Arthritis of any type (osteoarthritis, rheumatoid arthritis and approximately 100 more) can cause severe knee pain and stiffness. People living with these symptoms may feel like exercise is the last thing they want to do or even should do. However, most people with an arthritic knee can benefit from a comprehensive program of knee exercises that includes:
- Knee stretches to encourage flexibility in the knee joint and surrounding muscle;
- Knee strengthening exercises designed to build muscle around the knee, and
- Low impact aerobic workouts, which build muscle and improve overall cardiac health.
This article provides specific sets of exercises for knee stretches, strengthening, and low impact aerobic activities for those with arthritic knees
Benefits of Knee Exercises
Together, stretches, strengthening exercises and low-impact aerobic workouts can provide multiple benefits, includiNG
Reduces pain. Exercise strengthens muscles and stronger muscles provide better support to joints. By strengthening the muscles surrounding the knee, including the quadriceps and hamstring muscles, the knee becomes more stable and bones are more protected from impact, which in turn reduces pain. Exercise also releases endorphins, the body’s natural pain killers.
Increases range of motion and function. Pain can discourage a person from being active, thus compounding the problem of joint pain with stiffness, which leads to increased pain. Regular exercise will help keep the knee joint and surrounding muscles remain limber, thereby increasing knee function.
Helps with weight loss. Exercise combined with a nutritious, low fat diet can help shed pounds, thereby putting less pressure on the knee joint. The effect of weight loss has an amplified benefit: losing 10 pounds means 30 fewer pounds of pressure exerted on the knee with each step.
Helps maintain function. Chronic knee pain can prevent a person from doing day-to-day tasks or participating in sports and recreational activities. It’s frustrating and sometimes depressing. Exercise - along with perhaps physical modifications and adjusted expectations - can help arthritis sufferers return to the activities they love, and engage in everyday activities.
Knee Stretches
Gentle stretching is a core part of most arthritis treatment programs. For people with arthritis of the knee, there are four target muscle groups for stretching:
- Hamstrings (in the back of the thigh)
- Quadriceps (in the front of the thigh)
- Hip flexors (hip muscles)
- Calf muscles (lower leg muscles)
The stretches described below can be done once or twice a day. When doing the stretches, it is important to maintain the right form to avoid straining joints, using modifications if necessary
Hamstring stretches
The hamstring muscle is located on the back of the thigh. If the hamstring muscle is tight it can cause knee pain. These stretches can be felt on the back of the thigh.
Hamstring stretches should generally be done twice daily, such as once in the morning and once in the evening.
Forward fold stretch: Stand with legs shoulder-width apart and slowly start to fold forward, bending from the hips and keeping legs as straight as possible. Be sure to keep the lower back and legs as straight as possible, and keep the movements smooth and controlled with no bouncing. Maintaining good form is more important to stretch the hamstrings than touching the floor.
Modification: For those who are unable to touch even their ankles, a slight modification may make the stretch more comfortable. Instead of reaching for the floor, reach for a chair seat (pillows or cushions may be added to make the chair seat even higher, if necessary). Over time the stretch may become easier and less modification may be needed.
Hold the stretch for 20 to 30 seconds and repeat three times.
Supine leg raise: Pain and stiffness in the lower back may make forward fold stretches too uncomfortable. A supine leg raise is a gentler alternative. Begin the stretch by lying on the back with both legs extended. Bending the left knee, bring the left foot flat on the mat in front of the buttocks. You may use a strap (such as a rope or belt) as support around the ball of the foot, behind the toes, of the leg that is being lifted to stretch (here, the right leg). Hold the strap in both hands. Keep the right knee straight and locked. Slowly begin to raise the right foot to the sky, keeping the right leg as straight as possible. The right leg should be raised only as far as it will go while still keeping the back flat against the floor.
To help keep the back flat and also engage the core muscles, contract the gluteus and abdominal muscles, pulling the belly towards the floor. This stretch should be repeated three times on each side, holding legs in the air for 20 seconds each time.
Quadriceps Stretches
The large muscle group located on the front of the thigh, the quadriceps muscles are the strongest muscles in the body and control the extension of the knee.
Standing quadriceps stretch: Begin by placing the left hand on a wall or a chair for balance, then bend the right knee and bring the right foot back. Reaching back with the right hand, grab the ankle. Pull the ankle up and back, away from the buttocks, rather than toward the buttocks, which can cause stress on the knee. This stretch can be felt in the front of the right thigh.
Hip Flexor Stretch
The hip flexors are located above the quadriceps on the front of the thigh, and are involved in any upward movements of the knees.
Kneeling hip flexor stretch. Kneel on the floor with the left knee below and right leg extended forward, keeping the knee bent at 90º, the right foot will be flat on the floor along with the left shin. Rest hands on right knee and lean body forward. Do not let the right knee extend forward past the toes of the right foot. This stretch can be felt in the left hip flexor while the right knee is forward. Engaging the core muscles will help to keep the body stable and upright.
Repeat the stretch three times on each side, holding each leg for 20 seconds.
Calf Muscle Stretch
The calf is located at the back of the lower leg and is made up of two paired muscles, the gastrocnemius and the soleus. The calf muscles are essential for all active movements including walking and running.
Standing calf muscle stretch. This stretch is done two ways to properly stretch both calf muscles.
To stretch the gastrocnemius muscle: Face a wall and stand about 2 paces away from the wall. Extend both arms, placing hands on the wall at or just below shoulder height. Step the right leg slightly forward with the right knee bent, keeping the left leg straight and angled back. Lean the body forward using the wall for support, while at the same time stretching the left heel toward the floor. This should produce a stretch in the back of the left leg. To increase the stretch, move back from the wall a little more.
To stretch the soleus muscle: Same stretch as above, but bend the left knee slightly to isolate the soleus muscle during the stretch.
Repeat both stretches three times on each leg, holding for 10 to 20 seconds each.
As a general rule, never hold the breath while stretching – continue to breathe throughout the stretch. Keep movements smooth and avoid bouncing or straining.
While the above knee stretches are generally appropriate for anyone with knee arthritis, it is always advisable to discuss any stretching exercises with one’s treating physician.
Squats for Knee Strengthening
The squat is a multi-purpose knee strengthening exercise that targets the quadriceps, hamstrings and buttocks. Stand with feet shoulder-width apart, firmly planted on the ground. Then slowly bend the knees as if sitting back into a chair, keeping the back straight and the abdominals engaged. The knees should not go forward beyond the toes. Arms may be raised forward to help with balance.
A reasonable goal is four sets of 12. Small free weights may be held in each hand to add difficulty.
Modification 1: A person who is unable to keep his or her back straight may try squatting against the wall. Position the body in a full squatting position with the back flat against the wall. Raise the body by straightening the legs and sliding the back up against the wall, and then lower the body using the same method.
Modification 2: This version uses a chair. Stand with feet shoulder-width apart in front of the chair. Cross arms across the chest, grabbing opposite shoulders with opposite hands. Exhale and sit back, moving toward the chair until the thighs are parallel to the ground. Pause for a moment, and then rise slowly while keeping the core body engaged and back straight. If the chair feels too far down, place pillows on the seat until it is a comfortable height.
Thigh and Hip Strengthening Seated Leg Raises
This exercise strengthens the muscles in the front of the thigh, the quadriceps.
Begin by sitting in a chair with the knees bent, feet dangling above the ground. Add pillows to the seat of the chair if necessary. Hold onto the sides of the chair for stability, slowly extend left leg until it is nearly parallel to the floor. Try to keep the leg as straight as possible without locking the knee. Pause briefly holding the leg straight, and then return back to the starting position. Repeat with the right leg.
Perform three sets of 12 repetitions on each side.
Side-lying leg raise
This strengthening exercise mainly targets the muscles on the outside of the hip.
Lying on the left side of the body, bend the left knee so that the left foot is behind the body. Slowly raise the right leg until it makes a 45º angle with the rest of the body, keeping the leg as straight as possible. Pause at the top, and then start a controlled lowering to the starting position. If able, keep the lowered leg in line with the body and off the floor.
Repeat the leg raise 8-12 times on each side, performing three sets. If this exercise seems too easy, add light ankle weights.
Figure 4a:Side-lying leg raise
Side-lying leg raise raised
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