis guide's rule applies: keep pain at about 0 to 3, choose exercises that don't press on the front of the knee, and the swelling should be no bigger, warmer or more tender the next morning.

For kneeling (our suggestion): kneeling may feel like pressure or a dull ache. That's fine if it goes within a few minutes of standing up and the knee is no worse, and no more swollen, the next morning. Add kneeling time a minute or two at a time. For children with Osgood-Schlatter disease, an NHS trust's rule is to try not to go over 5 out of 10.

Sources 29, 30, 31, 19, 3, 8

The exercise plan: 3 stages

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

Stage 1

Settle: take the pressure off, keep the knee moving and the thigh working

About the first 2 weeks. No kneeling on the sore spot for now; ice and painkillers as the NHS advises for bursitis (the written steps below). If the bursa is infected, antibiotics and your clinician's advice come first. After a knee replacement, follow our knee replacement guide first; in a child, our Osgood-Schlatter or Sinding-Larsen-Johansson guide. Doses are borrowed from our knee pain and knee bursitis guides, as editorial starting points, unless a source is named.

Quad set (static quads) demonstrated on the 3D figure

3D demoQuad set (static quads)Beginner · No equipment

10 holds of 5 s, 2 to 3 times a day · As in our knee pain and knee bursitis guides

Harder: Straight-leg raise

Straight-leg raise demonstrated on the 3D figure

3D demoStraight-leg raiseBeginner · No equipment

2 sets of 10 each leg · As in our knee pain guide. Lock the knee straight first

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

Supine heel slide demonstrated on the 3D figure

3D demoSupine heel slideBeginner · No equipment

10 slow reps each side, once or twice a day · The move page's dose, an editorial starting point. Bend only as far as the front of the knee is comfortable, as our knee bursitis guide says

Harder: Hip windshield wipers

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 sets of 10 · As in our knee pain guide

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

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

10 to 15 min easy, seat high · As in our knee pain and knee bursitis guides; cycling is the bursitis guide's swap for kneeling activities

Easier: Recumbent exercise bike · Harder: Air bike intervals

Move on when: There's no heat or redness, any swelling is going down, the knee bends comfortably, and daily activities stay within the pain rule.

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

Stage 2

Build: strength without kneeling, then the first kneeling on something soft

About weeks 2 to 6, strength 2 or 3 days a week, standing and seated, as our knee pain and knee bursitis guides' second stage. Towards the end, short spells on all fours on a cushion, where your hands share the load (our suggestion).

Sit to stand from a chair demonstrated on the 3D figure

3D demoSit to stand from a chairBeginner · A bench or box

3 sets of 8 to 12, higher seat to start · As in our knee pain and knee bursitis guides

Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat

3D demoWall sitBeginner · A wall

4 holds of 20 to 45 s at a comfortable depth · As in our knee pain guide. Breathe normally through the hold

Easier: Straight-leg raise · Harder: Spanish squat (band squat hold)

3D demoStep-upBeginner · A step

3 sets of 8 to 10 each leg, low step first · As in our knee pain guide

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

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, an editorial starting point. If the full range hurts the kneecap, work from 90 degrees to about 45, as the move page says

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

Side-lying leg raise demonstrated on the 3D figure

3D demoSide-lying leg raiseBeginner · No equipment

3 sets of 12 each side · As in our knee pain guide. Hip strength helps kneecap pain

Easier: Lateral band walk · Harder: Lateral band walk, band at the feet

3D demoCat-cowBeginner · No equipment

8 waves, slower than feels natural, on a cushion or folded mat · The move page's dose. Your first kneeling, on all fours with the weight shared through your hands (our suggestion); leave it while there's swelling over the kneecap

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Move on when: These are comfortable, and a few minutes on all fours on a cushion leaves no extra swelling, warmth or pain the next day.

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

Stage 3

Back to kneeling: half-kneeling, then full kneeling on a pad

From about weeks 4 to 6: heavier leg strength, then kneeling on one knee and both knees on a pad, building time while the knee stays quiet, as our knee bursitis guide's last stage, with kneeling for floor jobs coming back by the written steps below. Keep using pads, take regular breaks and change position often.

Dumbbell goblet squat demonstrated on the 3D figure

3D demoDumbbell goblet squatIntermediate · A dumbbell

3 sets of 8 to 12, deeper as tolerated · As in our knee pain and knee bursitis guides

Easier: Bodyweight squat · Harder: Barbell front squat

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 8 each leg, back knee padded, stopping just short of the floor · As in our knee bursitis guide

Easier: Bodyweight squat · Harder: Reverse lunge

Reverse lunge demonstrated on the 3D figure

3D demoReverse lungeIntermediate · No equipment

2 to 3 sets of 8 each leg · As in our knee bursitis guide. Lower the back knee under control rather than dropping onto it

Easier: Split squat · Harder: Split squat with dumbbells

Kneeling lunge hip flexor stretch demonstrated on the 3D figure

3D demoKneeling lunge hip flexor stretchBeginner · No equipment

Hold 20 to 30 s, 2 to 4 times each side, kneeling knee padded · The move page's dose, an editorial starting point. Your first held half-kneel (our suggestion); stand for it if kneeling hurts, as the move page says

Harder: World's greatest stretch

Get up and down from the floor demonstrated on the 3D figure

3D demoGet up and down from the floorBeginner · No equipment

5 to 8 slow cycles down and up, changing the leading leg, kneeling on a cushion · The move page's dose, an editorial starting point. Our knee bursitis guide calls it the first real test of kneeling

Easier: Sit to stand from a chair · Harder: Bodyweight get-up

Toes-tucked kneeling (toe squat) demonstrated on the 3D figure

3D demoToes-tucked kneeling (toe squat)Intermediate · No equipment

Hold 30 to 60 s, 1 to 3 times a day, on a cushion · The move page's dose, an editorial starting point. Optional and last, only if you need to sit back on your heels; after a knee replacement, only if your team says deep bending is fine (our suggestion)

Easier: Plantar fascia stretch (seated)

Move on when: Our suggestion: a few minutes of kneeling on a pad leaves no extra swelling or warmth the next day; then build up kneeling for floor jobs, at home or at work, with pads and breaks. If the swelling comes back, drop back a stage and kneel less.

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

What to change for now

Kneeling for now: pads, breaks and position (written steps)

Our 3D figure can't show these changes. They come from the NHS, NHS inform, the American Academy of Orthopaedic Surgeons and an NHS trust; no trial has tested a kneeling pad or a kneeling time for knee pain, and where a step is our suggestion, it says so.

1. While it's sore, take the pressure off. With bursitis, the NHS says avoid activities that put pressure on the joint, use an ice pack wrapped in a tea towel for about 10 minutes at a time every few hours, take painkillers if they suit you, and put extra cushions around the knee at night.
2. When you do kneel, use padding: a thick pad, a kneeling mat or knee pads (the NHS and the American Academy of Orthopaedic Surgeons). For the garden, a kneeling stool or long-handled tools help, an NHS trust's leaflet says.
3. Kneel less and spread the load: kneel on the other knee, half-kneel, squat or sit on a low stool in turn (our suggestion, as our knee bursitis guide advises).
4. Bring the work closer rather than reaching far while you kneel: reaching raised the forces on the knee in a kneepad study.
5. Take regular breaks: stand up, stretch your legs and switch tasks (the NHS and the American Academy of Orthopaedic Surgeons). With kneecap pain, NHS inform also says cut down how much you kneel and how long you sit still.
6. Look after the skin: clean any cut on the knee (the NHS), because germs can get into the bursa through a cut, scrape or bite (the American Academy of Orthopaedic Surgeons). Cover a cut before you kneel (our suggestion).
7. Don't squeeze or drain a swelling yourself; leave that to a clinician (our knee bursitis guide).

Sources 3, 5, 4, 22, 24

Kneeling at work (written steps)

These come from the HSE, the Health and Safety Executive for Northern Ireland and government guidance.

1. Employers should assess kneeling and squatting work and reduce it: changing working methods, mechanical aids, rotating people between jobs, regular breaks, seating where possible, and knee pads or anti-fatigue matting (the HSE).
2. Knee pads protect on hard floors and help comfort, but they don't remove the strain of deep kneeling (the Health and Safety Executive for Northern Ireland).
3. Report knee pain or swelling at work early, so the work can be changed; the HSE asks employers to make sure workers know how to report symptoms.
4. In the UK, bursitis from kneeling a lot at work, and knee arthritis after 20 or more years of carpet or floor laying, are prescribed industrial diseases (government guidance).

Sources 17, 18, 6

Getting down to the floor and up again (written steps)

Floor jobs mean getting down and up. Steps 1 to 4 and 6 are the NHS's way up after a fall, which works for any time you're on the floor; getting down by reversing them is our suggestion.

1. Take your time, and don't get up too quickly.
2. Roll onto your side, then use your arms to push yourself onto your hands and knees (onto a cushion if kneeling hurts).
3. Crawl to something stable, such as a heavy chair or the sofa.
4. Put one foot flat on the floor, then stand up slowly, holding on.
5. To get down, reverse it: hold on, step one foot back, lower that knee onto a cushion, then the other, and put your hands down. The floor practice in stage 3 rehearses this.
6. Sit down and rest once you're up, if you need to.

Source 32

Kneeling comes back (written steps)

No trial has tested how fast kneeling should come back. These steps are our suggestion, built on an NHS trust's kneeling advice after a knee replacement and the NHS's and the American Academy of Orthopaedic Surgeons' bursitis advice.

1. First kneels on something soft: the bed or a thick cushion, then a firmer surface with a cushion or pad. That's an NHS trust's order after a knee replacement, and a sensible one for anyone.
2. Start with 1 to 2 minutes, then stand up and move.
3. Add a minute or two when the knee is no worse, and no more swollen, the next morning.
4. Half-kneeling on one knee comes before kneeling on both, and sitting back on your heels comes last, if you need it.
5. Keep using padding, take regular breaks and change position often, even once it has settled (the NHS and the American Academy of Orthopaedic Surgeons).
6. If the swelling comes back or the knee feels warm, drop back a stage and kneel less. Heat, redness or a high temperature need a same-day check.

Sources 24, 3, 5

After a knee replacement (written steps)

Your surgical team's advice comes first. These steps come from the NHS, an NHS trust's leaflet, a review, and one trial after partial knee replacement.

1. Don't kneel on your new knee until your doctor says you can (the NHS).
2. Once the scar is comfortable, start on a soft surface such as the bed, then try a firmer surface with a cushion or kneeling pad. Kneeling won't harm the knee replacement, the trust's leaflet says, though some people never find it comfortable.
3. Numbness by the scar is common, and it's one of the reasons people avoid kneeling (the review).
4. If kneeling is still hard, ask your physiotherapist to show you how: in the trial after partial knee replacement, one session of kneeling advice and instruction at 6 weeks improved kneeling a year later.
5. A kneeling stool for gardening, or long-handled tools if you can't kneel (the trust's leaflet).

Sources 26, 24, 23, 25

Positions to swap, and why

Habit or position	Why it matters	Instead
Kneeling on a hard floor, or with your weight on the sore spot	Pressure and friction from kneeling cause most bursitis, and most of the pressure of kneeling goes through the tendon below the kneecap.	A thick pad or kneeling mat; kneel on the other knee, half-kneel, squat or sit on a low stool.
Long spells of kneeling without a break	The NHS advises regular breaks, and the American Academy of Orthopaedic Surgeons says stop to stretch your legs and switch tasks.	Change position often, and stand and march on the spot between spells.Try: Standing march
Reaching far while you kneel	Reaching far raised the forces on the knee in a kneepad study.	Bring the work closer, or move along.
Kicking a carpet stretcher with your knee	Our knee bursitis guide notes that using a knee kicker went with bursitis in carpet layers.	Other tools and methods that cut kneeling.
Squeezing or draining a swollen kneecap yourself	Germs can get into the bursa through broken skin, and infected bursitis needs urgent treatment.	See a GP; clean and cover any cut over the knee.
Kneeling exercises, such as the reverse Nordic, while kneeling hurts	The move page says leave it out if kneeling hurts the knee.	Seated knee extensions, in the range that doesn't hurt.Try: Seated knee extension (chair)
Half-kneeling stretches on a bare floor	The move page says pad the kneeling knee, or choose another position if kneeling irritates the kneecap.	A standing quad stretch instead.Try: Standing quad stretch
Avoiding kneeling for months once it has settled	People often can kneel but don't, for fear of harm, and being taught to kneel helped in a trial after partial knee replacement.	Build kneeling back, as in stage 3.Try: Get up and down from the floor

Routines to follow

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

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

Strength and balance exercises for seniors

A 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.

40 minBeginner18 movesA bench or box, Something with weight

Balance exercises routine

Balance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.

10 minBeginner7 movesA wall, A bench or box

Low-impact cardio workout (no jumping)

A 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.

25 minBeginner9 movesA bench or box, A step

Yoga for knee pain: a 25-minute knee-friendly sequence

A 25-minute knee-friendly yoga practice with no kneeling and no deep bends: shallow standing poses, hip and thigh strength on the floor, and supported stretches.

25 minBeginner15 movesFirm cushion

More moves for this area

Questions people ask

Why does my knee hurt when I kneel?

Kneeling presses on the front of the knee, mostly through the tendon below the kneecap and the bump at the top of the shin. That shows up bursitis, kneecap pain, tendon pain and, in growing children, Osgood-Schlatter disease. Where it hurts tells them apart.

Is kneeling bad for your knees?

Not everyday kneeling. The link with knee arthritis is with years of kneeling or squatting at work: the odds rose about 26% for every 5,000 hours. Kneeling jobs also go with more meniscus tears and bursitis, so pads, breaks and less time kneeling help if you kneel a lot.

What is housemaid's knee?

It's bursitis: a soft, squashy swelling over the front of the kneecap from pressure and friction when kneeling. It usually settles in a few weeks with rest from kneeling, ice and painkillers. Get advice the same day if it becomes hot and red, the skin over it is broken, or you have a high temperature.

Do knee pads help?

Yes, for comfort and to protect the skin on hard floors, and good pads spread the pressure. But in a lab study, high-pressure spots remained over the bursa with pads on, and pads don't remove the strain of deep kneeling. Use them with breaks and shorter spells.

Can I kneel after a knee replacement?

Some can, though most find it hard: 60 to 80% report difficulty, and across 36 studies, 36.8% could kneel at least a year after surgery and 47.6% after 3 years. There's no evidence that kneeling harms the new knee, and an NHS trust suggests starting on a soft surface such as the bed, then a cushion or pad, once your team says you can. In a trial after partial knee replacement, being taught how to kneel helped.

Why does it hurt below my kneecap when I kneel?

Just below the kneecap is where most of the pressure goes when you kneel. A soft swelling there can be bursitis, a tender tendon can be patellar tendon pain, and in a growing child or teenager a tender bump there is often Osgood-Schlatter disease.

My child's knee hurts when they kneel. Is it serious?

Usually not. A tender bump below the kneecap in an active child or teenager going through a growth spurt is often Osgood-Schlatter disease, which usually settles as growth finishes, and keeping active won't cause long-term damage. A child with a limp and knee or thigh pain needs checking the same day, because it can come from the hip.

What exercises help knee pain when kneeling?

Strengthening the thigh and hip muscles: sit-to-stands, step-ups, wall sits and knee extensions, then split squats and half-kneeling, building up to kneeling on a pad. For kneecap pain, hip and knee exercises together are recommended, and for knee arthritis, exercise improves function.

How long can I kneel for?

There's no tested limit. Start with a minute or two on a pad, stand up and move, and add a little more time when your knee is no worse, and no more swollen, the next morning (our suggestion). At work, take regular breaks and change tasks often.

When should I see a doctor about knee pain when kneeling?

Get advice from NHS 111 now if your knee is very painful, you can't put weight on it, it locks or gives way, or it's red or hot and you have a very high temperature. See a GP if bursitis hasn't improved after 1 to 2 weeks of looking after it, or kneeling pain hasn't settled within a few weeks.

Is knee pain when kneeling a sign of arthritis?

It can be, especially from mid-life with an achy, stiff knee. But kneeling pain just as often comes from the kneecap joint, a bursa or a tendon. A GP or physiotherapist can usually tell from your symptoms and an examination.

Do I need a scan?

Usually not. Bursitis is diagnosed by examining the knee, sometimes with fluid taken by needle to check for infection or gout, and NICE diagnoses knee arthritis without a scan in most people aged 45 or over.

Related exercise guides

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.