Balance Exercises for Patients with Early Knee Osteoarthritis
Balance exercises are conditionally recommended for patients with early knee osteoarthritis to improve stability, control body position, and potentially reduce fall risk. 1
Types of Recommended Balance Exercises
- Tai Chi is strongly recommended as it combines meditation with slow, gentle movements that improve balance, strength, and fall prevention while also addressing depression and self-efficacy 1
- Exercises that improve control and stabilization of body position are specifically recommended by the American Physical Therapy Association for patients with knee OA 1
- Closed-chain, short-arc knee extension exercises help strengthen the entire thigh muscle while improving balance and stability 1
- Strength training of muscles around the knee, particularly the quadriceps, has been shown to significantly improve balance outcomes with a standardized mean difference of 0.3346 (95% CI: 0.3207-0.60) 2
- Yoga is conditionally recommended for knee OA and may help with balance through a blend of physical postures and psychosocial factors 1
Specific Balance Exercise Protocol
Home-based exercises to improve knee extensor strength:
- Quad sets (lying with legs straight)
- Short-arc quad sets (with pillow under knee)
- Long-arc quad sets (sitting)
- Gluteal squeezes (sitting)
- Closed-chain, short-arc knee extension (standing) 1
Exercise frequency and intensity:
- Perform each exercise 5-7 times
- Repeat 3-5 times daily (before getting out of bed, before climbing stairs, before sleep)
- Hold each position for 6-7 seconds, then slowly relax
- Rest 2-3 seconds between repetitions 1
Implementation Considerations
- Supervised sessions are more effective than unsupervised home exercises, particularly when led by physical therapists 1, 3
- Exercise programs should be performed at least 2-3 times weekly for optimal benefit 3, 4
- Program duration of 8-12 weeks shows significant improvements in pain, function, and balance 4
- Aquatic exercises in warm water (86°F) can provide additional pain relief while allowing balance work with reduced joint loading 1, 4
- Progression should be gradual, starting with exercises within the patient's capability and increasing intensity over several months 3
Additional Beneficial Approaches
- Combine balance exercises with weight loss if the patient is overweight, as a 5% reduction in body weight can lead to clinical improvements 1, 3
- Self-efficacy and self-management programs can enhance the effectiveness of exercise interventions 1, 3
- Aerobic exercises like walking, stationary cycling, or low-impact aerobics should complement balance training, showing a significant effect on balance (standardized mean difference = 0.6880,95% CI: 0.5704-1.302) 3, 2
Important Caveats
- The quality of evidence for balance exercises is considered low, resulting in only a conditional recommendation rather than a strong one 1
- While balance exercises are expected to reduce fall risk in OA patients, randomized controlled trials have not yet specifically addressed this outcome in the OA population 1
- Exercise should be approached with common sense and shared decision-making between clinician and patient, especially when pain is present 1
- Patients should never hold their breath during any of these exercises 1
- A proper manual with instructions can make home exercises beneficial even without constant supervision 5