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Exercises for Patients With Knee Osteoarthritis

Robert J. Petrella, MD, PhD


Rest is an important part of the treatment for osteoarthritis, but it must be balanced by regular exercise. Exercise is essential for two reasons: It keeps your joints from becoming stiffer, and it strengthens the muscles surrounding the joints. Strong muscles provide needed support, making movement easier and reducing pain.

This program for patients with knee osteoarthritis consists of five main exercises (figures 1, 2, 4, 5, and 7), along with three alternatives (figures 3, 6, and 8) in case the main exercises are too difficult.

To get the most out of these exercises, you need to gradually increase the number of repetitions and sets over the course of 7 weeks. The accompanying chart (table 1) can be used as a guide as you do the strength exercises. It will be helpful to mark the date when you start each new stage.

Stretching Exercises

Figure 1: Unloading the knee. Put a light weight (5 to 10 pounds) on your ankle and sit in a position that allows the leg to dangle (eg, on a bench, tall stool, edge of bed). Hold for 5 to 15 minutes, 1 to 3 times a day. Repeat for the other knee.

[Figure 1]

Figure 2: Knee extension. Sit in a chair and rest your foot on another chair across from you so that the knee is slightly raised. Gently push the raised knee toward the floor using only leg muscles. Hold the stretch for 5 to 10 seconds, then rest a minute. Repeat 10 times. Do every day up to 3 times a day.

[Figure 2]

Figure 3: Alternative knee extension exercise. Sit on the floor or bed with your legs extended, and place a rolled-up towel underneath your Achilles tendon. Gently push your raised knee toward the floor. Hold the stretch for 5 to 10 seconds, then rest a minute; repeat 10 times. Do every day up to 3 times.

[Figure 3]

Figure 4: Knee flexion. While sitting, loop a long towel underneath your foot. Gently pull on the towel with both hands to bend the knee, raising your foot 4 or 5 inches off the floor. Hold for 5 to 10 seconds, rest a minute, and repeat 10 times. Do with both knees every day, up to 3 times a day.

[Figure 4]

Strength (Resistance) Exercises

Figure 5: Quadriceps setting. While sitting in a chair, straighten your leg and hold. Repeat 5 to 10 times. Do the exercises with both knees, up to 3 times each day.

[Figure 5]

Figure 6: Alternative quadriceps exercise. Lie on a flat, firm surface with legs extended. Then raise one leg 1 foot off the surface and use it to trace a "T" pattern in the air. To start, repeat 5 to 10 times. Do the exercises every day, up to 3 times each day.

[Figure 6]

Figure 7: Wall slide. Leaning with your back against a wall, bend your knees 30°, sliding down the wall, then straighten up again. Move slowly and smoothly. Keep your feet and legs parallel, and center your kneecap over your second toe. Repeat 5 to 10 times, 1 to 3 times a day.

[Figure 7]

Figure 8: Resisted knee extension. If the wall slide exercise (figure 7) is painful, then use a piece of rubber exercise tubing such as Thera Band. Loop the tubing around the bottom of your foot, hold onto the ends while in a sitting position, and bend your knee about 30° (maximum). Straighten your knee against the resistance of the tubing, pushing as hard as is reasonably comfortable. Hold. Do 5 to 10 repetitions, 1 to 3 times per day.

[Figure 8]

Progression of Strengthening Exercises

Week Repeats Sets Weekdays Weekend

1 5-10 1 MWF off

2 10 1 Daily off

3 10 1 Daily Sat or Sun

4* 10 1 Daily Sat or Sun

10 1 MWF Sat or Sun

5 10 2 Daily Sat or Sun

6* 10 2 Daily Sat or Sun

10 1 MWF Sat or Sun

7 10 3 Daily Sat or Sun

*Extra set to be done after a rest period.

Dealing With Soreness

If you have increased soreness after doing these exercises, it may help to ice your knee or knees for 10 to 20 minutes. Place a bag of ice or frozen vegetables over the joint, with a towel between to protect the skin. Other helpful measures include elevating your leg on a chair, and taking acetaminophen before or after exercise if ice alone is inadequate.

If increased soreness or pain lasts for more than 2 hours after exercise, you should cut back to fewer repetitions of the strength exercises; then gradually build up again.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Petrella is medical director of the Centre for Activity and Ageing at the Lawson Research Institute, St Joseph's Health Centre, London, Ontario.