Knee osteoarthritis
My knee is stiff and achy. Is it arthritis, and can exercise help?
The most common joint condition in adults. Exercise and education are the core, first-line treatments in every major guideline.
What it feels like
Activity-related knee pain, short-lived morning stiffness, stiffness after sitting, and sometimes swelling, grinding or a feeling of the knee being less steady. It typically affects people over 45 and tends to fluctuate, with better and worse periods.
What is actually happening
Osteoarthritis is a change in the whole joint, including cartilage, bone and surrounding tissues. It is not simply wear and tear, and changes seen on imaging often do not match how much a knee hurts. The joint responds to loading, which is why strengthening and activity help rather than harm.
When to see a doctor
See a doctor promptly if the knee becomes hot, red and very swollen, especially with a fever or feeling unwell, if you cannot put weight on the leg, or if the knee locks or gives way after a fall or a twist. These need checking for infection, gout or an injury that needs medical care.
How it is assessed
Assessment covers your symptoms and goals, knee range of motion, strength around the hip and knee, walking and functional tasks such as stairs and sit-to-stand, and other factors that affect the knee, such as activity levels and previous injuries.
How it is treated
International guidelines from OARSI and NICE recommend exercise, including strengthening and general aerobic activity, together with education and, where relevant, weight management, as core treatments for everyone with knee osteoarthritis. A Cochrane review found high-quality evidence that land-based exercise reduces knee pain, and moderate-quality evidence that it improves physical function. Treatment is a progressive strengthening programme, a plan to stay active, and practical advice on pacing, footwear and walking aids if needed. If symptoms remain severe despite this, referral to a physician or orthopaedic surgeon may be discussed.
What to do first
Stay active, choose activities that are comfortable such as walking, cycling or swimming, and start simple strengthening such as sit-to-stands. Some discomfort during exercise is acceptable if it settles within a day.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- The Runner's Academy St. Clair West · Mon/Wed/Fri · 3:00 PM – 6:30 PM Book at Runner's Academy
References
This page is based on the following clinical practice guidelines and research.
- Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589.
- Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1(1):CD004376.
- National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022.