Knee osteoarthritis or a sore kneecap? Exercise is the best-proven treatment, and it's never too late to start.

Start here

Your first 30 days: a checklist

• Keep moving. Gentle activity is good for your knee, even if it aches a bit at first.
• Start simple strengthening exercises for your thigh and hip muscles, 2 to 3 times a week.
• Ask about a physiotherapist or an exercise and education programme for knee osteoarthritis, such as GLA:D.
• Ask your pharmacist whether an anti-inflammatory cream or gel is safe for you.
• Wear comfortable, supportive shoes with cushioned soles.
• If you carry extra weight, ask about support to lose some. Any amount helps your knees.
• Pace your day: spread out harder tasks and take short breaks rather than stopping altogether.
• Learn the warning signs, such as a hot, red, swollen knee with fever.

• Starting exercise safely: a friendly guide for every body: How to start moving more with confidence: whether you need to check with your doctor, how much to aim for, how to build up, warming up, and the warning signs that mean stop. (7 min read)

Understand your knee pain

Osteoarthritis, kneecap pain, and what's happening inside the joint.

• Understanding knee pain: osteoarthritis and kneecap pain: A friendly guide to the two most common causes of long-lasting knee pain: knee osteoarthritis and patellofemoral (kneecap) pain. What they are, how they're diagnosed, and why there's real hope. (6 min read)

Your treatment options

Exercise first, then weight, supports, pain relief, injections and, for some, knee replacement.

• Knee Osteoarthritis: Your Options: keeping your knees moving (video, 4:14)

• Knee osteoarthritis: your treatment options: What really helps knee osteoarthritis: exercise and weight management first, then physiotherapy, walking aids, braces, anti-inflammatory gels, injections, and knee replacement when it's needed. (7 min read)
• Choosing a physiotherapist: what to look for and what to ask: How to find a good physiotherapist (physical therapist) for back, joint or balance problems: checking they're licensed, what a good first visit looks like, signs of quality care, costs and coverage. (6 min read)

Exercises for your knees

Strong thigh and hip muscles take load off a sore knee. Some discomfort is okay; stop if your knee swells or the pain is sharp.

Before you start: Check with your clinician first if you have a new injury, recent surgery, osteoporosis or heart symptoms. Stop if you feel sharp pain, dizziness or chest pain. For chest pain, call 9-1-1.

• Knee Conditioning Program

  Stretches and strengthening for the muscles that support your knee: the front and back of the thigh, hips and calves.

  Knee; level: Beginner; you'll need: Mat and a sturdy chair; video, 8:56

  Based on the AAOS OrthoInfo knee conditioning program

  Printable program (opens AAOS OrthoInfo)

• Strength Training for Beginners

  How to start strength training safely: the main moves, how many sets and reps, and how to build up over time.

  Whole body; level: Beginner; you'll need: A chair; light weights or a band (optional); how often: 2 days a week; video, 6:20

  Follows the WHO and Canadian (CSEP) physical activity guidelines

Living well

Everyday tips, staying active, and handling flares.

• What Exercise Does for Your Body: and how much you really need (video, 4:38)

• Living well with knee pain: everyday tips that make a difference: Practical ideas for daily life with knee osteoarthritis or kneecap pain: pacing, stairs, getting up from chairs, shoes, staying active, managing flares and keeping your weight on track. (6 min read)
• Pain during exercise: how much is okay? The traffic light guide: Hurt doesn't always mean harm. Learn the pain-monitoring 'traffic light' that physiotherapists use, so you know when to keep going, when to ease back, and when to get checked. (6 min read)
• Strength training basics: getting stronger at any age: A beginner's guide to strength training for adults of any age: why it matters, how often, how many sets and repetitions, choosing the right effort, good form, progressing safely, and simple exercises to start with. (7 min read)

When to get help

Get emergency help now

• A knee that is red, hot and swollen, with a fever or chills, or you feel very unwell. Go to an emergency department now: this can be a joint infection
• A bad injury where the knee or leg looks bent or out of shape, or bone is showing
• A painful, swollen calf or leg together with chest pain or sudden shortness of breath
• After knee surgery or an injection: fever, spreading redness, or pain and swelling that is getting much worse

Call 9-1-1 or go to the nearest emergency department. Don't drive yourself.

Call your doctor or physio soon

• A painful, swollen, warm or red calf, even without chest symptoms
• Your knee swelled up quickly (within a few hours) after a twist or injury
• You can't put weight on your leg, or can't straighten your knee fully
• Your knee keeps locking (getting stuck) or giving way
• A hot, swollen knee without a fever
• Pain at night or at rest that is getting worse, or you're losing weight without trying
• Pain that hasn't improved after 6 to 12 weeks of exercise and self-care
• Side effects from pain medicines, such as stomach pain, black stools or swelling of your legs

A hot, red, swollen joint with fever needs to be seen the same day, ideally in an emergency department, because joint infections can damage a joint quickly. If you have leg swelling with chest pain or trouble breathing, call 9-1-1 or your local emergency number right away. For the second list, call your doctor, clinic or physiotherapist soon. If you can't reach anyone and you're worried, go to an urgent care centre or emergency department.

Questions to ask your team

1. What do you think is causing my knee pain?
2. Do I need an X-ray? Why or why not?
3. What exercises are best for me, and how often should I do them?
4. Can you refer me to a physiotherapist or a knee exercise programme?
5. What should I do if my knee flares up?
6. Which signs mean I should come back sooner?

From our guide Understanding knee pain: osteoarthritis and kneecap pain.

Go deeper

Written for clinicians and students. More technical material from Hibbert Medical, for readers who want more detail.

Podcast summaries

• Rehabilitation podcasts: Rehab specialists and physiotherapists on exercise, pain and recovery.
• Orthopaedic podcasts: Orthopaedic surgeons on joints, injuries and joint replacement.
• Sports medicine podcasts: Sports medicine clinicians on injuries, tendons and getting back to activity.
• Exercise science podcasts: What the evidence says about activity, strength and training.

Lectures

• Knee Pain: Evaluation, Imaging and Non-Operative Management: Residency family medicine: working out the cause of knee pain, and treating it without surgery.
• Knee Osteoarthritis: Comprehensive Physiatric Management: Residency rehab medicine: exercise, braces, injections and more for knee osteoarthritis.
• Osteoarthritis: Evidence-Based Management: Residency rheumatology: exercise, weight, medicines and surgery for osteoarthritis.
• Joint Injections: Knee, Hip and Shoulder: Residency pain medicine: when joint injections are used, and what they can and can't do.
• Total Knee Arthroplasty: Residency orthopaedics: how knee replacement is planned and done.
• Lower Limb: Leg and Knee: Medical school anatomy: the knee joint and the muscles around it.

Seminars

• Musculoskeletal Conditions: Clerkship seminar: back pain, knee pain and other common joint problems in family practice.
• Rheumatic Diseases: Clerkship seminar: arthritis and other joint diseases.
• Musculoskeletal Imaging: Clerkship seminar: what X-rays and MRI can and can't show in joints and bones.

Clinical cases

• Knee Osteoarthritis: Knee osteoarthritis in family practice: exercise first.
• Primary Knee Osteoarthritis with Varus Deformity: How osteoarthritis changes the knee over time.
• Joint Injection: Knee Osteoarthritis: What happens during a knee injection.
• Septic Arthritis of the Knee: Why a hot, swollen joint with fever is an emergency.

Common questions

What is knee osteoarthritis?

Osteoarthritis is the most common type of arthritis. In the knee, the smooth cartilage that covers the ends of the bones gets thinner and rougher, and the bone, joint lining and nearby muscles change too. It can cause pain, stiffness and swelling. It is not just 'wear and tear', and it doesn't always get worse. Many people's symptoms stay the same or improve, especially with exercise.

Will exercise wear out my knee faster?

No. Exercise is the most recommended treatment for knee osteoarthritis. Strong muscles help support and protect the joint, and movement helps keep cartilage healthy. Your knee may ache a bit more when you start, which is normal. It usually settles as you get stronger.

Do I need an X-ray?

Often not. Doctors can usually diagnose knee osteoarthritis from your age and symptoms, such as activity-related knee pain with little or short morning stiffness, in people aged 45 and over. X-rays don't match symptoms well: some people with big X-ray changes have little pain, and the other way around. An X-ray may be useful if your symptoms are unusual or you are being considered for surgery.

Do injections help?

A steroid injection can ease pain for a few weeks, which can help you get going with exercise. Guidelines don't recommend hyaluronic acid ('gel') injections, and there isn't strong enough evidence for platelet-rich plasma (PRP) or stem cell injections to recommend them. Ask your doctor about the benefits, risks and costs before choosing any injection.

When should I think about a knee replacement?

Knee replacement can be a very good option when knee pain, stiffness or loss of function is badly affecting your life and other treatments haven't helped enough. There is no 'right' age or X-ray score. It's a personal decision made with a surgeon. Exercise before and after surgery helps recovery.

Sources for this page

1. NICE NG226: Osteoarthritis in over 16s: diagnosis and management
2. Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
3. Kolasinski SL, et al. 2019 ACR/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020
4. Fransen M, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015
5. AAOS OrthoInfo: Arthritis of the knee
6. Arthritis Society Canada: Osteoarthritis
7. NHS: Osteoarthritis