October 14, 2021/Orthopaedics

The Best Exercises for Osteoarthritis (OA) of the Knee

Work on building strength and flexibility to keep the joints moving

woman with osteoarthritis biking for exercise

There’s an inevitability when it comes to osteoarthritis claiming residence within your knees. The wear-and-tear of daily life simply chews away at the shock-absorbing cartilage in your joints over the years.

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Even the toughest body parts eventually wear out, it seems. That’s just a reality.

But a bit of knee creakiness doesn’t mean that you should buy a recliner and kick your legs up, says physical therapist Kari Orlandi, DPT. Think the opposite, in fact, and keep your body moving.

“Inactivity makes knee osteoarthritis worse,” says Dr. Orlandi. “As soon as you stop moving, the joint becomes stiffer and stiffer. Think of it like this: Motion is lotion.”

The key, though, is to apply that “lotion” in a smart way. Here’s how.

What causes osteoarthritis (OA) in the knee?

Before looking at how to manage osteoarthritis in the knee, it’s a good idea to understand how that pain started in the first place with a little anatomy 101.

Rubbery and flexible connective tissue known as articular cartilage covers and sits between bones that meet in your knee. The slippery tissue cushions the joint, serving like a shock absorber as you walk, run, jump and otherwise move around the world.

That cartilage takes a beating, though, and small tears naturally develop as the malleable material grows more rigid over time. The articular cartilage in your knee eventually starts to flatten and stiffen like an old chair pad.

And when that cartilage stops absorbing the shock… well, you notice. (Ouch!)

Factors that lead to osteoarthritis in your knee include:

  • Aging. (Father Time strikes again.)
  • Injury, which can lead to early deterioration.
  • Excess weight that puts added strain on your knees. “For every 3 lbs. of weight you have, you put 10 lbs. of pressure on your joints,” notes Dr. Orlandi.
  • Genetics.

Symptoms of knee osteoarthritis

Osteoarthritis in the knee often introduces itself to you in four basic ways, says Dr. Orlandi. Those symptoms are:

  • Pain, which can vary in intensity from dull to sharp. It’ll often spike with more rigorous activity and ease with rest, ice and anti-inflammatory medications.
  • Stiffness in the joint, particularly after you’ve been sitting or lying down for longer periods. (Those first achy steps after getting up in the morning, for instance.)
  • Loss of flexibility and range of motion.
  • Swelling and a warm, burning sensation — usually a sign of more advanced arthritis.

Making a fitness plan with OA

First, some bad news: You’re not going to exercise arthritis out of your knee.

“There’s no amount of physical therapy that can change the arthritis,” notes Dr. Orlandi. “But what we can do is make its impact a lot less. The idea is to change the environment in which the arthritis lives in your body.”

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That starts with establishing a lifetime fitness routine that builds cardio, strength and flexibility. “The human body is awesome in its ability to adapt,” says Dr. Orlandi. “So even if you have a lot of arthritis that is painful, you can make a huge impact on how you feel.”

Aerobic exercises for knee osteoarthritis

The goal here is to get active to boost your heart rate — and to do so smartly. Listen to your body and adjust the intensity of your cardio activities in response to knee aches and pains, says Dr. Orlandi.

Ideal cardio fitness routines could include:

  • Walking. Track your steps using a fitness app or device to add motivation to your journey, suggests Dr. Orlandi. Invest in a good pair of walking shoes, too, in order to properly support your feet.
  • Swimming. Swimming decreases the stress placed on your knees. If you don’t want to swim, that’s fine, too. Just walking through chest-high water can give you a good workout. “You don’t have to be a fish,” says Dr. Orlandi.
  • Cycling. Regular bike or stationary bike, it doesn’t matter. Just pedal away knowing that you’re getting in a good workout while limiting stress on your knees.
  • Gym equipment. Ellipticals, rowing machines and other get-you-sweaty devices can offer solid workouts while lightening the load on weight-bearing joints.

Strength exercises for knee osteoarthritis

Aging doesn’t just cost you articular cartilage flexibility. It also takes a toll on your muscles, too — and that can lead to knee instability.

Sarcopenia is the natural loss of muscle mass that comes with age. The process typically starts around age 30. On average, adults lose 3% to 5% of their muscle strength every decade after that birthday.

A strength program targeting your lower body helps limit the decline in muscles supporting your knee. “Think of those muscles as load-sharing cables,” says Dr. Orlandi. “They work to limit stress and pressure on the joint.”

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Workout equipment offers numerous ways to build strength through exercises such as leg presses, hamstring curls and quad extensions.

If you don’t have equipment or a gym membership, no worries! Try these simple exercises:

  • Bodyweight squats. Stand with your feet shoulder-width apart, with your feet turned out slightly. Keeping your heels on the ground, bend your knees while dropping your butt and lowering your body. (Make sure to keep your weight on your heels instead of your toes.) Pause before returning to standing. Repeat.
  • Stair stepping. If you have stairs in your home, tackle those flights a few times a day. Stepping up and down off of a stool or block also is an option if you’re living in a one-floor residence.
  • Leg extensions. Sit on the edge of your bed or a chair and alternate kicking out your left and right legs.

Stretching exercises for knee osteoarthritis

Stretching can help minimize the loss of flexibility in and around your knee. “You want to make sure you’re stretching your hamstrings, quads, calves and hip flexors to help address any stiffness you might feel,” says Dr. Orlandi.

Examples include:

  • Hamstring stretch. Stand in front of a chair or steps. Place your right foot on the chair or step, with your heel on the surface and toes pointed up. Slowly bend forward at the waist, keeping your back as straight as possible. (No hunching!) You should feel the stretch in the back of your thigh. Hold for a few at least 10 seconds before returning to standing. Alternate feet and repeat 5-10 times.
  • Quad stretch. While standing, bend your left leg back, bringing your heel toward your butt. Grab your foot with your left hand and hold. Try to bring your left thigh back until it’s even with your right thigh. Hold for at least 10 seconds. Alternate legs and repeat 5-10 times. (Tip: Use a chair or wall to help with balance.)
  • Calf raises. Stand on a step with your heels hanging over the edge. (Use the stair railing or a wall for balance.) Rise up on your toes and then slowly drop your heels down until they’re below the level of the step. Hold for at least 10 seconds. Repeat 10 times.

Give yoga a try, too, to keep your joints and muscles in tip-top shape. (Learn some poses recommended by a certified yoga instructor to work your hips.)

Should you avoid certain exercises with OA?

Nothing is off-limits until your body says so, advises Dr. Orlandi: “Don’t approach your fitness routine with the idea that you just can’t do something,” she says. “Instead, look at moderation and modification.”

So if you’ve been a runner for years, osteoarthritis doesn’t mean you have to toss away your running shoes. Instead, consider scaling back mileage or intensity to ease strain on your knees. Try other activities, too, to work different muscles.

Just listen to your body and adjust accordingly, says Dr. Orlandi. And the most important thing? Don’t use osteoarthritis as an excuse to stop exercising and working your knees and surrounding muscles.

If you have pain that lasts a few days after a workout, it’s certainly OK to back off a little. But don’t take it as a message to stop.

“Giving up and throwing your hands in the air isn’t the answer for osteoarthritis,” says Dr. Orlandi. “Build exercise and movement into your lifestyle. You’ll be better off for it.”

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