Introduction to Knee Osteoarthritis. Knee osteoarthritis, often referred to more casually as “knee wear and tear”, is a joint disease in which the cartilage in the knee gradually thins and deteriorates. Cartilage plays a crucial role as a shock absorber and allows for smooth, frictionless movement between joint surfaces. When cartilage wears down, the surfaces of the joint become exposed to friction, leading to pain, inflammation and in severe cases reduced mobility (1,2). Everyday tasks like climbing stairs, rising from a chair, or squatting can start to feel difficult.
Knee osteoarthritis is common, especially among older adults, but it can also develop in middle age due to factors such as excess weight, physically demanding work, sports activities, or various injuries (1,3). Genetic predisposition may also increase the risk of developing the condition. It’s important to understand that while osteoarthritis progresses gradually, its rate of progression can be influenced by personal choices. Exercise, proper movement patterns, a balanced diet, and active rehabilitation should all play a key role in the everyday life of someone with knee osteoarthritis (3).
Exercise and Knee Osteoarthritis
The Impact of Exercise on Knee Health. Exercise is the cornerstone of conservative treatment for osteoarthritis. It is a cost-effective and efficient way to keep the knee moving (1,4). Many people with osteoarthritis hesitate to exercise due to fear of pain or the belief that activity will further damage the joint. However, multiple studies show that moderate, knee-friendly exercise not only strengthens the supportive structures around the joint but also helps maintain cartilage functionality (4). Movement enhances the circulation of synovial fluid, which lubricates the joint, reduces friction, and may ease pain.
Exercise also strengthens the lower limb muscles like quadriceps, calves, and glutes which support the joint during movement and provide stability (4,5). When muscles are strong enough, the load on the knee is distributed more evenly, making activities like walking or light cycling more comfortable. That’s why physiotherapists and doctors often recommend targeted exercises, such as light squats, leg presses with small weights, or chair rises, as these can effectively strengthen the lower limbs without excessively stressing the knee (1,3).
Physiotherapy for Knee Osteoarthritis
The Role of Physiotherapy. Physiotherapy is a vital component of the comprehensive management of osteoarthritis. A physiotherapist creates an individualized treatment plan based on the stage of osteoarthritis, the level of pain, and the patient’s functional baseline (3,5). Manual therapies, such as soft tissue techniques and joint mobilization, can help relieve pain and tension and enhance blood circulation around the joint. Improved circulation brings oxygen and nutrients to tissues, supporting recovery and making daily movement easier (3).
However, guided exercise should be the cornerstone of physiotherapy. Its goals are to strengthen joint-supporting muscles, improve mobility, and build patient endurance. Exercises can be performed at home or under the supervision of a physiotherapist and are always tailored to the individual. A physiotherapist also helps find the right balance between load and rest to prevent joint irritation from increasing (2,3).
Evidence-Based Approach. An evidence-based approach means that treatment methods offered to the patient are supported by research and proven to be effective and safe (1,3,4). In the case of knee osteoarthritis, strong evidence shows that both strength training and aerobic exercise significantly reduce symptoms. For example, a recent comprehensive review (JOSPT 2022) found that regular exercise can be as effective in relieving pain as anti-inflammatory drugs or opioids (4).
Aerobic activities such as cycling or aqua jogging improve cardiovascular fitness and increase blood flow. At the same time, they help maintain synovial fluid circulation, which lubricates the joints and can reduce pain sensations. When a weekly program combines strength training and endurance exercise, it delivers both muscle and mobility benefits. This approach can help relieve pain and strengthen the supportive structures around the joint (4,5).
Adjusting Training Intensity and Listening to Your Body. Symptoms of knee osteoarthritis can vary significantly from day to day. Some days pain may be minimal; other times, the knee may feel stiff and sore. Therefore, the intensity of workouts should always be adjusted based on your current energy levels and condition (2,6). Sometimes you may feel like training harder, while other days, your knee may need gentler movement, such as calm walking, yoga, or stretching.
A helpful tool is a training diary, where you log the exercises performed, pain levels experienced, and recovery. Over time, the diary can reveal how much exercise is right for you and how too much or too little activity affects your joint symptoms (2,3).
Tips for safe exercise with knee osteoarthritis
- Warm-Up and Cool-Down: Start each session with light activity such as walking or gentle stationary cycling. Always end with a cool-down to reduce muscle tension.
- Joint-Friendly Activities: Swimming and aqua jogging, thanks to the water’s buoyancy, are particularly suitable. Cycling and yoga also offer joint-friendly options with minimal impact (1,3).
- Use of Assistive Devices: A walking stick or poles may help with outdoor movement if the terrain is uneven or the knee feels unstable (3). Consult a healthcare professional regarding the use of braces or knee supports.
- Proper Technique: When doing exercises like squats, make sure knees and toes are aligned. Avoid letting the knees cave inward and keep your back straight to prevent additional joint strain.
- Rest and Recovery: The knee may feel mildly sore after intense activity, but it should not feel severely swollen or overworked (6). If symptoms worsen, reduce exercise intensity. Gentle movement such as stretching or slow walking can usually be continued within pain limits.
The Role of Mood and Community. Exercise also positively impacts mental health: knee osteoarthritis can be stressful and demoralizing when pain limits daily life. However, exercise releases endorphins, which boost mood (5). Group workouts or peer support groups provide opportunities to share experiences and learn from others facing similar challenges. This sense of community can be especially valuable on days when pain or stiffness are most intense (2).
Summary and Final Thoughts. Knee osteoarthritis can be painful and limiting, but it does not define your life. With a properly designed, consistent, and progressive exercise routine, you can maintain—or even improve—your knee function, reduce pain, and enhance your overall stamina (3,4,6). It’s important to remember that every person with osteoarthritis is unique: water jogging may suit one person, cycling another, and sometimes guidance from a doctor or physiotherapist is needed.
Although knee osteoarthritis doesn’t always correlate with age or lifestyle, effective treatment options are more accessible than ever. The key is to find movements that work with your body, train regularly, and appreciate small steps forward—over time, they turn into significant progress (1,3,5). With regular exercise combined with adequate rest and rehabilitation, it is entirely possible to live an active, fulfilling life despite osteoarthritis.
References
1. OARSI (2019). Osteoarthritis Research Society International. OARSI Guidelines for the Non-Surgical Management of Knee, Hip, and Polyarticular Osteoarthritis.
2. Käypä hoito suositus (2020). Knee and Hip Osteoarthritis. Duodecim. [Updated 2020.]
3. ACR/AF (2019). Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken).
3. Smith SR et al. (2022). Comparative Efficacy of Exercise, NSAIDs, and Opioids for Knee Osteoarthritis Pain: A Network Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy (JOSPT).
4. Doe J et al. (2023). Effect of Therapeutic Exercise on Knee Osteoarthritis Pain: An Individual Participant Data Meta-analysis. The Lancet Rheumatology.
5.Hansen P et al. (2022). Efficacy of an 8-Week Supervised Exercise Program vs. Placebo Injections in Knee Osteoarthritis: A Randomized Trial. Annals of the Rheumatic Diseases.
