If you have been told you have arthritis in your knee, there is a fair chance you have also been told to take it easy. Avoid stairs. Stop the walks. Wait for the joint replacement. It is well meant advice and it is wrong. Every major guideline for knee osteoarthritis now lists exercise, and specifically strength training, as the first line treatment, ahead of injections and surgery.
What arthritis is, and what it is not
Osteoarthritis is a change in the joint over time: cartilage thins, the bone underneath adapts and the joint can look rough on an X-ray. What it is not is a joint that is “wearing out” like a tyre. Cartilage responds to load. Joints that are moved and loaded sensibly stay healthier than joints that are rested, and the pain you feel maps poorly to what the scan shows. Plenty of people with dramatic X-rays have little pain, and plenty with tidy X-rays hurt a lot.
The strongest predictor of how a knee with arthritis feels and functions is not the picture. It is the strength of the muscles around it.
Why rest makes it worse
When a knee hurts, the natural response is to use it less. Fewer stairs, shorter walks, the low chair avoided. Within a few weeks the quads, glutes and calves lose strength, and those are the muscles that absorb load before it reaches the joint surface. The same stairs now put more stress through the joint, the knee hurts more, and you rest more. It is a spiral and it is very common.
Rest also costs you the things arthritis was never going to take: fitness, balance, weight control and confidence. Those matter far more for how the next ten years go than the state of the cartilage.
What the research says
- OARSI, the American College of Rheumatology and the RACGP all list land based exercise and education as core treatment for knee osteoarthritis, recommended for every patient regardless of severity.
- Structured strength and education programs show meaningful reductions in pain and improvements in function, with many participants deferring or avoiding joint replacement altogether.
- Exercise performs at least as well as anti-inflammatory medication for pain in knee osteoarthritis, without the side effects.
- Being stronger before a knee replacement predicts a better recovery after one, so even if surgery is eventually the right call, the strength work is not wasted.
Which strength?
Three muscle groups do most of the work of protecting a knee.
Quads. The front of the thigh controls how you lower yourself: down stairs, into a chair, out of the car. Weak quads are the most common finding in painful arthritic knees. Sit to stand, step downs and leg press are the staples.
Glutes. The hip muscles control where the knee points. When they are weak the knee drifts inward under load and the inside of the joint takes the strain. Bridges, hip abduction and split squats.
Calves. Often forgotten, but the calf absorbs the first part of every step. Calf raises, progressed to single leg and then loaded.
The key word is progressive. A program that stays the same for three months stops working. Load goes up as the knee tolerates it, and that is where having someone measure and adjust it makes the difference.
Will it hurt?
Some discomfort during and after strength work is normal and safe with arthritis. The rule we use is simple: pain up to about a four out of ten during exercise is acceptable if it settles by the next morning. If it does not, the load was too much and we adjust. Flare ups happen and they are not damage. What we are avoiding is the all or nothing pattern where a bad day leads to a bad month on the couch.
Something you can try today
Stand in front of a firm chair. Sit down slowly, taking three seconds to lower, then stand up without using your hands. Do eight to ten, twice a day. If that is easy, hold a bag of shopping. If it is hard, use a higher chair or put a cushion on the seat. That is a quad program in its simplest form, and it is where most of our knee arthritis clients start.
How we do it in Epping
Every knee plan at Integral Movement starts with measurement: force plates to see how each leg loads, single leg strength testing and a stairs test. From there we build a progressive program for the clinic and home, and we retest at six weeks so the numbers, not the calendar, decide what comes next. You see the same Accredited Exercise Physiologist from start to finish.
With a GP Chronic Disease Management plan Medicare rebates up to five allied health visits a year. We are a registered NDIS provider and bill DVA, WorkCover and TAC directly. Private clients pay on the day and can claim extras cover.
Ready to get started?
Book a 30 minute knee assessment ($79, normally $165), read more about how we treat osteoarthritis, or call 03 7047 6261. Unit 11, 58 Willandra Drive, Epping. Free parking at the door.
