Knee pain shapes how you move through the day, interrupts sleep, and often grows harder to ignore with time. For many adults, especially those over 45, the source of that pain is osteoarthritis, a gradual wearing down of the joint’s cartilage that affects around 654 million people worldwide.1 As cartilage thins and wears down, it leaves the knee more vulnerable to damage.
One common result is a meniscal tear, which is characterized by the fraying or splitting of the meniscus, the rubbery disc that cushions the knee and absorbs shock with every step.2 Together, osteoarthritis and meniscal tears form a painful duo that causes stiffness, swelling, and reduced mobility, and even results in up to 400,000 arthroscopic partial meniscectomies (a surgery to remove part of the meniscus) annually in the United States.3
Yet research has shown that outcomes from surgery aren’t always better than those from structured exercise or physical therapy (PT) for knee pain. This has prompted a deeper look into how these conditions are managed. Now, a study published in The New England Journal of Medicine (NEJM) brings new insights into the role of exercise and therapy in easing knee pain, highlighting the benefits of movement as the first course of action.4
Key Takeaways from the NEJM Knee Pain Study
In the featured study, called the Treatment of Meniscal Problems in Osteoarthritis (TeMPO) Trial, researchers ran a large multisite randomized controlled trial to test how different exercise delivery strategies influence knee pain tied to meniscal tears and osteoarthritis. The trial enrolled 879 adults ages 45 to 85 with imaging-confirmed meniscal tears, osteoarthritis changes, and ongoing knee pain.5
• Participants followed the same 12-week exercise plan across four delivery models — Everyone was prescribed 100 minutes of exercise per week, split into 25-minute sessions four times weekly for 12 weeks. One group did the full program at home. A second group did the same home program plus three weekly text messages and mailed pamphlets to support adherence.
A third group did home exercise with the same text support and added in-clinic sham PT visits that matched therapist time and attention without real biomechanical treatment, using inactive ultrasound, inert lotion, and minimal-force manual contact.
A fourth group did home exercise with text support and attended standard in-clinic PT that included supervised strengthening and functional work, stretching, and manual therapy from licensed therapists.
• Pain improved substantially in every group by three months — The primary measure tracked changes in knee pain over three months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore, a validated scale where scores range from 0 to 100, with lower numbers indicating more pain.
At the start of the trial, participants averaged a pain score of 46 out of 100, a level that significantly affects daily activities. By three months, every group showed an improvement in pain scores of more than one standard deviation. This degree of change represents meaningful relief that participants could feel in their everyday movements.
• Supervised physical therapy vs. home exercise — The group doing home exercises alone improved by nearly the same amount as the group receiving standard physical therapy plus home exercises. The difference was only 2.5 points on the 100-point scale, well below the 8-point threshold considered meaningful to patients.
Similarly, adding motivational text messages to home exercises made virtually no difference, with groups differing by just 0.1 points. Even more striking, participants who received sham physical therapy reported pain improvements nearly identical to those receiving standard physical therapy, with only a 0.7-point difference between these groups.
• Secondary measures supported these findings — Rates of treatment failure, defined as needing surgery, injection, or failing to show an 8-point improvement in pain, were similar across all groups. Between about 29% and 36% of participants met the failure criteria at three months, regardless of intervention type.
Among those who improved initially, most maintained benefits at 12 months, with treatment durability ranging from around 77% in the home-only group to nearly 89% in the standard PT group.
• At six months, a slight divergence appeared — At the six-month mark, participants in the standard physical therapy group showed a slightly larger improvement in KOOS pain scores compared to those in the home-exercise-only group.
However, this short-term divergence was not observed between standard and sham PT groups. Both had nearly identical outcomes throughout all time points. These patterns suggest that any small advantage seen at six months with standard physical therapy might be tied more to continued interaction with a provider than to the therapy content itself.
• Adherence rates were remarkably similar across all groups — Participants performed at least three sessions per week in about 76% to 82% of the weeks. This suggests that the act of committing to regular exercise, combined with the structure and attention that comes from enrolling in a trial, may drive much of the benefit. According to the researchers:
“Changes in KOOS pain subscores with home exercise plus text messages plus sham physical therapy and those with home exercise plus text messages plus standard physical therapy were virtually identical across all time points.
These findings suggest that contextual effects are likely to explain the small apparent differences in pain between home exercise and home exercise plus text messages plus standard physical therapy over a period of 12 months. Previous research has shown that 60 to 80% of the total effect of physical therapy for knee osteoarthritis can be attributed to contextual effects.”6
Is Exercise Really Safe for Knee Arthritis?
Many people with osteoarthritis worry that too much movement or the wrong way might make their knees worse. It’s an understandable concern — if the joint’s protective cartilage is already thinning, it’s easy to imagine that moving would only grind the bones together and speed up the damage. But the way osteoarthritis works doesn’t follow that simple mechanical logic.7,8,9
• Pain during movement does not mean cartilage is being “rubbed away” — Cartilage has no pain receptors. The discomfort you feel comes from inflamed synovial lining (a specialized tissue that produces the synovial fluid lubricating the joint), irritated tendons and ligaments stressed by altered mechanics, fatigued muscles working overtime, and increased pressure on bone beneath damaged cartilage.10,11
• Appropriate exercise does not speed cartilage loss — Studies tracking cartilage thickness show people with knee osteoarthritis who exercise regularly do not lose cartilage faster than sedentary individuals. Some evidence even points to protective effects, with the right kind of movement helping maintain function and reduce discomfort.
Exercise increases circulation in the joint capsule, helping synovial fluid distribute nutrients and remove waste. This natural lubrication effect is important, especially if the knee already shows signs of cartilage loss. Low-impact activity improves flexibility, preserves range of motion, and builds strength in a way that protects the joint from further strain.12,13
• Avoiding movement backfires and worsens decline — When you avoid using your knee because of discomfort, the muscles surrounding it weaken rapidly, particularly the quadriceps muscles on the front of the thigh that are essential for knee stability. Weaker muscles mean less shock absorption with each step, placing greater stress on the joint structures themselves.
Range of motion decreases as you move less, with the joint capsule and surrounding tissues tightening and becoming stiffer. This stiffness then makes movement more painful when you do attempt it, reinforcing the cycle of avoidance. As a result, cardiovascular fitness declines, weight often increases, and the systemic inflammation associated with inactivity can worsen joint symptoms.14
• Even with more advanced osteoarthritis, exercise can be safe and helpful when done carefully — You may need to scale movements, use supportive equipment, or avoid activities that involve sudden directional changes or deep knee bends. The key is consistency and control, not intensity. The goal isn’t to push through pain, but to move regularly within your limits and build from there.
Aside from exercise, there are other simple ways to strengthen and protect your knees over time. To learn more about strategies that support joint health and may lower your risk of problems later on, read “Common Knee Problems and How to Address Them.”
Exercises for Knee Pain — The PT-Backed Workout Plan
A consistent and well-structured exercise routine builds the muscle support your knee needs while improving mobility, stability, and daily function. This plan is designed to be accessible for beginners and scalable over time. All exercises are low-impact, joint-friendly, and aligned with physical therapy strategies used in clinical settings for osteoarthritis of the knee.
Warm-Up and Mobility
Before you begin doing knee strengthening exercises, it helps to prepare the joint with gentle movements. A short warm-up increases blood flow, activates surrounding muscles, and improves range of motion.
1. Start with 60 to 90 seconds of marching in place, allowing your arms to swing lightly.
2. Follow that with heel slides, either lying down or seated. Slowly slide your heel toward your glutes and return to the start, eight to 12 times per side. This helps restore flexion at the knee without compressing the joint.
Strength Block
Below are five exercises that you can build your routine around. They target key muscle groups that support knee alignment and absorb joint load, particularly the quadriceps, gluteus medius, and hamstrings.15
• Sit-to-stand
1. Start by sitting near the front edge of a sturdy chair, feet flat on the floor and about hip-width apart.
2. Keep your chest upright, shoulders relaxed, and head facing forward.
3. Cross your arms over your chest or place your hands on your thighs if needed.
4. Lean your torso slightly forward to shift weight over your feet, then press evenly through both legs to stand up tall. Avoid locking your knees at the top.
5. Pause briefly, then lower yourself back down with control, keeping your weight balanced and your movements steady.
6. Repeat for three sets of five repetitions. If you need extra support, place your hands lightly on a nearby chair back or countertop to help with balance.
• Mini squats at a countertop
1. Stand tall with your feet about shoulder-width apart and your hands resting lightly on a countertop for support. Keep your chest lifted and your eyes forward.
2. Slowly bend your knees and lower your hips into a mini squat, going only as far as feels comfortable. Pause for a couple of seconds at the bottom, then press through your feet to return to standing.
3. Keep your heels on the ground throughout the movement. Focus on keeping your knees aligned with your toes, not drifting forward or collapsing inward. Use the countertop as needed to help with balance.
4. Repeat for three sets of five repetitions.
• Straight-leg raise
1. Lie on your back on the floor or a yoga mat, with your legs extended and your arms resting by your sides. Keep both legs straight and relaxed to start.
2. Tighten the muscles on the front of one thigh, then slowly lift that leg about 12 inches off the ground, keeping the knee straight. Hold at the top for three seconds, then lower the leg back down with control.
3. Repeat for two sets of 15 repetitions on each leg.
• Side-lying leg raise
1. Lie on your side with your legs extended and stacked, keeping your hips aligned and your body in a straight line. Rest your upper hand in front of you on the floor to help maintain balance.
2. Keeping your top leg straight, slowly lift it to about hip height. Pause and hold for two to three seconds, then lower it back down with control
3. Repeat for two sets of 15 repetitions on each leg. Focus on steady movement and avoid rolling your hips backward as you lift.
• Step-ups
1. Stand in front of a low, stable step or platform, such as the bottom step of a staircase or a sturdy yoga block. Keep your posture upright and use a handrail or nearby counter for balance if needed.
2. Lift one foot and place it fully on the step. Press through that leg to bring your other foot up so that you’re standing on the step. Then step back down with control, returning to your starting position.
3. Repeat for one to two sets of 10 repetitions, switching legs each time or alternating sides.
4. You can also perform this movement sideways by stepping up and down laterally. If you choose the side-step version, focus on keeping your hips level and your movements steady.
Low-Impact Cardio
Adding aerobic movement improves circulation, supports weight management, and maintains overall endurance without straining your joints. Choose one of the following at a light-to-moderate effort:16
• Cycling — Be sure to adjust the seat so that your knee stays slightly bent when the pedal is at its lowest point. If you’re riding outdoors, padded cycling gloves can help absorb vibration. Avoid handlebars that force you to hunch forward, as this can add unnecessary strain to your hands, wrists, and elbows.
• Elliptical — Start with 10-minute sessions during the first few weeks, then gradually increase by five to 10 minutes each week. Begin with the lowest resistance and incline settings to give your joints time to adjust.
• Pool-walking or swimming — Consider taking a class with an instructor who can help you learn proper technique. Choose a swimming stroke that feels comfortable on your joints and doesn’t aggravate your symptoms.
Freestyle is often a good option for people with hip or knee arthritis since it keeps the legs relatively straight. In contrast, breaststroke involves more knee and hip bending, which may increase discomfort for some individuals.
Cool Down and Flexibility
End with light stretching to promote recovery and preserve your range of motion:17
• Calf stretch
1. Step into a staggered stance, with your affected leg straight behind you and your other leg bent in front. Hold onto a wall or chair for balance.
2. Lean forward slowly until you feel a stretch in the calf of your back leg. Hold for 30 seconds, then relax. Repeat five times.
• Hamstring stretch
1. Stand tall and place the foot of your affected leg on a low step.
2. Hinge forward at your hips until you feel a stretch along the back of your thigh, keeping your back straight and your hips level.
3. Hold for 20 to 30 seconds, then return to standing. Repeat five times.
• Quad stretch
1. Stand straight while holding a firm support.
2. Loop a towel around the ankle of your affected leg.
3. Keeping your back straight, gently pull the towel to bring your heel toward your bottom until you feel a stretch along the front of your thigh.
4. Hold for 20 to 30 seconds, then release. Repeat five times.
How Often Should You Do Knee Exercises?
In the TeMPO trial, participants completed 100 minutes per week, split into four 25-minute sessions combining strength, mobility, and functional moves. People who exercised three or more times weekly saw meaningful improvement in their symptoms. Adherence was strongest when sessions were spread across the week, not stacked into one or two days, making three days per week a practical target.18
• Tracking your sessions helps maintain consistency — In the trial, participants filled out home-exercise logs every two weeks, reporting how many days they completed the exercises.19
While you don’t need to log each workout formally, writing down the days you exercise or setting reminders can help you stay accountable. Even simple tools like a calendar, habit-tracking app, or sticky notes on your bathroom mirror can reinforce the habit until it becomes routine.
• As your symptoms change, so should your routine — If you feel stable and are moving without discomfort, you might add an extra repetition, increase time under tension, or raise the number of sets. If soreness lingers into the next day or your joint feels swollen or unusually stiff, scale the intensity down or give yourself an extra rest day. The goal is to stay active without overloading the joint. Let your symptoms guide your pace, not your willpower.
• Fitting exercise into your day depends less on time than on rhythm — Pairing it with other habits, like doing your strength block after brushing your teeth or stretching while watching the news, makes it easier to sustain. If mornings are hectic, aim for short sessions in the evening. If your afternoons drag, movement can be a natural energy reset.
• When to pause and see a clinician — There may be moments when your joint flares up or something doesn’t feel right. If pain becomes sharp, catches suddenly, or doesn’t settle with rest, it’s time to check in with a clinician.
The same goes for swelling that doesn’t improve after a day or two, or if you notice the joint giving way or locking during movement. These symptoms may signal a more complex issue that needs medical evaluation before continuing with your routine.
To help you stay consistent, the following table summarizes the full home exercise routine covered earlier:
Home Routine for Knee Support
| Phase | Exercise | Instructions |
|---|---|---|
| Warm-up (3 to 5 min) | March in place | Light arm swing, steady pace — 60 to 90 seconds |
| Heel slides | Lying or seated, slide heel toward glutes — 8 to 12 reps per side | |
| Strength block (8 to 12 min) | Sit-to-stand | From a chair, stand and sit with control — 3 sets of 5 reps |
| Mini squats (at counter) | Shallow squat, hold briefly — 3 sets of 5 reps | |
| Straight-leg raise | Lift leg ~12 in, hold 3 sec — 2 sets of 15 reps per leg | |
| Side-lying leg raise | Lift top leg to hip height, hold 2 to 3 sec — 2 sets of 15 reps per leg | |
| Step-ups | Step up, then down — 1 to 2 sets of 10 reps, alternating legs | |
| Optional cardio (10 to 20 min) | Cycling / elliptical / pool walking | 10 to 20 minutes at light-to-moderate effort (RPE 4 to 6/10) |
| Adjust equipment for comfort and joint alignment | ||
| Cool-down (3 to 5 min) | Calf stretch | Staggered stance, lean forward — hold 30 sec, repeat 1× per leg |
| Hamstring stretch | Foot on step, hinge at hips — hold 20 to 30 sec, repeat 1× per leg | |
| Quadriceps stretch | Towel around ankle, pull heel toward glute — hold 20 to 30 sec, repeat 1× per leg |
Should You Still Consider Knee Surgery?
As highlighted in the TeMPO trial, many patients who’ve undergone surgical reconstruction reported pain and function outcomes after one year that were similar to those seen with in-clinic physical therapy, home exercise, or a combination of the two. This outcome mirrors those reported in earlier research.
• A landmark study showed arthroscopy is no better than placebo for knee osteoarthritis — In 2002, a placebo-controlled trial evaluated 180 patients with knee osteoarthritis who were randomly assigned to one of three procedures — arthroscopic débridement (where damaged cartilage is trimmed and loose material is removed), arthroscopic lavage (where the joint is flushed out with fluid), or a placebo surgery in which no actual treatment was done.20
Pain levels, physical function, and mobility were tracked for two years across all groups. The results showed no clinically meaningful differences between the surgical and placebo groups at any time point. According to the authors:
“In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.”21
• A double-blind Finnish trial found meniscectomy matched sham surgery — Research published in 2013 also found no benefit from arthroscopic knee surgery for degenerative meniscal tears. In this multicenter, double-blind study, 146 middle-aged patients without osteoarthritis were randomly assigned to undergo either arthroscopic partial meniscectomy or a simulated sham procedure.
At the 12-month follow-up, both groups reported similar improvements in pain relief, knee function, and quality of life. There were no statistically or clinically meaningful differences between real and placebo surgery. The results strongly suggest that the perceived benefit of surgery was due to placebo or natural recovery, not the operation itself.22
• Arthroscopic meniscectomy raises long-term risk and knee replacement brings its own hazards — Research shows that arthroscopic knee surgery involving meniscectomy is linked to a threefold higher risk of later total knee replacement. Total knee replacement is sometimes recommended for knee osteoarthritis, yet it also carries real risks and tradeoffs.23 As researchers noted in the Journal of Arthritis:
“Total knee replacement (TKR) is often the end-point of many causes of knee pain and is used with increasing frequency. However, there are a wide variety of problems associated with TKR including ongoing pain, patient dissatisfaction and the need for revision surgery … TKR should be avoided unless absolutely necessary …”24
Taken together, these studies show that surgery often doesn’t outperform exercise for knee pain and function. Building strength and movement by exercising regularly and properly is, therefore, a more preferable starting point than surgery.
How to Protect Your Knees from Wear and Tear
Preventing knee osteoarthritis involves addressing the factors that contribute to cartilage breakdown and joint stress before they accumulate into irreversible damage. While you can’t change your age or genetics, there’s a lot you can do to reduce stress on your knees, including:
1. Maintain a healthy weight — Excess body weight increases the load on your knees and speeds up cartilage breakdown. The heavier you are, the more stress each step puts on the joint surfaces. Obesity also contributes to chronic inflammation and higher cytokine levels, which further degrade cartilage over time.
Research shows nearly 90% of people undergoing knee replacement are overweight or obese, and those in the most severe obesity category tend to need surgery seven years earlier than their normal-weight peers.25
2. Address injuries promptly and completely — Knee injuries like anterior cruciate ligament (ACL) tears and meniscal damage often happen from sudden stops, twists, or trauma, but the long-term damage comes when they’re not properly rehabilitated.
Even a minor injury can lead to altered mechanics that strain the knee over time. Full recovery isn’t just about pain resolution; it means restoring strength, mobility, and alignment to avoid compensatory wear and tear down the line.
3. Support joint health through nutrition — Cartilage is made up of collagen and other connective tissue proteins that rely on proper nourishment. Bone broth, collagen, and glucosamine supplements offer raw materials that may support repair and reduce inflammation.
Cruciferous vegetables like broccoli and Brussels sprouts also contain sulforaphane, which blocks joint-degrading enzymes. Optimizing vitamin D levels helps as well, as it regulates inflammation and maintains bone and cartilage strength. Low vitamin D levels are common in those with knee osteoarthritis.26
4. Consider mind-body exercises — Low-impact movements like yoga and tai chi help improve balance, coordination, joint awareness, and neuromuscular control, all of which support healthier movement patterns and reduce strain on the knees. They also enhance flexibility and build strength without compressing the joints.27
Frequently Asked Questions (FAQs) About Knee Pain
Q: Is it OK to exercise with knee arthritis?
A: Yes. Knee osteoarthritis exercises are not only safe when done properly, they are also an effective way to manage pain, protect joint function, and maintain mobility. Avoiding movement actually weakens the muscles that support your knee, which leads to greater stress on the joint and often worsens discomfort over time.
Q: What are the best exercises for knee pain?
A: The best knee pain relief exercises are ones that strengthen the muscles around your knee without irritating the joint. Focus on movements like sit-to-stands, mini squats, step-ups, straight-leg raises, and side-lying leg lifts. These target the quadriceps, glutes, and hamstrings, which are essential for stability and shock absorption.
Q: How many times a week should I do knee exercises?
A: Three times per week is an ideal target for most people with knee pain. That frequency allows enough stimulation to build strength while giving your joints time to recover.
Q: Is physical therapy better than exercising on my own?
A: Both approaches can be effective. The TeMPO trial showed that people who followed a structured home exercise program improved almost as much as those receiving supervised physical therapy. The main difference came down to consistency and support.
If you prefer guidance, need help modifying movements, or feel unsure about how to start, working with a physical therapist can be helpful. Otherwise, a solid home program is a strong option.
Q: What cardio is easiest on sore knees?
A: Cycling, elliptical machines, and water-based movement are all low-impact and well-tolerated by most people with knee arthritis. These activities reduce joint strain while still promoting circulation and cardiovascular health. Choose whichever one feels most comfortable and start with shorter sessions to gauge your response.
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