Knee Pain Doesn't Always Mean You Should Stop Exercising

Knee pain can be worrying.

Perhaps you've been told you have "wear and tear", or you've had an X-ray showing osteoarthritis. It's understandable to think that exercise might make the problem worse.

But avoiding movement altogether is often not the answer.

The knee is designed to move

Osteoarthritis is a condition involving the whole joint, rather than simply a piece of cartilage wearing away.

Symptoms can include pain, stiffness and reduced function.

But having osteoarthritis does not automatically mean you should stop being active.

In fact, exercise is one of the key treatments recommended by NICE for osteoarthritis.

NICE recommends tailored therapeutic exercise for people with osteoarthritis, including muscle strengthening and general aerobic fitness. (Nice)

"But exercise hurts!"

This is where things become more individual.

Some people experience an increase in discomfort when they first begin exercising. NICE specifically notes that joint pain can increase when therapeutic exercise is started, while regular and consistent exercise can provide longer-term benefits in pain, function and quality of life. (Nice)

That doesn't mean you should simply ignore severe pain.

Instead, exercise needs to be appropriately dosed.

A sports therapist or suitably qualified exercise professional can help determine:

• Which movements are appropriate

• How much resistance to use

• How frequently to train

• How much discomfort is acceptable

• How to progress

• When to reduce the training load

Strengthening the muscles around the knee

The muscles surrounding your hip, thigh and lower leg help you produce and control movement.

Exercises might include:

• Sit-to-stands

• Squats

• Step-ups

• Leg presses

• Hamstring exercises

• Calf raises

• Hip strengthening

The exact exercises should depend on your symptoms, abilities and goals.

Someone wanting to walk a mountain trail will require a different programme from someone whose main goal is getting around the supermarket comfortably.

Exercise can be part of the solution

It's tempting to think:

"My knee hurts, therefore I need to rest it."

A better question may be:

"What type and amount of movement can my knee tolerate and benefit from?"

Research and clinical guidelines increasingly support exercise as an important part of managing osteoarthritis rather than something that should automatically be avoided. (Nice)

If knee pain is new, severe, worsening or associated with significant swelling, instability or other concerning symptoms, appropriate medical assessment is important.

But for many people, carefully designed exercise can be a way of managing knee problems while rebuilding confidence and physical capacity.

References

1. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. NICE recommends tailored therapeutic exercise for everyone with osteoarthritis. NICE NG226 recommendations

2. NICE. Rationale and impact: Therapeutic exercise. The NICE committee concluded that exercise provides clinically important benefits for people with osteoarthritis and can reduce symptoms while maintaining or improving function. 

3. NICE. Evidence review: Clinical and cost effectiveness of exercise for the management of osteoarthritis. 

4. World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. 2020. WHO Guidelines