The knee joint is made up of the femur (thigh bone), patella (knee cap) and tibia (shin bone). The main joint of the knee is the tibiofemural joint which is split into lateral and medial. The knee cap is joined to the knee at the patellafemoral joint. All of these joint surfaces are lined with special cartilage called hyaline cartilage (articular cartilage) which acts as a protective layer. In addition to the hyaline cartilage, menisci (lateral and medial) act as extra cushioning in the knee joint. Over time as a natural part of the aging process, hyaline cartilage starts to break down and the menisci thin, causing the tibiofemoral joint space to narrow and symptoms to occur i.e. joint pain, stiffness or reduced range of movement.


For some people, the symptoms can be mild and may come and go. Other people can experience more continuous and severe problems which make it difficult to carry out everyday activities.

Risk Factors


  1. Analgesia – This can be more effective when taken routinely as oppose to only taking when there is significant pain.
  2. Pacing – Modifying activity or activity intensity i.e. Walking 1km with 2 breaks compared to walking 1km without breaks.
  3. Footwear – Supportive cushioning can improve symptoms over flat footwear.
  4. Weight Loss – Losing weight will reduce load through the knee.
  5. Hot / Cold Pack – A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.
  6. Manual Therapy – Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the muscles to keep your joints supple and flexible.
  7. Eating Healthy Diet – Eating a balanced diet and having an adequate fluid intake can also help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing, which may improve your symptoms.
  8. Exercise – Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness. The stronger you become, the better you will cope with different tasks and activities.
  9. Steroid Injection – Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems, to help settle excessive inflammation in the joint.
  10. Surgery – Surgery for osteoarthritis is only needed in a small number of cases where exercise and conservative treatments haven’t been effective or where your daily life is seriously affected, such as getting a good nights rest, or getting up and down steps.

How Much Should You Exercise?

Over a 12 week period, this study showed the effects of quad ex in 3 groups who were elegible for TKR secondary to OA – Groups exs 2x, 4x and 6x a week – Compared strength and symptoms. After 12 weeks 2x same strength as 6x and 2x better symptom management than 6x (Husted et al., 2021)

What Could This Mean?

Allowing for plenty of rest and recovery in between ex’s could help improve symptoms such as pain, stiffness and reduced range of movement at the knee.

What Exercises? (Fransen et al., 2015)


High-quality evidence indicates that land-based therapeutic exercise provides short-term benefits … in terms of reducing knee pain. Moderate-quality evidence shows improvement in physical function following land-based therapeutic exercises among people with knee OA

Intervention Suggested

Any land-based non-perioperative therapeutic exercise regimes aimed at relieving the symptoms of OA, regardless of content, duration, frequency or intensity. This means, any land based exercise of any content, duration, frequency or intensity can be beneficial for reducing knee pain and improving physical function among people with knee OA


What motivates you? What is going to be meaningful and something that will be more likely to continue with? Something you can do with friends and family?