Eric Tannenbaum, MD

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Knee Arthritis

Strengthening exercise is one of the most strongly recommended treatments for knee arthritis. Stronger thigh and hip muscles take pressure off the joint, reduce pain and make walking and stairs easier.

Prepared by Dr. Eric Tannenbaum, MD · Board-certified orthopedic surgeon, Southern Indiana Orthopedics

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Use this program for

  • Knee osteoarthritis
  • Knee stiffness and weakness from arthritis
  • Strengthening before a planned knee replacement

Before you start

  • Check with Dr. Tannenbaum or your physical therapist that this program fits your condition.
  • Warm up with 5 minutes of easy movement.
  • Move slowly and with control. Quality matters more than speed.
  • Use the pain guide below to decide how hard to push.
0 to 3 out of 10Safe. Keep going.
4 to 5 out of 10Acceptable if it settles by the next morning. Otherwise ease off.
Above 5, or worse the next dayToo much. Reduce the reps, range or weight.

Phase 1: Activate

Weeks 0 to 2

Wake up the thigh muscles and keep the knee moving.

1Quad set

  1. Sit or lie with the leg straight and a small towel roll under the knee.
  2. Tighten the thigh muscle to press the back of the knee down into the towel.
  3. Hold, then relax.

10 to 15 repetitions, hold 5 to 10 seconds, 2 to 3 times a day

You should see the kneecap move up slightly as the muscle tightens.

2Straight leg raise

  1. Lie on your back with the other knee bent.
  2. Tighten the thigh of the straight leg first.
  3. Lift the leg to the height of the other knee, then lower slowly.

3 sets of 10 to 15, once a day

If the knee bends during the lift, do more quad sets first.

3Heel slide

  1. Lie on your back with legs straight.
  2. Slide the heel toward your buttock, bending the knee as far as comfortable.
  3. Hold, then slide back out.

10 to 15 repetitions, hold 5 seconds, 2 times a day

A towel under the heel or a sock on a smooth floor helps it glide.

Phase 2: Strengthen

Weeks 2 to 8

Build strength for daily activities.

4Sit to stand

  1. Sit near the front of a sturdy chair with feet hip-width apart.
  2. Lean forward and stand up without using your hands, if you can.
  3. Lower slowly back to the chair.

3 sets of 8 to 12, once a day

Use a higher chair or a cushion to make it easier. Use a lower chair to make it harder.

5Standing hamstring curl

  1. Stand tall holding the back of a chair.
  2. Bend the knee to bring your heel toward your buttock.
  3. Lower slowly.

3 sets of 10 to 15 each side, once a day

Keep the thighs side by side. Add an ankle weight to progress.

6Bridge

  1. Lie on your back with knees bent and feet flat.
  2. Tighten your stomach and squeeze your buttocks.
  3. Lift your hips until your body is in a straight line from shoulders to knees, then lower slowly.

3 sets of 10 to 15, hold 2 to 3 seconds at the top, once a day

Progress to a single-leg bridge when 15 feel easy.

7Side-lying leg raise

  1. Lie on your side with the bottom knee bent for balance.
  2. Keep the top leg straight and slightly behind your body, toes pointing forward.
  3. Lift the leg toward the ceiling, then lower slowly.

3 sets of 10 to 15, once a day

Lead with the heel. If the toes turn up, the wrong muscle is working.

Phase 3: Function

Weeks 8 and beyond

Build endurance and confidence on stairs.

8Step-up

  1. Stand facing a step or stair.
  2. Step up with the sore leg, pushing through the heel, and bring the other foot up.
  3. Step down slowly with the other leg first.

3 sets of 8 to 12 each side, once a day

Keep the knee in line with the second toe. Use a lower step to make it easier.

9Calf raise

  1. Stand holding the back of a chair.
  2. Rise up onto your toes, then lower slowly.
  3. Progress to one leg at a time.

3 sets of 15, once a day

Take 2 to 3 seconds to lower.

10Stationary bike or walking

  1. Ride a stationary bike with the seat high enough that the knee is only slightly bent at the bottom.
  2. Start with low resistance.
  3. Walking on level ground is a good alternative.

10 minutes, building to 20 to 30 minutes, most days

Regular aerobic exercise is one of the most effective treatments for arthritis.

Avoid for now

  • Deep squatting or kneeling if it flares pain
  • Long periods without moving
  • High-impact exercise that leaves the knee swollen the next day

When to move ahead

Some discomfort is normal. Keep exercise pain at 3 to 4 out of 10 or less, and make sure it settles within 24 hours.

Stop and call our office at (812) 376-9353 if you have

  • Pain that is getting worse week to week, or severe pain at night
  • New numbness, tingling or weakness
  • Significant swelling, redness, warmth or fever
  • A joint that locks, gives way or will not move
The research behind this program
  1. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline, 3rd ed. 2021.
  2. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 ACR/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72(2):149–162.

Need more help?

Work with our physical therapists

Our physical therapists at the SIO Physical Therapy & MRI building, 745 Schnier Street in Columbus, work alongside Dr. Tannenbaum and can tailor this program to you.

Request an appointmentCall (812) 376-9353

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