What physio exercises are recommended for knee osteoarthritis?

Physiotherapy Exercises for Knee Osteoarthritis

For knee osteoarthritis, a comprehensive exercise program including quadriceps strengthening, aerobic exercise, and range-of-motion exercises is strongly recommended to reduce pain and improve function. 1

Core Exercise Components

Strengthening Exercises

• Quadriceps strengthening - Most important muscle group to target 2, 1

  • Dynamic strengthening exercises are preferred over isometric 2
  • Perform at moderate to vigorous intensity (60-80% of one repetition maximum) 2
  • 8-12 repetitions per exercise 2
  • At least 2 days per week 2

• Specific quadriceps exercises 2:

  1. Quad sets - Lying with legs straight, tighten thigh muscles near kneecap, hold 6-7 seconds, relax 2-3 seconds
  2. Short-arc quad sets - Place firm pillow under knee, straighten leg, hold 6-7 seconds, relax
  3. Long-arc quad sets - Sitting, slowly extend leg until straight, hold 6-7 seconds, lower
  4. Closed-chain exercises - Standing exercises that strengthen entire thigh while maintaining functional position

• Hip strengthening exercises should also be included as they provide similar benefits to knee-specific exercises 3

Aerobic Exercise

• Recommended duration: At least 30 minutes daily, up to 60 minutes for greater benefit 2, 1
• Best options 2, 1:
  • Low-impact activities: walking, cycling, swimming
  • Aquatic exercises (in warm water ~86°F) - particularly beneficial as buoyancy reduces joint loading 2
  • Tai Chi and yoga are emerging as beneficial options 2

Exercise Prescription Parameters

• Frequency: 3-5 sessions per week 4
• Duration: Approximately 1 hour per session 4
• Program length: 8-12 weeks minimum 4
• Supervision: Initial professional instruction is important 2
  • 12+ supervised sessions have been shown to be more effective than fewer sessions 2
  • Long-term, patients should integrate exercises into daily life 2

Implementation Strategy

1. Start with proper education about the nature of OA and importance of exercise 2, 1
2. Begin with supervised sessions to ensure proper technique 2
3. Progress gradually - increase intensity and/or duration over time 2
4. Combine approaches - both strengthening and aerobic exercises provide complementary benefits 2
5. Use adherence strategies - goal-setting, monitoring, and feedback 5

Additional Considerations

• Weight management is crucial for overweight patients - aim for at least 5% weight loss 1
• Appropriate footwear with shock-absorbing insoles may help reduce pain 2, 1
• Avoid high-impact activities that involve rapid loading of the joint 2
• For patients with limited mobility: Even being as physically active as abilities allow provides benefits 2

Common Pitfalls to Avoid

• Inadequate exercise prescription - failing to provide specific instructions on type, intensity, and frequency 1
• Neglecting progression - exercises should increase in difficulty as strength improves 2
• Focusing only on pain relief rather than functional improvement 1
• Abandoning exercise during mild flares - modification rather than cessation is usually appropriate 1

Exercise has been consistently shown to reduce pain (effect sizes 0.29-0.53) and improve function (effect sizes 0.24-0.58) in knee OA 2. When combined with other non-pharmacological approaches like weight management and education, exercise forms the cornerstone of effective knee OA management 1.