Exercise and Knee Osteoarthritis

Woman with ice pack on knee
Patrik Giardino / Getty Images

The knee is one of the most complex joints in the body with multiple bones, muscles, tendons, and ligaments working together to keep your legs moving and your body stable. Your knee is also the recipient of up to three times your body weight whenever you walk, making it vulnerable to pain and, sometimes, chronic conditions like knee osteoarthritis.

If you have knee OA, you might feel so much pain, stiffness, and swelling that you avoid exercise completely. But building strength and losing weight are two of the best things you can do to manage the pain. The key is to approach exercise in the right way.

The Basics of Knee Osteoarthritis

If you have knee pain of any kind, you should see your doctor to get a proper diagnosis. It's important to figure out the cause of your knee pain so you know exactly how to treat it. When it comes to knee osteoarthritis, there are risk factors that may make you more vulnerable.

Common Causes of Knee Pain

  • Genetics
  • Obesity
  • Past knee injuries
  • Repetitive stress injuries
  • Injuries involving a fracture or ligament tear which can affect knee alignment and lead to more wear and tear

The most common symptoms of knee OA are:

  • Pain during physical activities
  • Swelling and stiffness around the knee joint
  • Difficulty bending the knee; limited range of motion
  • Tenderness or pain in the knee
  • Weakness in the knee joint

There are a number of treatment options your doctor may talk to you about such as medication, cortisone injections, supplements or, in some cases surgery. However, one of the best proven treatments may be the one thing many OA sufferers avoid: Exercise. Working out is hard enough when you're pain-free, but trying it with joint pain and limited mobility makes it even harder. It's tough to find exercises that feel good on your body, but they are out there and it's worth experimenting to find what will work for you.

Exercise for Knee Osteoarthritis

If you do have knee OA, exercise, with your doctor's okay, is one of the best ways to manage the pain. Just a few things exercise can do for you:

  • Strengthen the muscles around your joints
  • Decrease bone loss
  • Reduce stiffness, pain, and swelling
  • Help you function better and lose weight
  • More energy
  • Better mood

The key is, first, talking to your doctor and/or physical therapist about what you can and can't do. Next, you'll probably have to experiment to figure out exactly how to work around your knee pain. For example, you may want to avoid high-impact activities that stress the joints, like running or aerobics and stick with low or no impact exercise like walking or cycling.

Deep knee bends, as in squats or lunges, might also be off the table, but there are always alternatives or modifications that may work for you. Your doctor or PT can help you create a solid workout plan, but below are a few ideas for how you can get started.

Water Exercise

If you're in pain, water exercise is a great choice. The buoyancy supports your body, allowing you to exercise without straining the joints. Some studies suggest that doing aerobic exercise as well as stretching, strengthening, and range of motion exercise in warm water (90-97 degrees Fahrenheit) can reduce pain and improve range of motion.

How to Get Started

  • Water aerobics: Many gyms and community centers offer water aerobics classes with a focus on cardio, strength and flexibility exercises in a choreographed routine. Most of these classes cater to people with joint problems or other injuries and if you enjoy a more social exercise environment, this might be a good choice for you.
  • Water walking: Another option is to keep it simple with water walking. You can walk in shallow water or use a flotation belt in deeper water. To get started, walk for about 5 to 10 minutes to get a feel for it. The resistance of the water will make your steps slower and it may feel intense at first. Go as long as you can and, each workout, add a few minutes until you can walk for 20 minutes. You can also wear webbed gloves to add resistance to your upper body as well.​
  • Water strength training: Almost any exercise you do in the gym can be done in the water. Squats, lunges, leg lifts, and leg kicks can work the lower body and you can use webbed gloves or water dumbbells for biceps curls, standing chest flies or presses, lateral raises or triceps pushdowns.

Low Impact Cardio

If you have knee OA, you may find high impact cardio like running or aerobics too stressful on the joints, but there are low or no impact alternatives. Walking, riding a stationary bike or using an elliptical trainer are just a few activities that can give you a great cardio workout without as much stress on the joints. Whatever activity you choose, make sure you:

  • Warm up: A steady warm-up can help lubricate your joints and get them ready for exercise.
  • Ease into it: Start with what you can handle, even if it's only a few minutes. Each time you exercise, add a few minutes until you can work out continuously for 20-30 minutes.
  • Stretch: Stretching your hamstrings, calves, and quads after a workout can keep you flexible and may help reduce pain over time.

Yoga and Pilates

Yoga and Pilates are also great choices if you have knee pain. Both help build flexibility, core strength and balance while reducing pain and stiffness. In fact, one study found that Iyengar yoga can reduce the pain and disability caused by knee OA. Some of the poses used in the study include:

Cardio and flexibility are just one part of the equation. Working on strengthening the muscles that support your knee can help you reduce pain and maintain lean muscle tissue in your lower body.

Strength Training for Knee Osteoarthritis

If you feel pain in your knees when you exercise, you may think strength training will only make things worse. It's true that some movements can exacerbate the problem, but working on the muscles that support your knee may reduce pain over time while helping you build more strength and endurance.

Those muscles include the:

  • Quadriceps: You can strengthen this muscle with a variety of exercises including leg extensions, straight leg raises, knee lifts, or push steps.
  • Hamstrings: These exercises are great for building strength in the hamstrings: Hamstring curls, pull-throughs or hamstring rolls.
  • Inner and outer thigh: Leg lifts and side steps work the outer thigh while inner thigh squeezes and lifts work the inner thighs.

If you need some guidance, a knee pain workout includes a variety of strength and flexibility exercises for the knees, but be sure to check with your doctor before trying this or any other workout.

A Word From Verywell

Living with knee OA can be frustrating, but avoiding exercise may make things worse. Daily movement, no matter what activity you choose, can help keep your joints strong, mobile and flexible. Not only that, it's a great reminder that you can take control of your situation, even if there are some limitations on what you can do.

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