Is walking good for knee osteoarthritis?

Does walking wear out the knee?

A common worry is that walking will speed up damage in an arthritic knee. Cartilage, however, relies on regular movement and loading to stay healthy, and inactivity weakens the muscles that protect the joint.

In an observational study of 1,212 people aged 50 or over with knee osteoarthritis, those who reported walking for exercise were less likely to develop new frequent knee pain (odds ratio 0.6), and progression of joint space narrowing was less common, compared with non-walkers 1. Observational studies cannot prove cause and effect, but these findings do not support the idea that walking harms the knee.

How much does exercise help knee osteoarthritis?

A Cochrane systematic review pooling 44 trials found that land-based therapeutic exercise reduced knee pain by 12 points and improved physical function by 10 points on 100-point scales immediately after treatment, and benefits were still present two to six months after formal treatment ended 2.

A guideline from the American College of Rheumatology and Arthritis Foundation strongly recommends exercise for knee, hip and hand osteoarthritis, along with weight loss for people who are overweight, self-management programmes, tai chi and use of a walking stick where needed 3.

How should I start a walking programme?

Start with a distance or time that causes little or no increase in pain, for example 10 minutes on flat ground, and increase gradually by a few minutes every few days as comfort allows. Several short walks a day may be easier than one long walk at first.

Mild discomfort during or after walking is acceptable if it settles within 24 hours. If pain increases the next day, reduce the distance for a few days before building again.

What else helps make walking comfortable?

Supportive, cushioned footwear, walking on even surfaces and avoiding steep hills initially reduce load on the knee. A walking stick held in the hand opposite the painful knee can reduce pain and improve confidence.

Strengthening exercises for the thigh and hip muscles make walking easier. Examples include sit-to-stand from a chair, straight leg raises, step-ups and bridging. Cycling and water-based exercise are good alternatives on days when walking is more painful.

Does weight loss matter?

For people with higher body weight, weight loss reduces the load on the knee with every step and can reduce pain and improve function. Combining diet with exercise tends to give more benefit than either alone.

Even moderate weight loss can make walking more comfortable. Walking itself contributes to weight management and overall health.

When is walking not advisable?

Seek assessment for a hot, red, very swollen knee, especially with fever, a knee that locks or gives way, a sudden severe increase in pain, or pain after an injury.

People with heart or lung conditions or other health problems should ask their doctor before starting a more intensive walking programme.

How can I tell whether I am doing too much?

A simple guide is how the knee feels the next day. If pain and swelling are no worse than usual by the following morning, the amount of walking is likely suitable. If the knee is more painful, stiffer or swollen, reduce the distance or intensity for a few days.

Flare-ups can happen even with a sensible plan. They usually settle with a short reduction in activity, pain relief and gentle movement, after which walking can be built up again.

What if walking is too painful?

If pain prevents walking, a physiotherapist can help find a starting point, for example water-based exercise, a stationary bike or strengthening exercises first. Pain relief such as topical anti-inflammatory gels may help people take part in exercise.

When pain and disability remain severe despite non-surgical treatment, knee replacement surgery may be discussed, and staying as active as possible before surgery supports recovery.

Frequently asked questions