FEATURED ARTICLE • PHYSIOTHERAPY & REHABILITATION
Knee Osteoarthritis Exercises: Physiotherapy Exercises for Pain Relief and Better Function
Knee Osteoarthritis Exercises: Physiotherapy Exercises for Pain Relief and Better Function
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Introduction
Knee osteoarthritis is a common musculoskeletal condition involving changes in the tissues of the knee joint. Pain, stiffness, reduced strength, difficulty with stairs, and reduced walking tolerance may affect daily activities. A well-designed exercise program can help improve muscle strength, joint movement, physical function, and confidence with activity.
The exercises below are educational examples. The most appropriate exercise, intensity, range of movement, and progression depend on symptoms, physical ability, other medical conditions, and individual goals.
Why Exercise Is Important in Knee Osteoarthritis
- Strengthens muscles around the knee and hip that contribute to lower-limb function.
- Helps maintain or improve knee range of motion.
- Supports walking, transfers, stairs, and other daily activities.
- Can improve physical function and exercise tolerance.
- May improve confidence with movement and activity.
- Helps maintain general fitness and healthy movement habits.
Before Starting Exercise
- Begin with a comfortable level of activity and progress gradually.
- Mild temporary discomfort can occur with exercise, but sharp, severe, or unusual pain should not be ignored.
- Use controlled movements and avoid sudden jerking.
- Warm up with gentle walking or easy range-of-motion movements before strengthening.
- Choose stable footwear and a safe exercise surface.
- If the knee is acutely swollen, very painful, unstable, or recently injured, seek appropriate professional assessment before progressing exercise.
Knee Osteoarthritis Exercise Program
Heel Slides
Purpose: Helps maintain and improve comfortable knee bending.
Starting position & performance: Lie on your back with both legs straight. Slowly slide one heel toward the buttocks, bending the knee as far as comfortable. Slowly slide it back.
Dosage: 10–15 repetitions per side × 1–2 sets.
Precautions: Move within a comfortable range and do not force painful bending.
Quadriceps Setting
Purpose: Activates the quadriceps muscles and is useful when knee movement or strength is limited.
Starting position & performance: Lie or sit with the leg comfortably straight. Tighten the front thigh by gently pressing the back of the knee toward the bed or floor. Hold briefly, then relax.
Dosage: 8–12 repetitions with a 5-second hold × 2 sets.
Precautions: Do not hold your breath or press forcefully enough to cause pain.
Straight Leg Raise
Purpose: Strengthens the quadriceps and hip muscles while the knee remains relatively straight.
Starting position & performance: Lie on your back with one knee bent and the other leg straight. Tighten the thigh of the straight leg and slowly lift it to about the height of the opposite knee. Lower slowly.
Dosage: 8–12 repetitions × 2 sets.
Precautions: Keep the knee straight without forceful locking. Stop if significant pain develops.
Seated Knee Extension
Purpose: Strengthens the quadriceps and improves active knee control.
Starting position & performance: Sit upright on a stable chair. Slowly straighten one knee to a comfortable range, pause briefly, then lower it with control.
Dosage: 10–15 repetitions per side × 2 sets.
Precautions: Use a comfortable range and avoid swinging the leg.
Sit-to-Stand
Purpose: Improves functional strength needed for getting up from chairs and daily tasks.
Starting position & performance: Sit on a stable chair with feet about hip-width apart. Lean slightly forward and stand using the legs. Slowly lower yourself back to the chair.
Dosage: 8–12 repetitions × 2–3 sets.
Precautions: Use arm support or a higher chair if needed. Keep knees comfortably aligned with the feet.
Mini Squat
Purpose: Strengthens the quadriceps, hips, and lower limbs in a functional standing position.
Starting position & performance: Stand behind a stable support. Bend the hips and knees slightly as though beginning to sit, then return to standing slowly.
Dosage: 8–12 repetitions × 2 sets.
Precautions: Use a shallow range initially. Avoid deep squatting if it increases symptoms.
Step-Up
Purpose: Improves leg strength and functional ability for stairs.
Starting position & performance: Stand facing a low, stable step with support nearby. Place one foot on the step, step up, then step down slowly.
Dosage: 6–10 repetitions per side × 1–2 sets.
Precautions: Start with a low step and use support when needed.
Calf Raises
Purpose: Strengthens calf muscles that contribute to walking and lower-limb function.
Starting position & performance: Stand holding a stable surface. Slowly rise onto the balls of the feet, pause briefly, and lower the heels with control.
Dosage: 10–15 repetitions × 2–3 sets.
Precautions: Keep the trunk upright and avoid bouncing.
Side-Lying Hip Abduction
Purpose: Strengthens hip muscles that help control the lower limb during walking.
Starting position & performance: Lie on your side. Keep the upper leg relatively straight and lift it upward without rolling the pelvis backward. Lower slowly.
Dosage: 8–12 repetitions per side × 2 sets.
Precautions: Keep movement controlled and avoid swinging the leg.
Supported Single-Leg Balance
Purpose: Improves balance and lower-limb control for safer mobility.
Starting position & performance: Stand beside a stable support. Shift weight onto one leg and lift the other foot slightly from the floor. Maintain an upright posture.
Dosage: 10–30 seconds per side × 2–3 repetitions.
Precautions: Perform next to a stable surface. Do not practice unsupported if balance is poor.
Stationary Cycling
Purpose: Provides low-impact aerobic exercise and repeated knee movement.
Starting position & performance: Use a stationary bicycle with the seat adjusted so the knee is slightly bent at the lowest pedal position. Begin with easy resistance.
Dosage: 5–10 minutes initially, progressing toward 15–30 minutes as tolerated.
Precautions: Adjust the seat to avoid excessive knee bending. Stop if significant pain develops.
Aerobic Exercise
Low-impact aerobic activities can complement strengthening. Depending on tolerance, examples include walking, stationary cycling, water-based exercise, or other comfortable activities. Start with short sessions and gradually increase duration.
Sample Weekly Exercise Structure
| Exercise Type | Suggested Frequency | Typical Starting Dose | Main Goal |
|---|---|---|---|
| Strengthening | 2–3 days/week | 1–2 sets of 8–12 reps | Strength and function |
| Range of motion | Most days | 10–15 repetitions | Mobility |
| Aerobic activity | 3–5 days/week as tolerated | 5–15 minutes initially | Fitness and activity tolerance |
| Balance | 2–3 or more days/week | 10–30 seconds × 2–3 | Balance and confidence |
Managing Symptoms During Exercise
- If symptoms are mild and settle after activity, the exercise may be tolerated, but progression should remain gradual.
- If pain becomes clearly worse during or after exercise, reduce resistance, repetitions, range, or duration.
- If substantial swelling, marked pain, locking, giving way, or a new injury occurs, stop and seek appropriate assessment.
- Regular moderate activity is generally more sustainable than occasional intense exercise.
Exercises That May Need Modification
There is no single exercise that must be avoided by every person with knee osteoarthritis. High-impact activity, deep knee flexion, heavy resistance, or exercises that repeatedly provoke significant symptoms may need modification. A physiotherapist can adjust range, load, technique, and progression.
Physiotherapy Assessment
- Pain severity, irritability, and aggravating activities.
- Knee range of motion.
- Quadriceps, hamstring, hip, and calf strength.
- Gait and functional movement.
- Ability to perform sit-to-stand and stairs.
- Balance and fall risk when relevant.
- Swelling, joint symptoms, and functional limitations.
- Individual activity goals and barriers to exercise.
How to Progress the Program
Progress one variable at a time when exercises are well tolerated. This may mean increasing repetitions, adding a set, increasing resistance, increasing walking or cycling time, or progressing a functional exercise such as a step-up. Maintain good technique and symptom control.
Clinical Case Study — Educational Example
A 62-year-old adult with knee osteoarthritis reports pain and difficulty standing from a low chair and climbing stairs. After assessment, the initial program includes heel slides, quadriceps setting, seated knee extension, sit-to-stand, calf raises, and short periods of low-impact aerobic activity. As strength and tolerance improve, the program is progressed to mini squats and step-ups. This is an educational example and not an individualized treatment prescription.
Frequently Asked Questions
Are exercises good for knee osteoarthritis?
Exercise is an important part of conservative management for many people with knee osteoarthritis because it can improve strength, mobility, physical function, and activity tolerance.
Which exercise is best for knee osteoarthritis?
There is no single best exercise for everyone. A combination of strengthening, range-of-motion, aerobic, and functional exercises can be selected according to symptoms and goals.
Can walking make knee osteoarthritis worse?
Walking tolerance varies. Gradual, comfortable walking can be useful, but duration and intensity should be adjusted if symptoms are significantly aggravated.
Should I exercise when my knee hurts?
Some people can exercise with mild symptoms, but significant or worsening pain should prompt modification and, when necessary, professional assessment.
How often should I do knee osteoarthritis exercises?
Strengthening is commonly performed several times per week, while gentle mobility and appropriate aerobic activity may be performed more frequently depending on tolerance.
Conclusion
A structured exercise program can help people with knee osteoarthritis improve strength, mobility, balance, and everyday function. Begin at an appropriate level and progress gradually. Consistency, controlled technique, and individualized adjustment are more important than exercising at high intensity.
Medical Education Note
This article is for general education and does not provide individualized diagnosis or treatment. People with severe pain, recent injury, major swelling, significant instability, or other medical concerns should seek appropriate professional assessment before changing their exercise program.