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Health & Exercise Forum

Prevent Knee Pain from Arthritis

Jun 20, 2011

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Janet Caputo, PT, OCS 

Just a few weeks ago, The Scranton Times-Tribune published a column on new research that shows an alarming increase in knee replacement surgery in the last decade. While the number of replacements have doubled for the general population, it reportedly tripled for those 45 to 64 years old: “boomers” who are attempting to stay active at all costs. 

Many patients ask what they can do to prevent or limit the progression of knee arthritis. Genetics, age, obesity, knee injury, and knee surgery can lead to osteoarthritis of the knee. Many individuals with knee arthritis experience pain that limits their daily and recreational activities. When pain develops, the body attempts to protect the knee from further injury by inhibiting the knee muscles, which eventually leads to muscle weakness. The muscles supporting the knee also weaken because individuals with knee pain avoid many activities. This cycle of pain and disuse creates a situation that leaves some patients wondering if knee replacement is their only option.   

Multiple studies have demonstrated that weakness of the thigh (quadriceps) muscle is associated with arthritic knee pain. But strengthening these muscles, especially the quadriceps, can help reduce the pain and disability associated with knee arthritis.   

While studies show that higher quadriceps strength does not necessarily protect against the development of knee osteoarthritis, they have shown that higher quadriceps strength can protect against the progression of knee arthritis and prevent the development of knee pain from the osteoarthritis. Even though knee arthritis still developed, individuals with strong thigh muscles denied pain, aching, and stiffness in their knee joints.  This is a significant finding, because it is pain from knee arthritis—not the osteoarthritis alone—that limits patients. 

Interestingly, these findings apply to females more than males, and the researchers believed that several factors contributed to this difference. First, woman’s quadriceps strength is generally 60% less than that of a man’s. Therefore, a male’s higher quadriceps strength may already provide greater protection against knee pain associated with quadriceps weakness. Second, women generally have greater knee joint laxity and less joint stiffness than men. Because a woman’s knee joint is already more flexible and their quadriceps weaker than a male’s, women are predisposed to abnormal movement of the knee, which can increase pain with arthritis. 

It is important to properly strengthen your quadriceps, because improper strengthening of arthritic knees can contribute to the progression of the disease, causing joint deformity (i.e. knocked knees or bowed legs) and joint laxity. The following are three exercises that you can do at home to properly strengthen your quadriceps muscles.  

1. Quadriceps sets: Lying on back with both legs straight, tighten front of thigh to push the back of both knees toward the ground. Hold 5 seconds then relax. Perform 3 sets of 10 repetitions.     

2. Straight Leg Raise: Lay on back with uninvolved knee bent and involved knee straight. Raise involved knee to level of bent knee. Hold 5 seconds. Slowly lower to start position. Perform 3 sets of 10 repetitions.  

3. Knee Extensions: While seated in a chair, raise leg until knee is straight. Hold 5 seconds. Slowly lower your foot to the floor. Perform 3 sets of 10 repetitions.

Aim to perform these exercises daily. After two weeks, add a 5-pound ankle weight for exercises #2 and #3. 

In one study, subjects who performed these exercises daily for 8 weeks experienced decreased knee pain, less knee stiffness, increased quadriceps strength, and improved knee function. Participants with mild arthritic symptoms showed greater improvement than those with advanced osteoarthritis.  

Knee pain from osteoarthritis can interfere with your ability to enjoy life. However, appropriate exercise, sometimes combined with other treatments (i.e. injections, bracing), may alleviate the incapacitating symptoms and allow you to engage in the active lifestyle that you desire. Please consult with your physician before performing any exercise routine. Your condition may necessitate referral to a medical professional for appropriate treatment and supervision.  


  • Arthritis Rheum;Ann Intern Med; J Musculoskelet Neuronal Interact  

Guest Columnist: Janet Caputo, PT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.  She is presently pursuing a doctor of physical therapy degree at the University of Scranton.  

Photos: Jen Hnatko. Model: Dominque DelPrete

Read “Health & Exercise Forum” – Every Monday.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliate faculty member at the University of Scranton, PT Dept.