Knee Pain and Arthritis: The Exercises and Weight Loss That Help — and Why Squats Are Not the Enemy
Painful knees send many Pakistani parents onto chairs for namaz, away from the stairs and towards injections — with the advice to rest. The research says the opposite: strong muscles and a lighter load are the treatment. Here is the evidence, a starter plan, and the myths about squats, stairs and running.
By Taha Raza
Published
'Ghutnon ka dard' is one of the most common complaints of Pakistani parents. The usual advice — rest, avoid stairs, stop sitting on the floor, wait for injections or surgery — makes sense if a knee is like a car tyre that wears out with use. It is not. Knee arthritis involves the whole joint, the muscles around it and how much load it carries, and the two treatments with the strongest evidence are the ones you can start at home.
What knee osteoarthritis is
Osteoarthritis changes the cartilage, bone and lining of the joint, but how much it hurts often does not match the X-ray: some people with severe-looking X-rays have little pain, and some with mild changes have a lot. Weak thigh muscles, extra bodyweight and inactivity all make pain worse — and all three can be changed. The cartilage does not grow back, but pain and function can improve a great deal.
What helps most
| Treatment | What the research found |
|---|---|
| Exercise | A 2015 Cochrane review of 44 trials: pain down by about 12 points and function up by about 10 points on 100-point scales — similar to what painkillers achieve |
| Weight loss | Each kilo lost removed about 4 kilos of force from the knee with each step (Messier 2005). In the IDEA trial, diet plus exercise (about 11% weight lost) gave the best results |
| Education and self-management | Understanding the condition and pacing activity are part of first-line care in the guidelines |
| Anti-inflammatory gels on the knee | Recommended for knee arthritis in the guidelines, with fewer side effects than tablets — ask your doctor or pharmacist |
Why weight matters so much for knees
A 2005 study in Arthritis & Rheumatism measured the forces through the knees of 142 overweight older adults with knee arthritis as they walked. Each kilo of bodyweight lost reduced the force on the knee by about 4 kilos per step. Multiply that by thousands of steps a day, and losing 5 kg takes tens of thousands of kilos off each knee every day.
The IDEA trial, published in JAMA in 2013, followed 454 overweight adults aged 55 and over for 18 months. The diet-plus-exercise group lost 10.6 kg on average (11.4 percent of bodyweight), the diet-only group 8.9 kg and the exercise-only group 1.8 kg. The diet groups had lower knee forces and less inflammation, and the combination of diet and exercise gave the best improvements in pain and function.
A starter plan
| Exercise | Sets × reps | How |
|---|---|---|
| Sit-to-stand from a chair | 3 × 8–12 | Hands crossed if you can; use a higher chair at first |
| Step-up onto the bottom stair | 2 × 8 each leg | Hold the rail; step up with the stronger leg first if needed |
| Glute bridge | 3 × 12 | Lying on your back, lift the hips and squeeze |
| Straight-leg raise or seated leg extension | 3 × 10–12 | Tighten the thigh, lift slowly, lower slowly; add an ankle weight later |
| Side steps with a band | 2 × 12 each way | Band around the knees or ankles, small steps, knees soft |
| Calf raises | 2 × 15 | Hold a wall or counter |
| Walking or exercise bike | 20–30 minutes most days | Build up gradually; a bike is gentle on painful knees |
A common rule in knee programmes: some pain during exercise is acceptable if it stays moderate, settles within a few hours and is no worse the next morning. If the knee is more painful or swollen the next day, do a little less next time — not nothing. Most people need six to twelve weeks of steady training to feel a real difference.
Squats, stairs and running
- Squats: sitting down and standing up is a squat, and it is one of the best exercises for arthritic knees. Use a chair as a target, go to a depth that is comfortable, and add depth or load slowly.
- Stairs: they are training, not damage. Take them with the rail and one step at a time if needed; it gets easier as the thighs get stronger.
- Running: a 2017 meta-analysis of more than 125,000 people found hip and knee arthritis in 3.5 percent of recreational runners, 10.2 percent of non-runners and 13.3 percent of elite competitive runners. Recreational running does not appear to wear out healthy knees. With established arthritis, walking and cycling are easier places to start.
Daily life with sore knees
- Many people use a chair for namaz while their knees strengthen, then return to the floor as strength comes back.
- Sitting cross-legged or squatting low for long periods can be painful — change position often rather than avoiding movement.
- Supportive, cushioned shoes help on hard floors.
- A walking stick in the hand opposite the painful knee takes load off it on bad days.
When to see a doctor
- A hot, red or very swollen knee, especially with fever.
- The knee locks, catches or gives way, or the pain started with an injury.
- Pain at night that wakes you, or that is quickly getting worse.
- No improvement after three months of regular exercise — to discuss injections or other options.
This article is general information, not medical advice. Get knee pain assessed by a doctor or physiotherapist, especially after an injury or if the knee is swollen, hot, locking or giving way.
Frequently Asked Questions
What is the best exercise for knee arthritis?
Strengthening the thigh and hip muscles — sit-to-stands, step-ups, bridges and leg extensions — two or three times a week, plus walking or cycling on most days. A Cochrane review of 44 trials found exercise reduced knee pain by about 12 points on a 100-point scale.
Is walking good for knee osteoarthritis?
Yes. Walking is one of the core activities in knee arthritis programmes. Start with a comfortable distance, build up gradually, wear cushioned shoes, and switch to an exercise bike on painful days.
Should I avoid squats with knee pain?
No — sitting down and standing up is a squat, and it is one of the best exercises for arthritic knees. Use a chair as a target, go only as deep as is comfortable, and add depth or weight slowly as the pain allows.
Does losing weight help knee pain?
Very much. Each kilo lost takes about 4 kilos of force off the knee with every step, and in the IDEA trial older adults who lost about 11 percent of their weight with diet and exercise had the biggest improvements in pain and function.
Can knee arthritis be reversed?
The cartilage changes do not reverse, but pain and function often improve a lot with strengthening exercise and weight loss — enough that many people return to stairs, walks and sitting on the floor.
Does running cause knee arthritis?
Recreational running does not appear to. A 2017 meta-analysis found arthritis in 3.5 percent of recreational runners compared with 10.2 percent of non-runners; only elite competitive runners had a higher rate, 13.3 percent.
Sources
- Fransen M et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2015
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 2019
- Messier SP et al. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism, 2005
- Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA, 2013
- Alentorn-Geli E et al. The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 2017
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