Recommended Physiotherapy Exercises for Early Knee Osteoarthritis
For patients with early osteoarthritis of the knee, a comprehensive exercise program should include low-impact aerobic exercises, quadriceps strengthening, range-of-motion exercises, and balance training, performed regularly under supervision when possible. 1, 2
Core Exercise Components
Aerobic Exercises
- Participate in low-impact aerobic exercises for 30-60 minutes most days of the week 2
- Choose from walking, cycling, swimming, or aquatic exercises 1
- Aquatic exercises in warm water (86°F) provide additional pain relief through buoyancy that reduces joint loading 1, 2
- Aerobic exercises have demonstrated significant effects on pain relief (effect size 0.52) and disability reduction (effect size 0.46) 1, 2
Strengthening Exercises
- Focus on quadriceps strengthening as a primary component of the exercise program 1, 2
- Perform the following home-based quadriceps strengthening exercises 5-7 times, 3-5 times daily 1:
- Quad sets: While lying with legs straight, squeeze the muscles on top of thigh; hold for 6-7 seconds, then relax; rest 2-3 seconds between repetitions 1
- Short-arc quad sets: Place a firm pillow under the knee; slowly lift foot and straighten leg; hold for 6-7 seconds, then relax 1
- Long-arc quad sets: While sitting, slowly extend leg until straight; hold for 6-7 seconds, then slowly bend knee to 30 degrees 1
- Gluteal squeezes: Tighten buttocks muscles; hold for 6-7 seconds, then relax 1
- Closed-chain knee extensions: While standing with back straight, slowly bend knees to 30 degrees, then push back up 1
Range-of-Motion/Flexibility Exercises
- Include gentle stretching exercises to address joint stiffness and limited motion 1, 2
- Perform range-of-motion exercises daily to maintain or improve joint mobility 1
- Focus on gentle stretching of muscles around the knee joint 2
Balance Exercises
- Include exercises that improve ability to control and stabilize body position 1
- Balance training can complement other exercise components, especially for older adults 2
Implementation Strategy
Exercise Frequency and Intensity
- Exercise at least 3 times per week for maximum benefit 2, 3
- Start with exercises within your capability and gradually increase intensity over several months 2
- Aim for moderate-intensity exercise (approximately 70% of maximal heart rate) 1
- For strengthening exercises, perform 8-12 repetitions at moderate to vigorous intensity 2, 3
Supervision and Setting
- Supervised exercise programs are more effective than self-directed programs 1, 2
- Aim for at least 12 supervised sessions for optimal results 2
- Consider physical therapist guidance initially to ensure proper form and technique 2
- Exercise programs can be performed in group settings or individually 1
Additional Therapeutic Approaches
Weight Management
- If overweight (BMI >25), aim for a minimum 5% reduction in body weight 1
- Combine dietary modification with exercise for optimal results in weight loss and improved function 1, 2
- Greater weight loss (10-20%) provides additional benefits for symptom relief 1
Self-Management Programs
- Participate in self-efficacy and self-management programs 1
- These programs help with goal-setting, problem-solving, and positive thinking strategies 1, 2
Special Considerations
Pain Management During Exercise
- Exercise is beneficial even for patients who are experiencing pain 1
- There is no specific pain threshold at which exercise should be avoided 1
- Use common sense and shared decision-making with your healthcare provider 1
- Modify exercises if they significantly exacerbate pain 2