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Knee osteoarthritis exercises and physiotherapy

Exercise is one of the main treatments for knee osteoarthritis. Strengthening the thigh and hip muscles and keeping the knee moving can reduce pain and make everyday things like stairs easier. Start gently and build up over weeks. Some mild discomfort is common, as long as it settles by the next day.

What is knee osteoarthritis?

Osteoarthritis is the most common kind of arthritis. In the knee, the cartilage that lines the joint gets thinner and the bone underneath changes. The knee can feel stiff and sore, especially after rest or a long day on your feet.

An X-ray is only part of the picture. A review of the research found that X-ray changes and knee pain often do not match: some people with a lot of change on the scan have little pain, and some with mild changes hurt a lot (Bedson and Croft 2008). NICE advises that in people aged 45 or over, osteoarthritis can usually be diagnosed from the symptoms and an examination, without an X-ray.

Why exercise helps

Stronger thigh and hip muscles help support the knee, and regular movement eases stiffness. NICE in the UK and the international osteoarthritis society OARSI both recommend exercise as a core treatment.

The latest Cochrane review (Lawford 2024) found that exercise probably improves pain and physical function in the short term. But the average benefit in the trials was small, and the authors could not be sure it was big enough to make a clear difference. Sticking with it matters, so choose exercises you can keep up. That is why the program below starts gently.

How to use this program

Pick the stage that matches you today. If you are not sure, start at stage 1. Move up a stage when the current one feels easy and your knee settles well afterwards.

Each exercise page gives a typical starting dose. As a rough guide, many programs use 2 to 3 sets of 8 to 15 repetitions. The lying and sitting exercises can be done most days, while harder strength work such as squats and split squats is often done 2 to 3 days a week so the muscles can recover between sessions. Your physio will adjust the exercises and the numbers to suit you.

Breathe normally through every repetition rather than holding your breath, especially if you have high blood pressure.

NICE also recommends general aerobic activity, and walking, cycling and swimming are common choices. If you carry extra weight, NICE advises that losing weight improves pain and function, and that any amount of weight loss is likely to help.

The exercise program

Stage 1: Get the muscles working

For painful or very stiff knees, and for anyone new to exercise. These are done lying or sitting, so the knee is not carrying body weight yet.

Stage 2: Build strength standing up

When stage 1 feels easy, usually after one to three weeks. These train the knee in standing and work the side of the hip. If your balance is not steady, do the standing ones next to a kitchen counter. For the squat, only go as deep as feels comfortable and controlled, and you can put a chair behind you to touch down on.

Stage 3: Stairs and single-leg strength

When stage 2 feels easy and the knee settles well afterwards. Step ups practice stairs, and the split squat loads one leg at a time. Side lying hip abduction is a harder version of the clamshell. Balance and control work (neuromuscular exercise) is part of programs such as GLA:D, and your physio can add balance exercises that suit you, such as standing on one leg while holding a counter.

What to avoid or change

You do not need to avoid movement, but you may need to change how much you do. Long spells of kneeling, deep squats with heavy weights and sudden jumps in walking distance can flare the knee. Build up in small steps instead.

When to see a physio or doctor

See a physio or doctor if your knee is not improving after 6 to 8 weeks of regular exercise, if pain is stopping you sleeping or doing daily tasks, or if the knee keeps giving way. It is also worth getting help at the start if you are not sure which stage suits you.

Check with your doctor before you start if you have a heart or lung condition, or blood pressure that is not under control. If you have fallen recently or feel unsteady, do the standing exercises next to a kitchen counter. After a knee replacement or other knee surgery, follow the program from your surgical team and physio instead of this one.

For physiotherapists

This page gives patients a starting framework. Most people with knee osteoarthritis do better with a program adjusted to their pain and strength and to what they want to get back to doing. A patient-reported measure such as the KOOS, alongside a performance test from the OARSI recommended set such as the 30-second chair stand test (Dobson 2013), helps show progress over the first 6 to 12 weeks.

See a doctor promptly if

  • The knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
  • You cannot put weight on the leg after a fall or injury. Get medical advice the same day. If the knee has changed shape, swelled up very quickly or you felt a pop or snap, or your foot turns cold, pale or blue or you have tingling or no feeling in the leg or foot, go to an emergency department straight away, and do not drive yourself.
  • The knee locks and you cannot straighten it. Get medical advice the same day.
  • The knee swells up quickly and a lot, with no clear reason. Get medical advice the same day.
  • A calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
  • Pain at night or at rest that keeps getting worse. See your doctor within a few days. If you have had cancer, now or in the past, see your doctor sooner, within a day or two, and mention it, even if the pain is not getting worse. Do the same if you have knee pain and are losing weight without trying, even if it does not hurt at night. If you are being treated for cancer now, contact your cancer team the same day.

Common questions

Is it safe to exercise with knee osteoarthritis?

For most people, yes. NICE and OARSI both recommend exercise as a core treatment. A review of trials found that exercise that loads the knee does not appear to harm the joint cartilage, although the evidence is still limited (Bricca 2019). Start at a level you can manage and build up slowly.

Should exercises hurt?

A little discomfort is common and is usually fine if it settles by the next morning and is not building up from week to week. Sharp pain, or a knee that is more painful or swollen the next day, means the load was too much. Your physio will help you set a limit.

How long before exercise helps?

Give it several weeks. The GLA:D program, for example, runs twice a week for 6 weeks, and people in it reported less pain on average at their 3-month check (Skou and Roos 2017). Strength builds slowly, so doing a little regularly matters more than doing a lot at once.

Do I need equipment?

Very little. Most of these exercises need only a chair, a towel and a step or the bottom stair. Terminal knee extension uses a resistance band.

References

  1. National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. https://www.nice.org.uk/guidance/ng226
  2. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011
  3. Lawford BJ, Hall M, Hinman RS, et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2024;(12):CD004376. doi:10.1002/14651858.CD004376.pub4
  4. Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders. 2017;18:72. doi:10.1186/s12891-017-1439-y
  5. Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. British Journal of Sports Medicine. 2019;53(15):940-947. doi:10.1136/bjsports-2017-098661
  6. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskeletal Disorders. 2008;9:116. doi:10.1186/1471-2474-9-116
  7. Dobson F, Hinman RS, Roos EM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis and Cartilage. 2013;21(8):1042-1052. doi:10.1016/j.joca.2013.05.002

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.