Your One Stop Physio with three great locations - Call to book today!

Strength Training With Knee Osteoarthritis

A question I get asked all the time is What do I do if exercise or strength training is painful?

Let’s explore it together. I’ll show you why strength training/exercise might be painful and what you can do about this.


I’ll start with a diagram of the knee. The left side of the knee is healthy while the right side of the knee has Osteoarthritis.

You can see that the Osteoarthritic side has the following:

– Additional bone in the joint space. These are called osteophytes. They narrow the joint space
– Breakdown of joint cartilage (wear and tear)

Although not shown, there may be pinched tendons, ligaments and muscles within the joint space (wear and tear)

Osteoarthritis (OA) is essentially a narrowing of the joint. There is not enough room in the joint and with movement there is pinching of structures. This causes tendon tears, inflammation, locking and importantly pain with movement and strengthening. It can be seen as wear and tear.

Exercise and strength training DOES NOT need to lead to wear and tear. When done correctly strengthening is the best treatment for OA.

This is 1 type/class of pain. We can call it osteoarthritic pain. There are other types of joint narrowing injuries as well as other injuries/pain.

The below X-ray shows a Healthy Knee Space on the left Versus a Loss of Joint Space in the Knee on the right, indicitaive of Knee Osteoarthritis.

What Can We Do About It?


If we can understand why you are getting pain then we can work out what to do about it.

OA narrows joint spaces. Therefore the main line of treatment is to open up and unlock joint spaces.

We can do that by the following:

– Joint mobilisation (hands on therapy) à Open up stiff joints, break down scar tissue. The joint glides rather than continues to lock up

– Massage – releases tight muscles and opens up stiff joints. Less pressure on joints with looser muscles. More temporary solution.

– Strength and mobility training – Once not painful (or with minimal pain) this can loosen and lubricate joints (hyaline fluid). Research show this is the best treatment for OA if pain is reduced

– Foam roll à release tight muscles to open up stiff joints

– Movement/technique modification/advice – Some movements may give pain. Moving with a different technique may be pain free. Joint stabilisation work can also help with this

– Dry needling – Similar to massage

Muscle Control

Some of my clients may have heard me speak about muscle control.

Muscle control is important for keeping joints tracking properly. Think of it like a train on tracks.

If the muscle is strong enough and has adequate control then the train stays on the track (the joint stays in the right place through movement).

If the muscle doesn’t control the joint adequately the joint can “run off the tracks” and make contact and impinge various structures. Very important for OA.

The best treatment for OA is exercise and strength work. It’s not just my opinion but the findings of a plethora of research including gold standard meta-analyses.

A large part of my job as a physiotherapist is to get people to exercise/strengthen but its best to do this pain free (or with minimal amounts of pain). Otherwise this can lead to some  “wear and tear”.

My treatment usually consists of the following when I am helping someone to begin strength training:

– Biomechanical analysis – Work out which areas need to be stronger or looser

–  Hands on therapy – Massage and joint mobilisations. Exercises that were painful are now pain free. Usually demonstrate this in room. No “wear and tear” now 🙂

– Strength training – Start at the right level and strengthen the right areas with minimal/no pain

– Mobility training – Mobilise/loosen stiff joints or tight muscles. Combination of techniques

– Load management advice – Training and other advice

– Activity modification

– Other – diet, nerve health. General wellbeing, diagnosis

Final thoughts
Strength training is just about the best therapy out there. When done correctly, joints are healthier and they stay healthy.

If not, it can lead to wear and tear.

I always tell my clients to aim high. Don’t let your pain limit you or your movement!

Individual Treatment & Group Exercise OA Strength Class

Depending on your current level of function we have two ways to start improving your Knee strength and function and decrease pain levels.

Group Classes

These group sessions are perfect for patients preparing for surgery or trying to prolong surgery, as the exercises are customised to the individual’s hip/knee Osteoarthritis. 

Note: To join the class, you must first have a one-on-one physiotherapy assessment to measure current function and limitations, full medical history, and set your individual goals and treatment plan so the strengthening exercises are started at the level you can achieve and improve.

  • Classes are run 2 x per week
  • Please refer to our brochure and ask our team for more detailed information.

Individual Treatment

One on One treatment with your Physiotherapist if you are not ready to join our group classes. Everyone has a different starting point with their care based on a number of factors. 

Having a Knee OA assessment will help identify the best starting point.

Nathan Lemke