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Background  Knee pain is studied mostly in older age groups, although in young adults it may be an indicator of future impaired musculoskeletal health. Therefore, the aim of this study was to examine the longitudinal association between knee pain and thigh muscle strength in young adult women and to explore the associations between muscle strength, body composition, physical activity and knee pain.Methods  The PEAK-25 cohort consists of women aged 25 at baseline (N=1064). At the 10-year follow-up n=728 attended for DXA-measured body composition and muscle strength assessment and n=797 answered the questionnaire on health and lifestyle. Independent samples t-test was used to compare women with and without knee pain, Spearman correlation was used to test the longitudinal association between strength and knee pain.    Results  Knee pain was reported by one third of the women at follow-up (n=260, 33%), although physical activity levels were similar in those with and without pain (high level 50 vs 45 % ( p = 0.18). Body composition differed, however. Women with knee pain had higher BMI (25.6 vs 24.1), fat mass index (9.2 vs 8.2) and % total body fat mass (34.7 vs 33.2). Simultaneously, they had lower % lean mass (total body 61.5 vs 62.8; legs 20.6 vs 21.0) and lower thigh muscle strength (extensors 184.9 vs 196.8, flexors 96.6 vs 100.9,  p <0.05), but slightly higher hamstrings-to -quadriceps ratio (0.53 vs 0.51,  p =0.04). Muscle strength at baseline weakly correlated with knee pain at follow-up (extensor r s = -0.04; flexor -0.02,  p >0.2). Overweight women had higher absolute thigh muscle strength, but lower weight-adjusted strength than normal weight women ( p <0.001). Leg lean mass explained 26-34% of the variation in muscle strength and adjustment for physical activity level had little effect.    Conclusion  Knee pain is already common among women in their mid-thirties. Lower thigh muscle strength in the mid-twenties was not associated with future knee pain, however women with knee pain tended to have lower thigh muscle strength and a body composition of higher body fat combined with lower lean mass. Maintaining a healthy body composition and adequate thigh muscle strength may be beneficial for knee joint health.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12891-021-04517-w.

Knee pain in young adult women- associations with muscle strength, body composition and physical activity