Strengthening the muscles around an osteoarthritic knee can reduce symptoms and help you keep moving because those muscles support the joint and help absorb load. It does not rebuild worn cartilage or cure osteoarthritis. The most useful programme combines locally targeted strengthening with general aerobic fitness, is adjusted to your symptoms and ability, and is performed consistently over time.
National Institute for Health and Care Excellence (NICE) guidance recommends tailored therapeutic exercise for everyone with osteoarthritis. That recommendation includes local muscle strengthening and aerobic fitness; it does not prescribe one exercise, resistance, class or timetable for every person.
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What happens in an arthritic knee
Osteoarthritis changes the tissues in and around a joint. Pain, stiffness and reduced confidence can make a person move less, which can gradually reduce muscle capacity and everyday function. A weaker leg may then make activities such as walking, rising from a chair or climbing steps feel harder. This cycle does not mean exercise has failed; it means the plan needs to match the person’s current ability and be progressed carefully.
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1Scan for outdated or missing drivers - takes under a minute2Clear out junk files and repair common Windows errors3Fix the driver behind crashes, sound loss and screen glitchesStrengthening is a way to improve the support and control available around the knee. It is symptom management and function training, not a method for replacing cartilage. NICE describes exercise as helping to reduce symptoms and improve or maintain physical functioning over time. NHS guidance similarly recommends regular activity that builds muscle and strengthens joints, alongside general fitness work.
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Why stronger muscles can make the knee feel better
They share the work of moving and supporting the joint
The quadriceps at the front of the thigh straighten the knee and help control the body when you stand, sit or take a step. The hamstrings at the back of the thigh help bend the knee and control movement. Muscles around the hip, including the abductors on the side of the hip, help control the position of the leg as it moves. Training these groups gives the limb more active support during ordinary tasks.
They help absorb and control load
AAOS patient guidance notes that the quadriceps and hamstrings help the knee absorb shock. Better strength and control can make movement more efficient, so the person may be able to perform a task with less strain or with fewer compensating movements. This is a functional explanation for symptom relief; it is not evidence that exercise reverses the underlying joint changes.
They make useful activity possible
Pain often leads people to avoid movement. A suitable strengthening plan can make daily activities more manageable, allowing a person to maintain general activity and fitness. NICE links long-term adherence with greater benefits for pain, function and quality of life. The benefit depends on continuing with a plan that remains practical, rather than completing a short burst and stopping.
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What clinical guidance recommends
NICE guideline NG226, published on 19 October 2022, gives this recommendation: “For all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness).” Therapeutic exercise is therefore a core treatment approach, not an optional add-on reserved for athletes.
The guidance does not identify one universally superior exercise or a single dose that suits every knee. Selection should reflect the person’s symptoms, physical ability, preferences, other health conditions, available space and the support they need to continue. A physiotherapist or other clinician can help select and adapt movements when the right starting point is unclear.
How strengthening compares with other exercise choices
| Approach | What it contributes | How guidance frames it |
|---|---|---|
| Local muscle strengthening | Builds capacity in muscles that move and support the knee and hip. | NICE gives local strengthening as an example of tailored therapeutic exercise for all people with osteoarthritis. |
| General aerobic fitness | Supports overall activity and endurance, making regular movement easier to sustain. | NICE and NHS guidance recommend general fitness alongside strengthening rather than treating the two as competing choices. |
| A combined plan | Addresses both local muscle capacity and whole-body fitness. | NHS patient guidance recommends a combination of strengthening and general fitness activities. |
| Home exercise | Can fit around work, transport, symptoms and daily routines. | NICE quality standard QS87 recognises home exercise as one possible route for tailored therapeutic exercise. |
| Supervised exercise or a suitable local class | Provides instruction, feedback and accountability when those are useful. | NICE says supervised therapeutic exercise sessions may be considered; the choice should reflect individual support needs. |
These categories are not mutually exclusive. Someone may strengthen at home, attend occasional supervised sessions to refine technique, and use an appropriate aerobic activity for general fitness. The best arrangement is the one the person can perform safely and consistently.
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Documented examples of lower-limb strengthening
A NICE evidence review accompanying the osteoarthritis guideline describes a lower-limb programme focused mainly on knee extensors and hip abductors. It is an example of the exercises used in evidence, not a universal prescription. The review lists:
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- Isotonic quadriceps contractions, in which the muscle shortens or lengthens while the knee moves.
- Isotonic hamstring contractions.
- Quadriceps exercises using a resistance band.
- Straight-leg raises.
- Side-lying hip abduction.
- Partial squats.
- Dynamic stepping.
- Side-stepping with a resistance band around the thighs or ankles.
The review does not turn this list into a dose that every reader should copy. Number of repetitions, resistance, range of movement, rest periods and progression need to be selected for the individual. A resistance band is an optional tool appearing in the example; buying one is not a NICE requirement, and the band itself does not treat arthritis.
How to start a plan without guessing
- Clarify the problem. If you have not been assessed, or if pain, stiffness or loss of function is changing, ask a qualified clinician whether osteoarthritis and another condition need to be distinguished. People with marked instability or unusual loading may need a more specific assessment.
- Describe your real starting point. Note which activities are difficult, what range of movement feels comfortable, and whether you can exercise on your own. This information helps a clinician or physiotherapist tailor the programme.
- Choose a small set of appropriate movements. The documented examples show several ways to train the quadriceps, hamstrings and hip abductors. You do not need to perform every listed exercise. Select movements that match your ability and can be done with controlled technique.
- Add general fitness in a tolerable way. NICE and NHS guidance place aerobic fitness alongside strengthening. The format can be chosen around your symptoms, environment and preferences rather than around a single required activity.
- Agree how to progress. Progress may involve changing resistance, movement range, repetitions or task difficulty, but the correct change depends on how the knee responds and what function you are trying to regain. A clinician can set these details when self-selection is uncertain.
- Make the routine repeatable. Put sessions into your normal week, use a home or class setting that you can reach, and arrange supervision if feedback or encouragement improves your ability to continue.
- Review function, not just pain. Notice whether a previously difficult task is easier, whether movement feels more controlled and whether general activity is becoming more manageable. NICE identifies benefits across pain, functioning and quality of life, so a single daily pain score is not the only useful measure.
Is it normal for exercise to hurt at first?
NICE recommendation 1.3.3 says: “Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise.” An early increase in pain or discomfort can therefore occur when an inactive joint and its muscles begin working. NICE nevertheless advises that regular, consistent exercise is beneficial and that longer-term adherence increases benefits for pain, function and quality of life.
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This is expectation-setting, not permission to ignore every painful response. The acceptable level and pattern of symptoms differ between people and exercises. If you are unsure whether a response is reasonable, reduce guesswork by asking a clinician or physiotherapist to review the movement, load and progression. Do not assume that severe, persistent or function-limiting worsening is harmless simply because exercise was recommended.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.When supervision is worthwhile
Some people can follow a tailored home programme independently. Others benefit from supervised therapeutic exercise, at least while learning technique or deciding how to progress. Supervision may be particularly useful when pain makes movement frightening, when weakness or balance affects exercise selection, or when previous attempts have not been sustained.
NICE quality statement QS87 recognises both supervised sessions and home or suitable local-class exercise. This is a support decision, not a ranking in which supervised exercise is always better. Consider the setting in which you are most likely to attend, perform the exercises correctly and continue for the long term.
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Why braces and insoles are not the default answer
Strengthening should not be confused with an automatic recommendation for a brace, insole, tape, splint or other support. NICE advises against routinely offering these devices for osteoarthritis. Its stated exception is a person with joint instability or abnormal biomechanical loading when exercise is ineffective or unsuitable without the device and the device is likely to improve movement and function.
That exception requires individual clinical judgement. A support should not be bought on the assumption that it will rebuild cartilage or replace strengthening. If a clinician recommends one, ask what problem it is intended to address, how it should be used with exercise and how success will be judged.
Common mistakes that reduce the chance of benefit
- Treating the exercise list as a fixed prescription. The evidence-review examples illustrate options; they do not specify one routine for every knee.
- Changing too many variables at once. If resistance, range and volume all change together, it becomes difficult to identify what the knee tolerates.
- Stopping after an early flare. NICE expects that pain may increase at the start, so a short-term response should be discussed and managed rather than used automatically as proof that exercise cannot help.
- Forcing movement through uncontrolled pain. Regular exercise is encouraged, but every painful response is not automatically safe. Seek individual advice when symptoms are difficult to interpret.
- Ignoring general fitness. Local strength work and aerobic activity serve different purposes; guidance supports including both where appropriate.
- Choosing a setting you cannot maintain. An ideal programme that is too inconvenient is less useful than a suitable plan you can perform consistently.
- Expecting a cure. Strengthening can improve symptoms and function while osteoarthritis and cartilage wear remain present.
How to decide what to do next
If symptoms are mild and you already know which movements you can perform safely, a tailored home programme may be a practical starting point. If you are uncertain about diagnosis, have instability or abnormal loading, cannot exercise without substantial difficulty, or need help staying consistent, arrange an assessment with a clinician or physiotherapist. Ask for a plan that states which muscle groups and functions are being targeted, how symptoms will be monitored and when progression should be reviewed.
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The central decision is not whether strengthening is “good” or “bad” for an arthritic knee. It is how to match therapeutic exercise to the person, then repeat it consistently enough for strength and function to improve. NICE, NHS guidance and the evidence review all support that tailored, sustained approach while making clear that exercise manages osteoarthritis; it does not restore worn cartilage.
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