Table of Contents
Table of Contents
If you have knee osteoarthritis, you might assume that exercise will make your joints feel worse. In reality, staying active is one of the most effective ways to manage pain and keep doing the things you love. A large body of research shows that regular exercise reduces knee osteoarthritis pain and improves function at levels comparable to common pain medications, with far fewer side effects.
“The key is finding the sweet spot between doing enough to create hypertrophy within the muscles around the knee and not overloading a joint that’s already irritable,” says Charlie Page, lead physiotherapist and director at South Coast Home Physiotherapy in Hampshire, United Kingdom.
Exercise works on multiple levels for people with knee osteoarthritis. It strengthens the muscles that support the joint, maintains range of motion, and can even reduce inflammation and slow cartilage breakdown over time. Physiotherapist Dr. Milica McDowell, AVP of Education at US Physical Therapy, explains: “Motion is lotion, and we need to focus on keeping that joint moving and the muscles around it strong every single day.”
There’s no single perfect exercise for knee osteoarthritis. The most effective programs combine a few different types of movement, and the best routine is one that fits your life and feels manageable enough to stick with.
Low-impact aerobic exercise like walking, cycling, and swimming is ranked among the most beneficial options for reducing pain and improving overall function. Page recommends swimming and cycling for people who find weight-bearing painful at first. “The lack of compressive forces means the already smaller joint space isn’t further compressed,” he explains.
Strengthening exercises are just as important. Building up the legs (quadriceps, hamstrings) and hip muscles creates a more stable joint. Research shows that doing quadriceps strengthening exercises over 8 to 12 weeks significantly reduces pain and improves function, and adding hip-strengthening exercises can get you results even faster.
Mind-body exercises like tai chi, yoga, and Pilates can be just as effective as aerobic exercise for pain and function, and may offer additional benefits for quality of life, which is good news if you can’t tolerate much cardio. And if your pain is severe or you carry extra weight, aquatic exercise provides relief and fitness without heavy loads on your joints.
Core strengthening exercise is often overlooked, but worth considering, says Dr. McDowell. “Working on core strength is often a surprising exercise for those with knee osteoarthritis. The stronger your core, the less stress is placed on your knee.”
Both Page and Dr. McDowell recommend simple, functional movements that strengthen the muscles around the knee without special equipment.
This functional movement builds quadricep and glute strength while directly translating to everyday independence. Page calls it one of his go-to exercises across all age groups.
This low-compression chair-based exercise isolates the quadriceps, which are essential for knee stability. Clinical trials confirm that combining quadriceps and hamstring strengthening reduces both pain and morning stiffness.
Dr. McDowell recommends the bridge because it engages the calves, hamstrings and glutes, all muscles that help protect the knee.
Page recommends this range-of-motion exercise for anyone who wakes up with a stiff knee. It prioritizes joint mobility and is especially helpful first thing in the morning.
Studies consistently show that moving your body with moderate effort 3 to 5 times a week for 20 to 60 minutes at a time really makes a difference. You’ll feel the most improvement around 6 to 8 weeks. Remember, sticking with it over the long haul is more important than going all-out for a short time, and the benefits fade away if you stop.
Page generally recommends little and often rather than long, infrequent sessions. “For most older adults, that looks like 10 to 20 minutes of targeted exercises around five times a week, with at least one or two rest days built in,” he says.
Dr. McDowell recommends exercising at least two days per week, with the understanding that flare-ups are common. “If the knee or muscles around the knee get sore, take an extra day of recovery before repeating the exercises,” she advises.
Both low- and high-intensity resistance training improve strength, pain, and function, so the load should match your current pain level and confidence.
Some discomfort during exercise is normal, especially since osteoarthritic knees tend to be stiff and achy when you first start moving. “Exercise should challenge you, but it shouldn’t alarm you,” says Page.
However, there are a few warning signs to watch for. If your knee is acutely swollen, hot to the touch, and significantly more painful than usual, that’s a sign of a flare-up and a good time to rest. Any sudden, sharp pain during a movement should be a signal to stop that exercise. Locking, where the joint gets stuck in one position, or giving way, where the knee buckles unexpectedly, can indicate a mechanical issue that needs professional assessment.
Dr. McDowell adds that loud cracking or popping noises (called crepitus) or pain lasting more than three to four days warrants a professional evaluation before continuing. If pain is significantly worse the day after exercise and hasn’t settled within 24 hours, Page says that’s usually a sign to scale back for a day or two.
The best exercise program is one you’ll actually do. Start where you are, even if that means just 10 minutes of gentle movement, and build from there. A combination of low-impact aerobic activity, strengthening for the thighs and hips, and gentle range-of-motion movements covers the bases that research supports most. If you’re unsure where to begin, a physiotherapist or physical therapist can help you tailor a routine to your pain level and goals. “Consistency matters far more than intensity, and it’s the best way to build a longer-term habit,” says Page.
References:
DISCLAIMER: These statements have not been approved by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent disease.
