Best Exercises for Knee Arthritis and Joint Pain

What is Knee Arthritis?

Knee arthritis, also known as knee osteoarthritis or knee OA, is a natural degenerative process where the cartilage at the end of the bones in the knee joint wears down over time. I like to describe it as similar to the wearing down of treads on a vehicle’s tires. It’s a gradual process that happens to everyone, but at different rates depending on a lot of factors.

When we’re born, the cartilage in our knees is pristine and thick. It helps to protect and pad our joints. However, over time, this cartilage undergoes rubbing and stress in high contact areas such as where the thigh bone (femur) and the shin bone (tibia) meet the knee cap (patella). The cartilage slowly begins to thin in these areas of contact.

The body responds by growing extra small pieces of bone to help protect from excessive rubbing. These areas are called bone spurs.

As this arthritic process continues to worsen, inflammation begins to build in the area causing pain, swelling, and stiffness.

Osteoarthritis vs Rheumatoid Arthritis vs Post-Traumatic Arthritis?

Osteoarthritis

• Another name for normal knee arthritis. “Osteo” means bone. This is the current topic of this article.

Rheumatoid arthritis

• Rheumatoid arthritis is an autoimmune disease that attacks not only the knee joints but also many other joints throughout the body at the same time. It usually occurs in joints on both sides of the body as well. This process occurs when the body’s own immune system begins attacking its own cartilage causing weakness of the tissue and bone softening.

Post-traumatic arthritis

• Post-traumatic arthritis occurs after a significant injury to a joint. This is commonly seen developing after a fracture or ligament tears. The increased instability in the joint often leads to increased “wear and tear” in the joint resulting in excessive cartilage degradation faster than it would normally occur.

How Will Knee Arthritis Affect Me?

Symptoms of knee arthritis include joint pain, swelling, and stiffness. These symptoms gradually increase in severity over time as the degeneration progresses. Most people can ignore the symptoms for many years in the beginning, but eventually, the knee joint pain will be significant enough to cause the person to discontinue many of the aggravating activities.

As the condition worsens, the individual becomes increasingly more sedentary as they don’t want to increase their knee pain. However, this is a vicious cycle as it typically leads to increased body weight, which, in turn, adds even more compression through the joints. The joints become even stiffer as they’re not moving as often.

Physical therapy knee exercises can help break this cycle and ease knee arthritis pain, though they must be done correctly as to not worsen the knee pain.

Aggravating activities can include walking up and down hills and/or stairs, squatting, kneeling, walking on unlevel surfaces (such as sand at a beach), and spending several hours with your knee bent (like when you ride in a car).

The knee joint pain will be worse after increased activity spent on your feet. You won’t typically have pain immediately, but rather it can take several hours to the next day to arrive. You may notice the onset of swelling around your knee.

A Baker’s cyst is often found on the backside of the knee. This is a small, golf ball-sized pocket of fluid. Remember that fluid follows the path of least resistance and the backside of the knee is the weakest area of the joint capsule that holds the fluid in the knee joint. Therefore, this is usually the first place that the fluid leaks outward.

Additionally, there may be an audible and/or palpable grind sensation in the knee joint when the knee moves from a straight position to a bent one. This is medically known as joint crepitus and it is an indicator of worn cartilage. You may have heard your doctor describe it as “bone on bone” rubbing.

How to Diagnose Knee Arthritis?

Diagnosing knee arthritis is commonly performed using an x-ray of the knee joint. X-rays clearly show the bone quality within the joint and can easily identify bone spurs and irregularities.

Other Potential Causes of Knee Pain

Knee arthritis is often present along with other medical diagnoses in the knee joint. It is typical to see other types of knee injuries including meniscus tears, ligament sprains, and IT band Syndrome at the same time someone also has knee arthritis present. If you’re questioning whether you have knee arthritis, check out my other knee strengthening exercises article as it outlines several other knee pain conditions and exercises to help with pain relief from those.

Knee Arthritis Treatment Options

The number one intervention is to simply TAKE ACTION! You’ve come to the right place in that you found this article and video. Now, you must not ignore this knee pain as it will only worsen over time. The earlier that you take action, the longer you can maintain healthy knee joints.

Physical therapy exercises are meant to strengthen the muscles that surround and support the knee joint. Strengthening these muscles with exercises MUST always be performed within a pain-free range of motion. A “no pain, no gain” mentality will get you further into trouble with knee arthritis.

You must identify a pain-free range of motion with each exercise and stay within the range until the tolerance of the joint improves over time. Eventually, it will allow for an increased range of motion as the muscles grow stronger.

Physical therapy stretches will improve the flexibility of the muscles that cross the knee joint to help to reduce any excessive stress that is placed through the joint.

Corticosteroid injections are anti-inflammatory injections. They will help to reduce the inflammation within the joint. These injections can be an effective way to reduce symptoms to allow an individual improved tolerance to physical therapy exercises. It will also help to reduce any swelling that may be present in the joint.

I do want you to understand, though, that corticosteroid injections are only short-term relief treatments. They may be effective for several months depending on the severity of the cartilage degeneration that is present, but the effectiveness of each sequential injection will decrease gradually.

The injections will help treat the symptoms, but they are NOT treating the cause of the pain. This is why they are best utilized in conjunction with physical therapy exercises.

There are knee braces that have been developed to help with some forms of knee arthritis. These braces are called knee unloader braces. There are several kinds of them with varying amounts of support depending on the size of the brace. This brochure from Ossur (a common manufacturer of these types of braces) shows a few of the different models of unloader braces.

Unloader braces are most effective when there is only one side of the knee joint that is producing most of the pain. When worn, they provide an opening-type force on the side of the joint that has the most compression/pain, which helps to reduce the compression through that side. These braces are recommended to be worn when the individual is performing weight-bearing activities.

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Glucosamine and Chondroitin are oral supplements meant to protect the cartilage within the joints. There is an endless number of websites out there that try to sell these pills as a sure solution to relieving joint pain.

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There have been numerous research studies performed on this topic, though the outcomes are a mixed bag. Some studies have found that taking around 1-gram of Glucosamine and Chondroitin per day for at least 3 months does help to relieve knee pain when combined with exercise, however, there has been an equal number of studies that have found no difference.

My take on it is that if your doctor says it is safe for you to take, then it certainly won’t hurt to try taking these supplements for a few months to assess for yourself and see if you notice any difference in your knee pain.

Platelet-rich plasma (PRP), prolotherapy, and stem cell injections are all other types of injection options that you may hear about. I’m not going to cover them in this article as the medical research is still very much so mixed on the efficacy of each in regards to knee arthritis.

Total Knee Joint Replacement

Ultimately, there may come a time when you can no longer effectively manage your knee pain through a combination of oral medications, exercises, and injections. It is quite scary for some to think about undergoing total knee joint replacement surgery. The surgery should definitely be considered an invasive procedure. There will be a long incision made in order to open the joint up enough to remove and replace the end of the long bones in the knee.

However, this surgery overall has excellent outcomes when performed by a qualified orthopedic surgeon. As long as these patients commit to performing the proper total knee joint replacement exercises after surgery, there should be no reason why they cannot return to full function within 3-4 months after surgery.

What Orthopedic Surgeons Don’t Tell You!

As mentioned before, as a physical therapist with a clinic located within the same building as an orthopedic surgeons group, I treat on average 10 patients with total joint replacements every week. I’ve been doing this for years and I have definitely picked up on some things that orthopedic surgeons conveniently “fail” to tell you before having a joint replacement procedure.

1. Losing weight before surgery WILL HELP! There have been some impressive studies that have shown that if you lose even just 10-lbs of weight, your knee joint compressive forces will decrease by 30-lbs per step. Start by eating healthier. Exercise also helps, but calories in vs calories out produce a much larger effect than just exercise alone.
2. A total knee replacement is a significant surgery. Your body will not understand that it will have a new beautiful knee joint installed. Rather, your body will think that you just got hit by a truck! You WILL have knee pain for many months after surgery. It is completely normal and expected. Hang in there! Keep your eyes on the horizon as things will slowly improve and by 3-4 months post-op, your pain will be minimal.
3. You MUST MUST MUST let your physical therapist stretch your knee back to its normal range of motion (greater than 125 degrees of flexion). Yes, it will hurt. There’s no way around it. But, do your best to grit it and let them help you. We’re doing it because we want you to SUCCEED and we want to get you back to the best version of yourself before you had knee arthritis pain.
4. Along with #3, you must also stretch your knee to the best of your ability every day at home. You’ll probably only be spending 2 visits (1.5 to 2 hrs) per week with your physical therapist, which is not enough stretching time. In order to not lose range of motion, you will need to stretch into the painful end range every day.
5. You can do this! I absolutely love working with my total joint replacement patients. Once they learn to buy into doing their home exercises, it is amazing to see how quickly they can get back to doing the daily activities and/or hobbies that they used to love before the knee arthritis pain began.

What Knee Exercises to Avoid

Due to the biomechanics of the knee hinge-type joint, there are some knee exercises that should be avoided as they create significant stress and compression to the joint. This will likely only lead to increasing knee pain and inflammation.

Deep squatting exercises near or beyond 90 degrees (thighs parallel to the floor), lunging, repetitive kneeling, using a resisted knee extension machine, any kind of jumping or high-impact activity, and performing repetitive step-ups onto a high step should all be performed with caution.

Preferably you would be under the watchful eye of a physical therapist if you were about to attempt one of these activities as they could help modify the activity as needed to ensure that you do not aggravate the joint.

What to Expect From Knee Arthritis Exercises

The following physical therapy knee arthritis exercises should typically be performed every day initially with a couple of rest days spread throughout the week. The rest days can be used as just passive stretching days, which allows for muscle recovery.

Expect to have to begin some of the exercises within a limited, yet pain-free range of motion. Remember the pain-free zone diagram from earlier in this article? Be sure to always stay within that zone, which will allow for the exercises to strengthen the muscles that support the knee joint without increasing the arthritis pain or inflammation.

It will be a slow process over several weeks, but a gradual improvement in knee symptoms (decreased knee pain, stiffness, weakness) should be seen. You may also notice a gradual increase in the range of motion that you can do the exercises within without feeling knee pain.

For a general time frame, exercises will take approximately 6-8 weeks for significant improvements to be observed.

Ready to work?! 😃