Knee Pain Exercises

Exercises in Osteoarthritis of Knee & other Knee Pains

Are knee pain exercises helpful?

It depends on the types of pain. If the pain is of acute onset; it is not helpful and pain may increase after exercises.

When the exercises should not be done in knee pain?

Knee exercises should be avoided in the following conditions:

  • Sudden onset 1st-time pain of less than a month duration
  • Pain after some trauma like fall, twisting, etc.
  • Pain associated with swelling, the rise of local temperature, redness
  • If pain increases during exercises
  • Pain is moderate to severe in intensity

In all these, situation a doctor must be consulted before starting or doing exercises.

When knee pain exercises can be done?

In the following situations knee exercises can be done safely:

  • Pain is of long duration, particularly if it is of more than 3 months
  • No swelling, the rise of local temperature, redness
  • Pain is mild to moderate in intensity

In what disease conditions knee pain exercises are helpful?

There are a lot of different causes of knee pain. Knee pain exercises are particularly helpful in osteoarthritis of the knee whether it is primary or secondary to rheumatoid arthritis or spondyloarthritis. It should be avoided in acute meniscal injury, ligament injury, or bursitis of acute onset.

What is the evidence that knee pain exercises are helpful?

Several studies prove the effectiveness of various exercises in knee osteoarthritis and knee pain. There is high-quality evidence of the effectiveness of exercises in knee pain in osteoarthritis of the knee and moderate-quality evidence of improvement functions of the knee after knee exercises. Some references to these studies are given below.

How do exercises help in a painful knee in osteoarthritis?

Pain in osteoarthritis of the knee is related to cartilage breakdown and inflammatory reaction because of prostaglandins and interleukins. These in turn cause peripheral sensitization of nerves to produces pain. It has been seen in some studies that dynamic mechanical compression of the knee reduces inflammation and reduces cartilage breakdown.

There is also central sensitization in the higher centers in chronic knee pain. Exercises decrease the excitability of the motor cortex in the brain and therefore, reduces pain by creating a motor-evoked potential drop, and that is why pain relief is almost universal whatever was of the mode of exercise.

What are the other benefits of knee pain exercises apart from pain relief?

Osteo-arthritis also weakens muscles around it and they are atrophied. That’s why thigh and calf muscles should be strengthened. These muscles bear loads of knee joint and protect the knee joint from further damage. Several studies have also proved that other functions like movement of the joint, walking, etc are also improved with exercises.

Thus, we must do few exercises regularly and must not use braces or knee supports for a long time which otherwise weakens knee muscles.

What types of knee exercises are most useful?

There is a lack of uniform recommendations of types of knee exercise for knee pain in osteoarthritis of the knee. These are aerobic, stretching, strengthening, etc. Studies have proved that all are beneficial. Some studies recommend that strengthening exercises are better. The exercises that we have recommended here are a mixture of stretching and strengthening.

How long and how frequently the knee pain exercises be done?

Again, there is a lack of uniformity in recommendations. We recommend about 30 min of exercise a day for 6 days a week. If some days are dropped, even then at least 3 days of exercises are needed.

Are these exercises helpful in knee pain other than osteoarthritis of the knee?

Yes, these are helpful in other knee pain also, but the pain should be chronic and the pain should be mild to moderate.

If pain increases after some particular exercises, should we continue exercises?

Pain is our body’s language. If pain increases after certain types of movement or a particular type of exercise, listen to the body’s language and stop that particular movement and exercise. But you should continue with other exercises which do not increase pain during or after exercises.

Should we continue exercises till we feel pain?

You should stop before your pain is increasing. Increase the duration of knee pain exercises gradually over time.

What exercises should we do?

A short description of types of knee pain exercises are given below:

  • Isometric Quadriceps Exercise:

The person should be sitting in a long sitting position. A towel roll is to be placed under the knee joint. The person is asked to press on the towel by the knee. Hold it for 10 sec, repeat it 10 times. Other parts of the body will be relaxed, normal breathing is continued.

  • Isometric Hamstring Exercise:

The person should be sitting in a long sitting position. The hip and knee joint of the exercised limb is in a semi-flexed position. The person is asked to press the floor/bed by the heel. Hold it for 10 sec, repeat it 10 times.

  • VMO (Vastus Medialis Obliquus) Strengthening Exercise:

The person should be sitting in a long sitting position. A Pillow is placed under the knee joint so that the knee will be resting in a flexed position. The person is then asked to press down by the knee on the pillow, so that the same side heel will be lifted, slightly, and simultaneously. Hold it for 10 sec, repeat it 10 times.

  • Quadriceps Strengthening Exercise:

The person should be sitting on a chair. The person will be asked to straighten the knee slowly to full 90-degree movement. Hold the end position for 10 sec. After completion of it, make the limb slowly down to complete the exercise .repeat it 10 times.

  • Hamstring Stretching exercise:

The person should be sitting in a high sitting position with a non-exercised lower limb hanging down at the edge of the plinth. The person is asked to lean forward (from the hip joint, without bending the spine forward), and try to touch the toes with the same-sided hand. The opposite hand can be used for the stabilization of the knee joint.

  • Gastrocnemius Stretching Exercise:

The person should be sitting in a high sitting position with a non-exercised lower limb hanging down at the edge of the plinth. The person is now asked to make a loop with a towel and hold the two ends of the towel loop. The loop will surround the anterior and front parts of the foot. The person will then be asked to lean backward to force the ankle joint towards passive dorsiflexion. Maintain it for 30sec. Repeat for 3-5 times.

 

References:

  1. https://pubmed.ncbi.nlm.nih.gov/25187640/
  2. https://pubmed.ncbi.nlm.nih.gov/22511582/
  3. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004376.pub3/full
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074793/

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