An Evidence-Based Review on the Best Exercises For Knee Pain In Osteoarthritis Management

Osteoarthritis (OA) is a chronic joint disease characterized by progressive cartilage degradation, subchondral bone remodelling, osteophyte formation, and inflammation, causing significant pain and functional disability.

It particularly impacts weight-bearing joints, most notably the knee [1]. The fact is, nearly all OA sufferers have issues with their knees meaning that it’s more important that ever to make sure that there’s practical and effective advice available.

Among vast array of potential treatment for knee OA, exercise remains a cornerstone. Exercise therapy has been consistently endorsed by numerous clinical guidelines, attributing to its benefits in pain alleviation, functional improvement, and quality of life enhancement with minimal side effects [2,3].

We’re going to break down the best and most effective exercise regimens for OA knee pain, as detailed by multiple studies in the last 30 years.

The Rationale for Exercise in Knee Osteoarthritis Management

Exercise delivers multifaceted benefits in OA management. Firstly, it fosters the strengthening of muscles around the knee joint, which contributes to enhanced joint stability and reduced joint load [4]. Furthermore, exercise boosts local blood flow, thereby improving the delivery of nutrients to the cartilage and promoting waste removal, slowing the progression of the condition. It also attenuates inflammation and fosters improved proprioception, culminating in pain alleviation [5].

The type of exercise, its intensity, frequency, and duration, have been shown to significantly influence the outcomes of arthritis patients. We will now discuss some of the most beneficial exercises for knee OA, encompassing aerobic exercises, resistance training, and flexibility exercises.

Aerobic Exercises For Arthritis

Aerobic exercises, such as brisk walking, cycling, and swimming, promote overall physical fitness and cardiovascular health. They are characterized by rhythmic, repeated, and continuous movements of the same large muscle groups for a sustained duration [6].

Recent systematic reviews and meta-analyses indicate that aerobic exercises reduce pain and improve physical function in individuals with knee OA [7,8]. Notably, low-impact aerobic exercises, like cycling and aquatic exercises, are preferable as they exert less stress on the knee joint while providing the benefits of aerobic activities. For optimal results, aerobic exercises should be performed for at least 150 minutes per week, distributed over several days [9]. Water based exercises are the best place to start for any people who’s knee pain is too substantial for any notable walking or cycling.

Resistance Training With OA

Resistance or strength training exercises, typically involving weight lifting or body-weight exercises, aim to bolster muscle strength, endurance, and power. In the context of knee OA, these exercises principally target the quadriceps and hamstrings, the major muscle groups straddling the knee joint [10].

Research has consistently indicated that resistance training significantly mitigates pain, enhances physical function, and improves quality of life among knee OA patients [11,12]. Resistance training can be executed two to three times a week, ensuring a day of rest between sessions to facilitate muscle recovery [13].

Flexibility Exercises For Arthritis

Flexibility exercises, including stretching and range of motion exercises, aim to maintain or enhance joint flexibility and muscle elasticity, critical for preserving joint function and mitigating stiffness, a common complaint in knee OA [14].

While flexibility exercises may not directly alleviate pain or improve physical function as effectively as aerobic or resistance training, they supplement these regimens and contribute to overall joint health [15]. Flexibility exercises are best performed daily or at least several times a week.

Best Knee Exercises For Arthritis

1. Straight Leg Raises

Straight leg raises are a beginner-level exercise, serving as an excellent way to start your exercise routine if your knee pain is significant. This exercise helps in building strength while putting little to no strain on the knee.

To perform a straight leg raise, lie flat on your back on a comfortable surface. Bend one knee while keeping the other leg straight. Tighten the quadriceps (the large muscles at the front of your thigh) of your straight leg and raise the leg to the height of the bent knee. Hold for a moment, and then slowly lower your leg back to the floor. Repeat this exercise for 10-15 repetitions and switch to the other leg. Aim for two sets on each side.

2. Quad Clenches

Quad clenches are aimed at improving quadriceps strength and knee stability. Lie on your back and place a small rolled towel under your affected knee. Tighten your quadriceps by trying to press the back of your knee down onto the towel. Hold for a few seconds and then release. Repeat 10-20 times every 4-6 hours.

3. Short Arc Quads

This exercise aims to strengthen your quadriceps and improve knee stability. Lie flat on your back and use a rolled-up towel or foam roller to prop up the knee of your affected leg. Keep your leg relaxed on the towel and your foot flat on the ground. Lift the foot off the ground by straightening the knee and hold for a few seconds. Repeat this exercise 10-15 times for each set, and aim for two sets every day.

4. Calf Raises

alf raises are designed to strengthen the calf muscles, which help support the knee. Stand tall and slowly raise up onto your toes, lifting your heels off the ground. Hold the position for a few seconds, then slowly lower your heels back down to the ground. Do two sets of 10-15 repetitions each day. You can use a wall or chair for balance if needed.

5. Mini Squats

Mini squats can help improve your knee's range of motion and strengthen the surrounding muscles. Stand upright with your feet hip-width apart and place your hands on a stable surface for support (like a chair or countertop). Slowly lower your buttocks as though you are about to sit down on a chair but don't go down fully - just about a quarter of the way. Make sure your knees don't move past your toes. Return to the standing position. Repeat the exercise for 10-15 repetitions, aiming for two sets every day.

6. Step-ups

Step-ups are a great exercise for enhancing leg strength and knee stability. Use a low step or a sturdy box for this exercise. Step up onto the box with one foot, then bring the other foot up to meet it. Step back down and repeat. Aim for 10-15 repetitions on each leg.

7. Hamstring Curls

This exercise targets the hamstrings, the muscles located at the back of the thigh. Stand tall and hold onto a chair or countertop for support. Slowly bend one knee, lifting your heel off the floor while keeping your thighs aligned. Slowly lower your foot back to the ground. Aim for 10-15 repetitions on each leg.

Remember, before starting any new exercise regimen for arthritis, it's essential to consult with a healthcare provider or a physical therapist to ensure the exercises are safe and appropriate for your specific condition. Start slowly, listen to your body, and gradually increase the intensity and duration of the exercises as your strength and flexibility improve.

8. Wall Squats

Wall squats aim to strengthen the quadriceps, a set of muscles that are vital for knee mobility and stability. Stand with your back against a wall, feet hip-width apart, and positioned about two feet away from the wall. Slowly slide your back down the wall, bending your knees until they reach about a 45-degree angle. Ensure that your knees are directly above your ankles, not pushing past your toes. Hold this position for about 5-10 seconds, then slowly slide back up the wall to the starting position. Aim for two sets of 10-15 repetitions daily.

9. Gentle Lunges

Lunges are dynamic exercises that can help increase strength in your quads and glutes, both of which support your knees. To perform a lunge, stand upright, then take a step forward with one foot. Lower your body until the knee of your forward foot is at a 90-degree angle. Keep your back straight and ensure the knee of your forward foot doesn't move past your toes. Push back up to the starting position, then switch legs. Do 10 repetitions on each leg, for two sets daily. As lunges are a more advanced exercise, they should be approached with caution if you have severe knee arthritis.

10. Seated Leg Press

If you have access to gym equipment, the seated leg press can be an excellent exercise for knee arthritis. This exercise primarily targets the quadriceps and also engages the glutes and hamstrings. Sit on the machine with your feet flat on the footplate, knees bent at a 90-degree angle. Push against the footplate to straighten your legs, then slowly return to the starting position. Perform two sets of 10-15 repetitions each.

11. Cycling or Stationary Biking

Cycling or stationary biking provides a great low-impact cardiovascular workout and helps improve knee flexibility and strength. Cycling promotes a smooth circular motion that improves joint mobility without placing undue stress on the knee. Start with short periods of low-intensity cycling and gradually increase your duration and intensity as your strength improves.

12. Swimming and Water Aerobics

Swimming and water aerobics offer an excellent form of low-impact exercise for those with knee arthritis. The buoyancy of the water reduces stress on the joints while providing resistance to help strengthen your muscles. Water exercises can include walking or jogging in water, leg lifts, knee lifts, and various other movements.

It's crucial to note that while these exercises are generally safe for people with arthritis, everyone's situation is unique. Always consult with your healthcare provider or a physical therapist before starting a new exercise regimen to ensure the exercises are suitable for your specific condition. Furthermore, while exercising, if any activity causes you pain, it's essential to stop and seek advice from a professional. It's also important to remember that consistency is key in seeing improvement over time.

Should You Do Knee Exercises For Arthritis Pain Conclusion

In conclusion, knee arthritis can be a debilitating condition significantly impacting an individual's mobility and overall quality of life. However, an appropriately tailored exercise regimen can prove instrumental in managing the symptoms associated with knee arthritis. Exercises such as hamstring stretches, calf stretches, leg lifts, step-ups, wall squats, gentle lunges, seated leg presses, cycling, and swimming, can contribute to improving knee flexibility, strengthening the surrounding muscles, and enhancing overall knee functionality.

Yet, it's essential to bear in mind that although exercise is generally beneficial for individuals with knee arthritis, its appropriateness and effectiveness may vary significantly based on individual factors. Thus, it's imperative to consult with a healthcare provider or physical therapist before embarking on a new exercise regimen. Additionally, any exercise that induces pain should be immediately discontinued and reported to a healthcare provider.

It is also worth mentioning that there are other wholistic treatments that should be kept in mind with nutrition playing a large part in potential OA care, particularly certain vitamin and mineral dificiencies which can be easily covered with joint specific supplements.

Future research should continue to explore optimal exercise regimens for individuals with knee arthritis, considering various influencing factors such as age, disease severity, and comorbid conditions. With consistent adherence to an appropriate exercise regimen and guided healthcare advice, individuals with knee arthritis can significantly improve their condition, leading to a more active, less painful lifestyle. 


[1] Palazzo, C., Nguyen, C., Lefevre-Colau, M. M., Rannou, F., & Poiraudeau, S. (2016). Risk factors and burden of osteoarthritis. Annals of Physical and Rehabilitation Medicine, 59(3), 134-138.

[2] Fernandes, L., Hagen, K. B., Bijlsma, J. W. J., Andreassen, O., Christensen, P., Conaghan, P. G., ... & Lohmander, L. S. (2013). EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the Rheumatic Diseases, 72(7), 1125-1135.

[3] Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., ... & McAlindon, T. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578-1589.

[4] Lange, A. K., Vanwanseele, B., & Fiatarone Singh, M. A. (2008). Strength training for treatment of osteoarthritis of the knee: a systematic review. Arthritis Care & Research, 59(10), 1488-1494.

[5] Hurley, M. V. (2002). The role of muscle weakness in the pathogenesis of osteoarthritis. Rheumatic Disease Clinics, 28(3), 641-655.

[6] Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Gohdes, D. D., ... & Garber, M. B. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical therapy, 85(12), 1301-1317.

[7] Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (1).

[8] Juhl, C., Christensen, R., Roos, E. M., Zhang, W., & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis & Rheumatology, 66(3), 622-636.

[9] OARSI. (2019). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578-1589.

[10] Bennell, K. L., & Hinman, R. S. (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport, 14(1), 4-9.

[11] Segal, N. A., Glass, N. A., Torner, J., Yang, M., Felson, D. T., Sharma, L., ... & Nevitt, M. (2010). Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis and Cartilage, 18(6), 769-775.

[12] Silva, L. E., Valim, V., Pessanha, A. P., Oliveira, L. M., Myamoto, S., Jones, A., & Natour, J. (2008). Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Physical therapy, 88(1), 12-21.

[13] ACSM. (2009). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine & Science in Sports & Exercise, 41(3), 687-708.

[14] Altman, R. D., & Marcussen, K. C. (2001). Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 44(11), 2531-2538.

[15] Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., & Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Annals of Internal Medicine, 132(3), 173-181.

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