Let’s be honest: when your knee is stiff, looks swollen, and feels achy, the mere thought of moving it any more than necessary seems, well… totally unnecessary. Climbing a set of stairs, carrying groceries from your car, even sometimes just getting up from your chair — it all hurts.
So why would you move your knee more to exercise? Because that’s precisely what you need to do to feel — and move — better. Exercise is an important part of your knee arthritis treatment plan, and your doctor will recommend it, whether you have osteoarthritis or an autoimmune, inflammatory form such as rheumatoid or psoriatic arthritis.
Here’s what’s happening in your knee when you have arthritis, and why exercising helps relieve pain and stiffness.
How Arthritis Affects Your Knees
The knee is one of the largest, strongest joints in your body, says Wayne Johnson, MD, orthopedic surgeon and assistant clinical professor at the University of Oklahoma. It’s made up of three bones: the thighbone, the shinbone, and the kneecap.
The ends of those bones — where the three meet in the joint — are covered with articular cartilage, a smooth, slippery substance that cushions and protects the bones as you move around. Your knee also has an additional cushion called the meniscus — a tough, wedge-shaped rubbery substance between the thigh and shin bone that helps protect the cartilage.
In osteoarthritis (OA), the cartilage in the knee joint gradually wears down, and the protective space between the bones decreases. Bone on bone rubbing and friction in the joint can, over time, produce painful bone spurs, and lead to stiffness and swelling. This makes it tough to bend and straighten your knee.
The meniscus can wear down, too. “Think of it like a brake pad in your car,” says Dr. Johnson, who is a fellow of the American Academy of Orthopaedic Surgeons. “It won’t last forever. And the number of cycles you put on it cause wear and tear, so it may not be able to protect cartilage as well as it could before it was worn out.” A tear in your meniscus or other injury to your knee can damage or cause additional wear, which can predispose you to knee OA earlier than you would with the normal aging process, adds Dr. Johnson.
Knee arthritis is relatively common, and starts most often in people 50 years of age and older, says Dr. Johnson. The lifetime risk of developing OA of the knee is about 46 percent.
With rheumatoid and other forms of inflammatory arthritis, the immune system mistakenly attacks a protective lining in your joint called the synovium, and destroys cartilage in the knee joint. RA tends to affect smaller joints first (such as those in your hands and feet), but in some cases may spread to both your knees as the disease progresses.
How Exercise Helps Knee Arthritis
Exercise programs for arthritis that include strength and aerobic exercise can help reduce symptoms, improve joint motion and function, enhance balance, and control body weight. “With knee OA, strength training exercises are particularly important,” adds Lauren Shroyer, MS, director of product development at the American Council on Exercise.
That’s because as you age, balance can decline for multiple reasons; arthritis in your knee can affect balance as well. “Strength exercises help stabilize your knee and retain that balance for longer periods of time.”
Plus, your body relies on muscles to help motor joints, adds Dr. Johnson. For the knee, that’s the quadriceps in the front of the thigh and hamstrings in the back.
“You can’t cure arthritis or make it go away,” says Dr. Johnson. “But if you strengthen the muscles that support and stabilize the knee, you can take some of the stress load of weight-bearing or walking off a joint that’s worn out and weakened from arthritis, and place it on the stronger muscle.”
Precautions to Keep in Mind Before Exercising with Knee Arthritis
If you’re new to exercise, it’s always smart to first talk to your doctor. Your doctor or physical therapist can make sure the exercises are safe for you and help you gain strength, without exacerbating inflammation or aggravating joint pain. Likewise, if you’ve had surgery on your knee, get guidance from your doctor or physical therapist on what knee exercises are safe for you. More tips to help protect your joints:
Start slowly
Ease your joints into exercise if you haven’t been active for a while, say experts. Push too hard too fast, and you can overwork your muscles and worsen joint pain. Go easy at first, then increase the length and intensity of your work out as you progress.
Move gently
At the start of every exercise activity, start with five minutes or 10 minutes of stretching to help elongate the muscles and make them easier to move, says Dr. Johnson; and do it again at the end. Don’t force any stretches; keep your movements slow and easy. With strength training, begin with fewer reps or lower weight, and build up gradually.
Do a little every day
If you have a flare of RA or an increase in OA pain, you should still stay active, suggests Dr. Johnson. Some simple stretching, like these range-of-motion stretches, may diminish some of the pain.
Stop if your knee (or anything else) hurts
“Listen to the pain,” says Shroyer. Take a break when your joints start to ache; or you feel any new joint pain, it’s time to stop. Talk to your doctor about what pain is normal and when it could be a sign of something more serious.
Exercises to Help Relieve Knee Arthritis Pain
The following knee exercises were recommended by Shroyer at ACE and Dr. Johnson from the AAOS:
1. Knee Exercise: Quadricep Stretch
Stretches the front of your thigh
- Stand behind a sturdy chair or next to a wall and hold on for balance.
- Bend one knee and bring your heel up toward your buttock.
- Grasp your ankle with your hand and gently pull your heel closer to your body.
- Hold the stretch for 30 to 60 seconds.
- Repeat with the opposite leg; then repeat the sequence one or two more times.
Tip: Don’t arch or twist your back while stretching.
2. Knee Exercise: Hamstring Stretch
Stretches the back of your thigh and behind your knee
- Lie on the floor with both legs bent and feet on the ground.
- Lift one leg off the floor and bring the knee toward your chest.
- Clasp your hands behind your thigh below your knee. (You can also loop a towel around your thigh and grasp the end, if that’s easier.)
- Straighten your leg and then pull it gently toward your head, until you feel a stretch.
- Hold the stretch for 30 to 60 seconds.
- Repeat with the opposite leg; then repeat the sequence one or two more times.
Tip: Don’t put your hands (or towel) at your knee joint and pull.
3. Knee Exercise: Straight-Leg Raises
Strengthens the front of your thigh.
- Lie on the floor with your elbows directly under your shoulders to support your upper body.
- Keep your neck and shoulders relaxed.
- Place your leg with the affected knee straight in front of you, and bend the other leg so your foot is flat on the floor.
- Tighten the thigh muscle of the straight leg and slowly raise it 6 to 10 inches off the floor.
- Hold this position for 5 seconds and then relax and bring your leg to the floor. Repeat for three sets of 10.
Tip: Try this exercise while you watch your favorite TV show, suggests Dr. Johnson. Start with five reps at every commercial until you get to 30; then gradually work your way up to a total of 50, and 100. As the exercise becomes easier, you can gradually increase the resistance by adding ankle weights in one-pound increments.
4. Knee Exercise: Hamstring Curls
Strengthens the back of your thigh
- Stand behind a sturdy chair or next to a wall and hold on for balance.
- Bend your affected knee and raise your heel toward the ceiling as far as possible without pain.
- Hold this position for 5 seconds and then relax.
- Repeat for 3 sets of 10.
Tip: Flex your foot and keep your knees close together. As the exercise becomes easier, gradually increase the resistance by adding ankle weights in one-pound increments.
5. Knee Exercise: Slow “March”
Strengthens stabilizing muscles of your foot, knee, and hip
- Stand next to a wall or door frame for support.
- Balance on right foot; hold on to wall or door frame to stay steady, if needed.
- Keep your knee straight over your ankle, with a slight bend.
- Slowly lift your left foot until your knee is level with your hip, or as close to that position as you can get without pain.
- Slowly lower it back to the floor; then repeat with the other foot (as though you are slowly marching in place).
- Repeat the sequence as many times as you can, while holding the correct position.
Tip: Pay attention to any loss of stability, advises Shroyer. For example, if your right foot is on the floor and your right knee wants to bow in when you lift your left, don’t raise your left foot so high. Focus your attention on keeping your right foot stable, making sure both the ball and heel of the foot have equal and balanced pressure on the floor.
6. Knee Exercise: Sit-and-Stand
Increases range of motion and strengthens back of thigh and buttocks
- Stand in front of a sturdy chair that won’t move, with a table in front of you for support, if needed.
- Stand with your feet planted on the floor about hip-distance apart.
- Press your buttocks and hips back first, then bend your knees and slowly lower yourself into a seated position.
- Hold on to the table, if needed, so you don’t fall back into the chair.
- Then tip forward from the hips, push through your feet and up with your legs to a standing position.
- Repeat the sequence three times; gradually build up to more reps.
Tip: It’s important to reach back with your hips firstwhen lowering to a seated position, then bend your knees second. “Bending your knee first puts a lot of pressure into the joint,” explains Shroyer. A cue you’re doing it wrong: if you notice your knees going over your toes as you sit back (instead of staying stable over your ankle and heel), or if you feel a sharp, stabbing pain in your knee joint.
7. Knee Exercise: Bodyweight Squat
Progression from the sit-and-stand to help strengthen thighs and buttocks
- Stand with your feet shoulder-distance apart, or a little wider.
- If needed, hold on to something stable, like the back of sturdy chair or kitchen sink.
- Keep your chest lifted and shift your weight back into your heels while slowly pushing your hips back, as is you were sitting down into a chair.
- Keep your feet flat and lower yourself as far as you’re comfortable (such as a quarter or halfway down to where a chair would be).
- Push through your heels and bring your body back up to standing.
- Repeat the sequence three times.
Tip: Gradually build up to five or 10 reps, says Shroyer: “Strong buttock muscles are essential to support and stabilize the knee.”
