Arthritis is a common problem that affects an estimated 25% of the population, according to the CDC . By far, osteoarthritis is the most common form, the one most people ask us about.
It’s typically characterized by frequent bouts of pain, swelling, stiffness, and loss of mobility. At its core, it’s a “wear and tear” problem, joint tissue being worn down by excessive use or, more often than not, incorrect movement as a result of joint insufficiencies or muscle weakness.
The knee is one of the most common locations for osteoarthritis to develop. The meniscus (wedge-shaped cartilage between your femur and tibia) gets worn away, decreasing the protective space between the leg bones and causing the bones to rub painfully against each other.
Knee osteoarthritis develops slowly over time and as it does, the pain increases. This can be a good thing because unlike acute injuries that occur suddenly, chronic conditions like osteoarthritis can be addressed, stopping them in their tracks.
How to Get Relief from Knee Osteoarthritis Pain
For example, losing weight can reduce the strain on your knees—your whole musculoskeletal system, in fact. Supplements like Omega-3s and glucosamine can help to restore degenerating cartilage.
Addressing postural and movement problems can also facilitate smoother, more natural joint movement. By far the best way to combat osteoarthritis is to correct movement and activation patterns of the knee and the joints above and below including the foot, ankle and hip.
The knee is often the victim of dysfunction above or below and if these other joints aren’t addressed, the knee pain will never resolve and degeneration will continue.
The exercises below do just that and unlike so many of the exercises typically recommended for knee arthritis like static quad, calf and hamstrings stretches, we follow a 4-pillar system we call “Triple-A” to build a solid foundation of movement that provides lasting range of motion improvements without irritating tendons or ligaments:
Pillar #1: Improve Tissue quality
Pillar #2: Activate sleepy muscles and strengthen weak ones
Pillar #3: Restore static and dynamic joint Alignment
Pillar #4: Build strength and endurance through a joint’s full Active ROM
Using this system, you’ll restore proper movement and activation patterns, which can relieve – and perhaps, completely eliminate – knee osteoarthritis pain.
Start with the Beginner Routine 2-3 times a week for 3-6 weeks, then move to the Intermediate Routine for another 3-6 weeks.
Beginner Exercise Routine for Knee Osteoarthritis
Exercise #1: Active Self Myofascial Release for the Plantar Fascia
This technique serves two purposes: improving the pliability of the plantar fascia and waking up the intrinsic foot muscles that create the arch and extend your toes. These are both critical factors in hip and knee health.
- For this technique, you’ll want to use a massage ball—either a specialized massage ball, or any form of hard ball (such as a lacrosse ball) will do.
- Place the ball on the ground, and either sit or stand above it.
- Put your foot on the ball, and place the ball directly beneath your metatarsals (near your toes).
- Wrap your toes around the ball so you’re flexing your toes downward.
- Roll your foot forward to move the ball toward your heel. At the same time, extend your toes (lift them toward your knees).
- Continue rolling forward, backward, and around to target the entire underside of the foot, applying consistent pressure sufficient to feel uncomfortable without causing excessive pain.
- Massage for 1-2 minutes, then switch feet.
Exercise #2: Extended Knee Ankle Plantar-Dorsiflexion
This technique activates the VMO (medial quadriceps head), a muscle that is often “shut off” in people who have knee problems. It also encourages a fuller range of motion in the ankle joint, working both your calves and the tibialis interior, which plays a role in dorsiflexion.
- Sit on a workout bench or chair.
- Extend your right leg out in front of you until the knee is fully straight and the quads activated. Hold that position and make sure to keep your knee extended through the entire exercise.
- Pull your toes up toward your knee (dorsiflexion) as high as you can, and hold for 5 seconds.
- Point your toes downward away from your knee (plantarflexion) as far as you can, and hold for 5 seconds.
- Perform 3-5 cycles per leg, for a total of 2 sets per leg.
Exercise #3: Seated Tibial Rotation
This technique helps to activate your hamstrings and trains your neglected range of tibial rotation. This range is absolutely important, because without it, more rotational stresses go through soft tissue like the meniscus, which leads to wear and tear.
- Sit down on a bench or chair, with your knees at roughly a 90-degree angle.
- Lift your heels off the ground so only the balls of your feet remain planted.
- Rotate your heels outward (tibial internal rotation), and hold for 5 seconds at the end-range, activating your muscles to push for a deeper rotation.
- Rotate your heels inward (tibial external rotation), and hold for 5 seconds at the end-range, activating your muscles to push for a deeper rotation.
- Perform 3-5 cycles for 2 sets.
Exercise #4: Hip Extension / Knee Flexion Dissociation
This is an excellent exercise to restore proper hip and knee movement patterns.
- Start from a standing position. Shift your weight onto your right foot and lift your left foot.
- Extend your left foot out in front of you with your knee straight.
- Slowly bring your leg backward and bend your knee as far as you can to activate the hamstrings and glutes, lengthening your rectus femoris (quad muscle).
- Perform 3-5 extensions and flexions, then switch to your right leg.
- Repeat for 2 sets per leg.
Exercise #5: Slumpy Psoas Activation
This is a technique critical for activating the psoas (hip flexor) muscle for both its functions of hip flexion and extending the lumbar spine. It will improve lower back stability and dynamic stability of the hip joint.
- Sit on a bench or chair, and begin in a slumped position.
- Place your right hand on your left knee. Press down against your knee with your hand, and drive your knee upward into your hand.
- Hold that activation, and slowly sit up straight into proper posture (enter the pelvic tilt, extend the lumbar spine, and stick your butt out).
- Hold for 5 seconds, then lower, and switch sides.
- Repeat 3-5 reps per side for a total of 2 sets.
1. ASMR: Plantar Fascia
1-2 minutes per foot
2. Extended Knee Ankle Plantar -Dorsiflexion
3-5 per leg, hold 5 sec
3. Seated Tibial Rotation
3-5 cycles, hold 5 sec
4. Hip Extension / Knee Flexion Dissociation
3-5 cycles per leg
5. Slumpy Psoas Activation
3-5 sets per side, hold for 5 sec
Download these exercises in PDF Format!
This downloadable pdf includes all you need to get started on the path towards improving knee health and restoring optimal function.
Intermediate Exercise Routine for Knee Osteoarthritis
Exercise #1: Seated 4-Way Metatarsal Pressure (MTP) Slide
This exercise is going to work the intrinsic foot muscles to improve the arch of your foot, making your body better-able to absorb the force of running, jumping, and walking to reduce wear and tear on your knee.
- Sit on a bench or chair with your knees at a roughly 90-degree angle.
- Slide your right foot as far forward as you can without lifting it off the ground.
- Use your upper leg muscles to press down against the ground, driving pressure through the metatarsals.
- Hold for 2-3 seconds, then slide it backward into ankle dorsiflexion, as far back as you can while keeping your foot flat on the ground.
- Hold for another 2-3 seconds before returning to the start position.
- Slide your foot out to the right as far as you can, keeping the foot planted on the ground and applying pressure.
- Hold the ankle inversion for 2-3 seconds before sliding your foot as far inward as possible to train ankle eversion.
- Return to the starting position, and switch feet. ALWAYS make sure your foot remains flat on the ground and apply pressure to your metatarsals.
- Perform 3-5 reps per side, for 1-2 sets.
Exercise #2: Standing Glute Activation
This technique is intended to not only activate the glute muscles, but also eliminate a common dysfunctional movement pattern when activating the glutes. It will help to maintain even balance through your foot and improve knee alignment, decreasing stress on your knees.
- Stand in a comfortable position, with your feet shoulder-width apart.
- Press your metatarsals down into the ground as you slowly activate your glutes as hard as you can squeeze them.
- Make sure your feet DO NOT MOVE and your knees remain in a neutral position. Prevent the feet and knees from twisting inward or outward as you tighten your glutes.
- Hold for 5-10 seconds, and slowly relax the glute muscles and release pressure on your toes.
- Repeat 4-6 times, rest, and perform a second set.
Exercise #3: Standing Tibial Rotation
This exercise is a progression of the Seated Tibial Rotation Exercise performed in the Beginner Routine.
- Start in a standing position, with your weight rest on your left foot.
- Flex your knee to bring your heel up toward your butt as high as you can.
- Rotate your heel outward while maintaining the knee activation. Hold for 5 seconds.
- Rotate your heel inward as far as you can, and hold for 5 seconds. Feel the activation in your hamstrings while you hold and twist.
- Repeat 3-5 inward/outward rotations on the right foot, then switch to your left foot.
Exercise #4: Active Self Myofascial Release for the Quadriceps
This is a simple ASMR variation that anyone, even those with limited joint mobility, can easily perform from a seated position. It’s excellent for increasing soft tissue pliability to increase range of motion.
- Sit on a bench or chair, with your feet on the ground and knees bent to a 90-degree angle.
- Straighten your knee and drive your thumbs into the quad muscles.
- Hold the thumb position and flex your knee, bringing your foot backward. This helps to stretch out the tissues and increase range of motion.
- Straighten your leg, shift your thumbs to a new position, and repeat.
- Continue massaging all along your leg, extending and flexing your knee, for 1-2 minutes per side.
Exercise #5: Standing Dead Bug
This exercise does wonders to train the intrinsic foot muscles and the lower leg muscles that play a role in maintaining your balance, as well as the r psoas, abs and lats – all while working the diagonal core muscle pattern that is central to walking, running and rotational sports.
- Stand with your feet together, posture erect, comfortable stance
- Bring your right knee up to hip height directly out in front of you, and lower your left hand to your kneecap.
- Use your hand to press down gently on your knee, and use your leg to push your knee up against your hand.
- Push for a 2-count.
- Return to starting position, and switch sides—left knee to right hand.
- Repeat 3-5 times per side, for a total of 2 sets
6. Seated 4-Way MTP Slide
3-5 sets per side, hold for 2-3 seconds in each position
7. Standing Glute Activation
4-6 reps, hold for 5-10 seconds
8. Standing Tibial Rotation
3-5 cycles per side, hold for 5 seconds in each position
9. ASMR: Quads
1-2 minutes per leg
10. Standing Dead Bug
3-5 times per side reps
Start with the Beginner Routine to build the foundation, and work your way up to the Intermediate Routine. By the time you complete the second 3-to-6-week cycle, you’ll notice massive improvement in your lower body mobility—and specifically in your knee health.
Keep these routines in your regular stretching and workout rotation to continue training your knees to combat pain, stiffness, and movement limitations. It will pay off exponentially for the rest of your life.