Knee Arthritis – Taking Steps Forward

How To Improve Your Mobility, Strength, and Function

Man with knee arthritis

So you’ve been diagnosed with knee osteoarthritis? Understandably, you’re a little concerned…and questions are running through your mind. Is there any way to get better? Will it keep getting worse? Will you need surgery? Here we’ll provide some answers to your questions and start with a bit of good news: your diagnosis of knee arthritis does not have to be a sentence to a life of pain and disability – ultimately leading to knee replacement surgery. There are steps you can take to improve and this is where you start…

You’re Not Alone

First thing’s first – you should know that knee arthritis is common…really common. 27 million people in the US are diagnosed with arthritis1 – that’s 1 in 5 adults2. And that number is projected to reach 67 million by 20303. More than 50% of people older than 65 years have arthritis on their x-rays4.

Will all of these people need their knees replaced? I hope not.

Millions of people who have arthritis have very little pain, if any. Only about half of adults with knee arthritis are affected in their daily lives5.

So what makes the difference? If only half of people with knee arthritis are affected by it, it’s not necessarily the arthritis that leads to pain and disability – maybe it’s the symptoms associated with it…

Do any of these symptoms sound familiar to you? 6
– Knee pain
– Joint stiffness
– Decreased muscle strength

Pain With Loading?

It’s unfortunate that people with knee arthritis generally spend less time participating in physical activity7. Maybe this is because being on your feet and putting weight through your knee over and over again can lead to painful symptoms.

Did you know your knee needs to absorb up to 1.5x your body weight with every step you take? And 6x your body weight when going down stairs? 8

Therefore, even a little bit of weight loss can go a long way 9. 5 pounds lost equals 30 pounds off your knee every stair you step down.

Don’t let knee arthritis get in the way of your physical activity. One thing I recommend to many of my patients is to ride a stationary bike* for exercise. This allows for great mobility of the knee without putting any weight through your joint. Give it a try.

Feeling Stiff?

Probably the most common complaint I hear from patients with knee arthritis is that their knees feel stiff. This is why it is highly recommended that you perform range-of-motion exercises to improve your knee mobility10.

Another great way to improve mobility in your knee is with manual mobilization from your Physical Therapist11.

To get the most bang for your buck – so to speak – is to focus on strengthening your leg. Several studies have shown that strength training not only increases your strength, but also decreases joint stiffness in people with knee arthritis12,13,14,15.

How’s Your Strength?

To help absorb the load your knee takes, the muscles in your leg need to be strong – especially the big muscles in the front of your thigh – your Quadriceps. These muscles have a protective role in your knee as shock absorbers16.

Quadriceps muscle weakness is a major risk factor for developing knee arthritis17 and a strong predictor of pain and decreased function in people with arthritis18.

On a positive note, Quadriceps strengthening has proven to help reduce pain and improve function in people with knee arthritis 19.

Another important group of muscles in your leg is your hip abductors. Strength here helps with proper mechanics of your knee as you walk20. Hip abductor weakness is common in people with knee arthritis 21. It makes sense, then, to strengthen them.

Exercises For Knee Arthritis

1. Knee Flexion Mobilizations


2. Knee Extensions for Quadriceps Strengthening


3. Clamshells for Hip Abductor Strengthening


Question: What other exercises have you found help improve function with knee arthritis? You can leave a comment by clicking here.

*This stationary bike is one I recommend because I’ve used it myself and have found it to be of good quality and incredible value.  This is an affiliate product, which means that if it is purchased through the link provided, I will receive a small commission.  However, there is no price difference for the purchaser.  Thanks for your support!

  1. Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part II. Arthritis Rheum. 2008;58(1):26–35.  ↩
  2. Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of doctor-diagnosed arthritis and arthritis- attributable activity limitation—United States, 2007–2009. MMWR Morb Mortal Wkly Rep. 2010;59:1261–1265  ↩
  3. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):226–229.  ↩
  4. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;20(1):3–25.  ↩
  5. Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of doctor-diagnosed arthritis and arthritis- attributable activity limitation—United States, 2007–2009. MMWR Morb Mortal Wkly Rep. 2010;59:1261–1265.  ↩
  6. Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. J Orthop Sports Phys Ther. 2004;34:676–685. jospt.2004.1432  ↩
  7. Thomas SG, et al. Physical Activity and its relationship to physical performance in patients with end stage knee Osteoarthritis. JOSPT. 2003;33(12):745–754.  ↩
  8. Andriacchi TP, Andersson GB, Fermier RW, Stern D, Galante JO. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62:749–757.  ↩
  9. Felson DT, Zhang Y. An update on the epidemiol- ogy of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343- 1355. 0131(199808)41:8<1343::AID-ART3>3.0.CO;2–9  ↩
  10. Zhang et al., 2008. OARSI recommendations for the management of hip and knee osteoarthritis. Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16 (2008), pp. 137–162  ↩
  11. Fransen et al., 2001. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. Journal of Rheumatology, 28 (2001), pp. 156–164  ↩
  12. Huang MH, Lin YS, Yang RC, Lee CL. A compari- son of various therapeutic exercises on the func- tional status of patients with knee osteoarthritis. Semin Arthritis Rheum. 2003;32:398–406.  ↩
  13. Bouet V, Gahery Y. Muscular exercise improves knee position sense in humans. Neurosci Lett. 2000;289:143–146  ↩
  14. Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. In- vestigation of clinical e ects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008;88:427–436. http://dx.doi. org/10.2522/ptj.20060300  ↩
  15. Marks R. The e ects of 16 months of angle- specific isometric strengthening exercises in midrange on torque of the knee extensor mus- cles in osteoarthritis of the knee: a case study. J Orthop Sports Phys Ther. 1994;20:103–109.  ↩
  16. Jeerson RJ, Collins JJ, Whittle MW, Radin EL, O’Connor JJ. The role of the quadriceps in controlling impulsive forces around heel strike. Proc Inst Mech Eng H. 1990;204:21–28.  ↩
  17. Jeerson RJ, Collins JJ, Whittle MW, Radin EL, O’Connor JJ. The role of the quadriceps in controlling impulsive forces around heel strike. Proc Inst Mech Eng H. 1990;204:21–28.  ↩
  18. Amin S, Baker K, Niu J, et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum. 2009;60:189–198. http://  ↩
  19. Jenkinson CM, Doherty M, Avery AJ, et al. E ects of dietary intervention and quadri- ceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial. BMJ. 2009;339:b3170.  ↩
  20. Chang A, Hayes K, Dunlop D, et al. Hip abduc- tion moment and protection against medial tibiofemoral osteoarthritis progression. Arthri- tis Rheum. 2005;52:3515–3519. http://dx.doi. org/10.1002/art.21406  ↩
  21. Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoar- thritis. Sports Health. 2012;4:284–292. http://  ↩
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  • P Biz

    Standing Terminal Knee Extensions are always my go-to exercise for building quadracep strength. It’s closed-chain so it is safer on the joint, creates less shear force and maximizes VMO recruitment. I also like low lateral step-ups (as tolerated) to teach better body mechanics while loading the joint since it involves multiple joints and muscles.

    • Michael Curtis

      These are great ideas, thanks!

  • Lianne

    I opted for a brace rather than surgery, and it helped immediately. So, which muscle group needs strengthening to keep my knee aligned side to side? It feels like my knee shifts out, and that causes pain.

    • Michael Curtis

      Lianne, I think the reason the brace helps Is because of this “shifting” or instability of your knee joint you’re describing. The quads are probably the muscle to focus on the most, however, I think you likely need overall leg strength to help support your knee. If you can eventually tolerate squats and even single leg squats to really get your leg strong, I would hope this strength would better support your knee. Of course, though, I’d first recommend seeing a PT in person to get evaluated so they can give you more specific guidance.