Knee osteoarthritis is one of the most common causes of knee pain in Australia, particularly as we get older. It can make walking, stairs, gardening and getting up from a chair harder, and many people worry that exercise will wear the joint out faster.
Research tells a different story. Australian clinical guidelines recommend exercise as a core, first line treatment for knee osteoarthritis, alongside education and weight management where relevant. Here is what the evidence suggests and how to get started safely.
What is knee osteoarthritis?
Osteoarthritis is a condition affecting the whole joint, including cartilage, bone, ligaments and the surrounding muscles. It is no longer thought of simply as wear and tear. The joint is constantly responding to load, and changes develop over time through a mix of age, genetics, previous injury, body weight and activity levels.
Common symptoms include pain with activity, stiffness after rest or first thing in the morning, swelling, reduced range of movement and sometimes a grinding feeling. Importantly, the amount of change seen on an X-ray does not always match how much pain someone feels.
What does the research say about exercise?
A large body of research suggests that regular exercise may reduce pain and improve function in people with knee osteoarthritis. The benefits seen are often comparable to those reported for common pain medicines, without the same side effects.
Exercise may help by strengthening the muscles that support the knee, improving joint nutrition, building confidence in movement and supporting overall health. Australian guidance also notes that arthroscopic (keyhole) surgery is not recommended for knee osteoarthritis, which places even more emphasis on active, conservative care.
What types of exercise may help?
There is no single right exercise. The most helpful program is one that suits your goals and that you can keep doing. Options include:
Strength training: exercises for the quadriceps, hamstrings, hips and calves, such as sit to stands, step ups, bridges and leg press.
Aerobic exercise: walking, cycling, swimming or water-based exercise to improve fitness and general health.
Neuromuscular and balance training: exercises that improve control, alignment and confidence during everyday tasks.
Mobility work: gentle movement to maintain or improve knee bend and straightening.
A physiotherapist can assess your knee, strength and movement and design a progressive program. Our mobility, strength and movement therapy focuses on building capacity at a pace that suits you.
Is some pain during exercise okay?
This is one of the most common worries. For many people, mild discomfort during exercise is acceptable and does not mean the joint is being damaged. A common guide is that pain during exercise should stay at a level you find manageable and settle back to your usual level within 24 hours.
If pain or swelling flares and lingers beyond that, the program usually needs adjusting rather than stopping altogether. Changing the exercise, reducing the load or adjusting the number of repetitions often helps.
How do you get started safely?
Start with something manageable and build gradually. Two to three strength sessions a week, along with regular walking or another aerobic activity you enjoy, is a common starting point. Water-based exercise can be a gentle option if land-based exercise feels too provocative at first.
Keeping a simple record of your exercises and how your knee responds over the next day can help you and your clinician adjust the plan. Consistency over months matters more than any single session.
It also helps to choose activities that fit your lifestyle. Some people enjoy a structured gym program, while others prefer walking along the beach, cycling or a supervised class. Research suggests the programs that help most are the ones people actually stick with, so enjoyment and convenience are worth considering.
What else can help alongside exercise?
Exercise works well as part of a broader plan. Other approaches that may help include:
Education about osteoarthritis and how to manage flare ups
Weight management if relevant, as even modest weight loss may reduce knee load and pain
Hands-on care, such as soft tissue work or joint mobilisation, to ease pain short term and support exercise
Supportive footwear and pacing of daily activities
Discussing medicines with your GP or pharmacist
You can read more about our approach to arthritis and joint pain and knee pain management. For long-standing pain affecting sleep and mood, chronic pain management may also be useful.
When should you see a doctor?
Most knee osteoarthritis can be managed with conservative care, but see your GP promptly or seek urgent care if you notice:
A hot, red, swollen knee, especially with fever or feeling unwell
Being unable to bear weight after a fall or injury
The knee locking so you cannot straighten it
A swollen, hot or painful calf
Rapidly worsening pain or deformity
How can you manage a flare up?
Most people with knee osteoarthritis have times when pain and stiffness increase for a few days, often after a busy weekend, a long walk or a change in routine. A flare up is common and does not usually mean the joint has been damaged.
- Reduce, rather than stop, your activity and keep the knee gently moving
- Swap higher load exercises for easier versions, such as a shorter walk or cycling instead of stairs
- Try heat or ice, whichever you find more comfortable
- Spread demanding tasks across the day or week
- Gradually build back to your usual program as symptoms settle
If flare ups are becoming more frequent, it may be a sign your plan needs reviewing.
Should you look beyond the knee?
Strength and control at the hip and ankle can influence how load passes through the knee. Weak hip muscles, for example, may change how the knee moves during walking and stairs. Many exercise programs for knee osteoarthritis include hip strengthening for this reason, and it is worth mentioning any hip pain or ankle problems at your appointment. If it is your first visit, our new client information page explains what to bring.
Frequently asked questions
Will exercise make my arthritis worse?
Research suggests that appropriate, well-progressed exercise does not speed up knee osteoarthritis and may help reduce pain and improve function. Starting at the right level and building gradually is the key.
How long before exercise helps?
Many people start noticing changes after six to eight weeks of consistent exercise, although this varies. Ongoing benefit generally depends on keeping exercise as part of your routine.
Can I use a Medicare plan for knee osteoarthritis?
If you have a chronic condition, your GP may be able to set up a Chronic Condition Management plan, which provides a Medicare rebate for a limited number of allied health visits per calendar year. Speak with your GP about eligibility.
Getting help on the Gold Coast
If knee osteoarthritis is limiting how you move, The Good Joint in Mermaid Beach can help you build a practical exercise plan, with appointments from 7:15am Monday to Friday and on-the-spot HICAPS claiming. You can book online or call 07 5651 6594.
Related reading: What is runner's knee and how do you treat it? and Is clinical Pilates good for back pain?
