Exercises for Arthritic Knees

Knee arthritis is one of the most common joint issues for older adults. The knee is one of the most injured joints of the body due to its proximity to the ground creating excessive force on the joints over the years. Knee arthritis is characterized by degeneration of the cartilage of the knee, which leads to significant stiffness, swelling, grinding of the knee joint, and eventual muscle weakness. Knee arthritis can eventually affect one’s ability to walk, stand for long periods of time climb stairs, or complete basic daily activities like getting up and down from a chair. Most doctors will recommend medication, steroid injections, and lifestyle changes to help manage symptoms of knee arthritis, but exercise is widely regarded as one of the most effective long-term strategies for improving function and reducing pain in arthritic knees. Some individuals with knee arthritis may even see a reduction in symptoms with a proper exercise routine. 

Knee arthritis cannot necessarily be cured or reversed, but the symptoms of knee arthritis can decrease with the proper plan of care. You can eventually have less pain, stiffness and improved function or you can delay possible surgery.

Exercise can certainly help people with knee arthritis have less symptoms and improve their quality of life, but exercise also can help delay or avoid a future knee replacement. Strength and mobility exercises can reduce stress on the knee joint, improve balance and stability, improve walking, and improve ability with those daily activities. For those preparing for a knee replacement surgery, building strength and maintaining joint range of motion beforehand—known as prehabilitation or prehab—can lead to better post surgical outcomes and faster recovery. Prehab can facilitate a more confident post-op recovery process as well. The biggest regret among knee replacement patients is they wish they did more prehab! If you are planning a knee replacement in the near future, always start a program sooner than later. It is never too late to start strengthening your body for surgery. 

Whether you’re living with chronic knee arthritis, considering a total knee replacement, or recovering from knee replacement surgery, the right kind of exercise can help you move with less stiffness, less pain, and eventually, greater independence.

Why Exercise Is Crucial for Arthritic Knees 

It’s a common misconception that people with knee arthritis should avoid physical activity to “protect” their joints. In reality, avoiding movement can cause more harm than good. Joints are designed to move. New research actually suggests movement is the best way to reduce pain and improve outcomes. The good ol’ RICE protocol (Rest, Ice, Compression, Elevation) after an injury is not being challenged by new research. Prolonged inactivity leads to more inflammation in the joint, muscle atrophy/weakness, joint stiffness, poor circulation, and even increased pain—all of which contribute to a decline in physical function and overall quality of life.

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Numerous scientific studies have confirmed that targeted exercise is not only safe for people with knee osteoarthritis (OA), but also highly effective in reducing symptoms and improving joint health. A lstudy published in the journal Osteoarthritis and Cartilage (Fransen et al., 2015) analyzed data from over 10,000 patients and showed that land-based exercise programs significantly reduce pain and improve physical function in individuals with knee osteoarthritis (OA). The benefits were comparable to non-steroidal anti-inflammatory drugs (NSAIDs), but with fewer side effects. These studies give great hope to those with knee OA, but what exercises should we do if the knee is continually in pain and exercise is difficult. We will address this!

Benefits of Regular Knee Exercise

• Reduces pain and stiffness: 

  Regular movement helps lubricate the knee joint by stimulating the production of synovial fluid, which nourishes cartilage and reduces friction. Exercise also releases endorphins—natural pain-relieving chemicals in the brain. According to a 2019 Cochrane review, participants with knee osteoarthritis who engaged in consistent physical activity reported up to a 25% reduction in pain intensity.

• Strengthens muscles that support the knee

  The quads are the “problem child” of an arthritic knee. The quads often lose strength as we age, which is known as sarcopenia. Strong quadriceps, hamstrings, and hip muscles help stabilize the knee and absorb shock, reducing the mechanical load on the joint itself. Your muscles are designed to accept this mechanical load. They are designed to absorb the weight of your body with each step and the force of each step. The bone is not. Research shows that weaker quadriceps are associated with faster cartilage degeneration in patients with knee OA (Arthritis & Rheumatism, 2003). Strengthening these muscles can help improve these symptoms. 

• Improves balance and coordination

  Osteoarthritis can reduce proprioception of the knee joint. Proprioception is a tricky concept to grasp so here’s a quick way to figure it out. Close your eyes. Now reach your hand over your head. How do you know your hand is above your head if you can’t see it? You can feel it! That is proprioception. Your joints are communicating with your brain to tell you where they are. The lack of proprioception in the joints can increase our risk of falls. Balance training can enhance our proprioception and neuromuscular control improving our overall  stability.

• Increases range of motion

  Stiffness, especially in the morning or after sitting for a long period of time, is a hallmark sign of arthritis. Stiffness causes difficulties with bending or straightening the knee, which leads to walking problems. Continued stretching exercises can reduce the tightening of soft tissues around the joint, preserving or even restoring functional movement. Consistent stretching has been shown to improve both extension and flexion range of motion post knee replacement surgery as well. Research shows pre-op range of motion is a good predictor of post-op range of motion.  

• Aids weight management, easing pressure on the joint

  Increased body weight is a major risk factor for the progression of knee arthritis. For every extra pound of body weight, there is an additional ~4 pounds of pressure on the knee joint during walking. Exercise helps burn calories and maintain a healthy body weight, reducing this mechanical strain and associated inflammation. However, exercising with a painful knee is very difficult. Choosing exercises that do not cause increased pain is key to weight loss.

• Enhances function and independence in daily life

  Ultimately, the goal of arthritis management is to maintain or restore independence in daily activities. Exercise not only improves overall cardiovascular health, but also improves leg strength and endurance, allowing individuals to continue with their daily routine and do basic tasks like standing at the kitchen sink, walking the dog, dressing without needing to sit down, and sleeping. The American College of Rheumatology and Arthritis Foundation (ACR/AF) guidelines strongly recommends exercise the first treatment for knee osteoarthritis.

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Before You Start

Always consult your physician or a Doctor or Physical Therapy when starting a new exercise routine. If you have an extensive medical history, clearance from your physician will ensure you are safe to exercise.

Prior to exercising, completing a warm up is helpful to help loosen the joints for a more pain free workout. Walking or biking for 5-10 minutes is a great warm up to do.

When starting a new exercise program, always start out slowly. The first session may seem easy and you may be eager to start full force, but try to only do basic exercises for a few days until your body gets used to the new changes. If you have soreness longer than 72 hours post workout, you may have overdone it. If you have pain after a workout, this may also be a sign to scale back. 

When starting a new workout with knee arthritis, you may need to use a chair, wall, handrail or walker to provide balance support and keep you safe. Overtime you can challenge your balance as you can confidence and strength. 

Best Exercises for Knee Arthritis 

Quad sets: Tighten your thigh muscle by pressing the back of your knee down towards the floor or bed while keeping your leg straight. Hold this contraction for five seconds, then relax.

This exercise is great for isolated quad contraction. This is a great beginners exercise for those with more significant knee pain. 

Clam shells: Lie on your side with your knees bent and feet together. Keeping your feet touching, lift your top knee as high as you can without rotating your hips. Slowly lower your knee back down.

Clam shells work the glute muscles, a key muscle needed for balance support, walking, and to improve knee pain. 

Knee bends: Stand at back of a chair and place hands on chair for balance support. Bend knee and bring heel towards bottom, then lower leg back down.

This is a great exercise to work the hamstrings (back of thigh muscles). The hamstrings are responsible for bending the knee.

Straight leg raise: Lie on your back with one knee bent and the other leg straight. Tighten your thigh muscle and slowly lift your straight leg to about 45 degrees. Hold briefly, then slowly lower it back down.

Being able to complete a straight leg raise is needed for daily activities such as lifting leg in and out of bed, getting your leg into the car. This exercise works the hip flexors. 

Bridges: Lie on your back with your knees bent and feet flat on the floor. Lift your hips toward the ceiling while tightening your glutes and core muscles. Hold at the top, then lower back down slowly.

This is another important exercise because it is very functional. Bridges are important for mobility in bed. You’ll need to be able to bridge to move around in a laying position. 

Seated kicks: Sit on a chair with your back straight and feet flat on the floor. Slowly straighten one knee, lifting your foot off the ground. Hold briefly, then lower it back down.

This is a great exercise for knee cap mobility and quad contraction. Our quads become very weak with knee arthritis.

Stand up sit down: Sit on a chair with your feet flat on the floor. Lean forward slightly and stand up fully, then sit back down slowly with control.

This exercise works the quads, glutes, ankle, hamstrings. It can be more challenging for someone with knee arthritis due to the weight bearing position.

Step ups: Stand in front of a step or sturdy platform. Step up with one foot, then bring the other foot up to meet it. Step back down one foot at a time and repeat.

This is a challenging exercise that works the quads and glutes.

Tips for Success

Stay consistent with your exercise routine! Even when exercises seem too easy or boring, keep moving your joints and working towards a goal of improving your overall strength. If you have trouble staying on task or need help with an exercise routine, check out the 6 Week Pre Surgery Exercise Class (an online exercise class for individuals with knee arthritis taught by Dr. Samantha Smith PT, a knee replacement specialist).

If your exercises become too difficult or painful, always switch to the modification of that exercise. Your goal should not be to increase pain and swelling of the knee when exercising.

Track your progress with your workouts by keeping a journal of your symptoms and exercises. Write down what size dumbbells you are using, what resistance bands you are using, how many sets and reps you are completing. 

Work with an expert to help reach your goals faster! A physical therapist can show you ways to make your workouts harder or easier. They will also help you complete the exercises with proper form. If you are looking to complete an exercise program in the comfort of your own home, this online program (taught by a knee replacement specialist) is a great resource!