Knee Osteoarthritis: Physiotherapy Strengthening Exercises Guide

Updated October 2026

Osteoarthritis is the most common form of arthritis, and the knee is one of the joints it affects most. If you live with knee osteoarthritis (OA), you’ll know how stiffness and pain can make walking, stairs or getting out of a chair harder than they should be.

Exercise is one of the most effective treatments available. International guidelines recommend exercise and education as first-line care for every person with knee OA, whatever their age or X-ray findings. This guide covers why strengthening works, seven exercises to start with, how much pain is acceptable, which activities to modify, and how our knee physiotherapy team in Guelph can help.

Why Strengthening Exercises Help Knee Osteoarthritis

Osteoarthritis involves the whole joint: cartilage, bone, the joint lining and the muscles around it. Strengthening doesn’t regrow cartilage, but it helps in several ways:

• Stronger quadriceps absorb load. The thigh muscles act as the knee’s main shock absorbers. Weakness in them is common in knee OA and is linked to more pain.
• Stronger hips improve alignment. Hip muscles control how your knee tracks when you walk, climb stairs and stand on one leg.
• Movement nourishes cartilage. Cartilage has no blood supply; loading and unloading the joint helps move fluid and nutrients through it.
• Pain becomes less sensitive. Regular exercise reduces pain over time, partly through changes in how the nervous system processes pain signals.

A Cochrane review of 54 trials found that land-based exercise reduces knee OA pain and improves physical function, with benefits comparable to those of common pain medications. You can read more about the wider picture in our guide to managing arthritis symptoms with physiotherapy.

7 Knee Osteoarthritis Exercises to Start With

Do these 2 to 3 times a week on non-consecutive days. Start at the lower number of repetitions, move slowly, and progress gradually. Warm up first with 5 to 10 minutes of walking or an exercise bike.

1. Quad sets. Sit with your leg straight and a small rolled towel under your knee. Tighten the muscle on the front of your thigh to press the knee down into the towel. Hold 5 seconds, relax. This is a good starting point if your knee is very sore.
2. Straight leg raises. Lie on your back with one knee bent. Tighten the thigh of the straight leg, then lift it to the height of the other knee. Hold 3 to 5 seconds and lower slowly.
3. Sit-to-stands. Sit near the front of a sturdy chair, feet hip-width apart. Lean forward and stand up without using your hands if you can, then sit down slowly with control. Use a higher seat or a cushion to make it easier.
4. Bridges. Lie on your back, knees bent and feet flat. Squeeze your buttocks and lift your hips until your body is in a straight line from shoulders to knees. Lower slowly.
5. Side-lying leg lifts. Lie on your side with the bottom knee bent. Keep the top leg straight and in line with your body, and lift it toward the ceiling without rolling backward. This strengthens the hip muscles that control knee alignment.
6. Step-ups. Holding a rail, step up onto a low step (start at 10 to 15 cm) with the sore leg, straighten fully, then step down slowly with the other leg. Keep your knee in line with your second toe.
7. Heel raises. Stand holding the back of a chair. Rise up onto your toes, pause, and lower slowly. Progress to one leg at a time.

Exercise	Main muscles	Starting dose
Quad sets	Quadriceps	10 x 5-sec holds
Straight leg raises	Quadriceps, hip flexors	2 sets of 8–10 each leg
Sit-to-stands	Quadriceps, glutes	2 sets of 8–10
Bridges	Glutes, hamstrings	2 sets of 10
Side-lying leg lifts	Hip abductors (glute medius)	2 sets of 8–10 each side
Step-ups	Quadriceps, glutes	2 sets of 6–10 each leg
Heel raises	Calves	2 sets of 10–15

When an exercise feels easy for the full number of repetitions, progress it: add a set, slow down the lowering phase, use a lower chair, a higher step, or add a light ankle weight or resistance band. Aerobic activity such as walking, cycling or water exercise on most days adds further benefit. If balance is also a concern, see our balance, strength and flexibility exercises for seniors.

How Much Pain Is OK During Exercise?

Some discomfort during exercise is normal with knee OA and doesn’t mean you are damaging the joint. A practical rule many physiotherapists use:

• Acceptable: mild to moderate discomfort during exercise that settles within an hour or two, and is no worse the next morning.
• Modify: pain that is clearly worse the next day, or swelling that builds up after sessions. Reduce repetitions, range or load for the next session rather than stopping altogether.
• Stop and get advice: sharp or catching pain, the knee giving way, or a hot, very swollen joint.

Knee Arthritis Exercises to Avoid or Modify

Very few activities are completely off-limits with knee OA, but some are best modified, especially during a flare:

• Deep squats and lunges under heavy load. Work in a pain-tolerable range first, for example squatting only to a chair height.
• Jumping and high-impact drills such as plyometrics, if they cause pain or swelling.
• Sudden pivoting and twisting sports, which put high loads on the joint.
• Prolonged kneeling, if it’s painful. A cushion or kneeling pad can help.
• Long periods without moving. Stiffness after sitting is common, so get up and move regularly.

Running and cycling aren’t automatically harmful. Whether they suit you depends on your symptoms and how you build up, which is something a physiotherapist can help you plan.

What Physiotherapy for Knee Osteoarthritis Includes

A home program is a great start, but many people get better results with guidance, especially when it comes to choosing the right level and progressing safely. At Westwood Physiotherapy, care for knee OA typically includes:

• Assessment of strength, range of motion, walking, balance and how your hips and back contribute to your knee pain
• A progressive exercise program that is reviewed and updated as you get stronger
• Education on how OA works, pacing, and staying active during flares
• Manual therapy to ease stiffness alongside exercise
• Supports where they help, such as knee braces or custom orthotics
• Weight management advice, since even a modest loss of body weight reduces load on the knee

The GLA:D Canada program

GLA:D (Good Life with osteoArthritis in Denmark) is an evidence-based education and exercise program for people with hip and knee osteoarthritis. It combines education sessions with supervised neuromuscular exercise classes focused on knee control and alignment in everyday movements. Westwood has a GLA:D-certified physiotherapist on the team. Ask us whether the program is right for you.

Frequently Asked Questions

What are the best exercises for knee osteoarthritis?

Exercises that strengthen the quadriceps and hip muscles, such as sit-to-stands, step-ups, bridges and side-lying leg lifts, combined with regular aerobic activity like walking or cycling. The best program is one you can do consistently at the right level for your knee.

Can exercise make knee arthritis worse?

Appropriate exercise doesn’t speed up joint damage and is recommended for people with knee OA. Some discomfort is normal. If pain is clearly worse the next day or the knee swells, reduce the amount rather than stopping completely.

Is walking good for knee osteoarthritis?

Yes, for most people. Start with distances that feel comfortable and build up gradually. Supportive footwear and, if needed, a walking pole or cane in the opposite hand can make walking easier.

Can knee osteoarthritis be cured?

There is no cure for osteoarthritis, but symptoms can improve significantly. Many people reduce their pain and get back to activities they had stopped through exercise, education and weight management.

How long before strengthening exercises help knee pain?

Many people notice changes within 6 to 8 weeks of regular exercise, with further improvement over several months. Consistency matters more than intensity.

Do I need a referral to see a physiotherapist for knee arthritis in Ontario?

No. You can book directly with a physiotherapist in Ontario. Some extended health plans require a referral for reimbursement, so check your policy.

Knee Osteoarthritis Physiotherapy in Guelph and Tavistock

If knee osteoarthritis is limiting how far you can walk or what you can do, our physiotherapists can build a program around your goals. Learn more about our arthritis and chronic pain physiotherapy, or contact Westwood Physiotherapy to book at our Willow Rd or Woodlawn Rd clinics in Guelph, or our Tavistock clinic.

References

1. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578–1589. doi:10.1016/j.joca.2019.06.011
2. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020;72(2):149–162. doi:10.1002/acr.24131
3. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2015;(1):CD004376. doi:10.1002/14651858.CD004376.pub3

This article is general information and isn’t a substitute for an assessment by a qualified health professional.