knee pain

Knee Osteoarthritis - Part 1 Your Options

Osteoarthritis (OA) is the most prevalent joint disease and a leading source of chronic pain and disability worldwide.

There is a common perception among people with knee arthritis that nothing can really be done, (outside of taking medications or having knee replacement surgery).

This study by Mitchell and Hurley (2008) showed that many people were unaware of the options available to them, despite consulting with their general practitioner.

Research indicates less than 4% of people attending a GP clinic with knee osteoarhritis are referred to a Physiotherapist.

The intention behind this blog post is to inform you of some of your options, so you can make an educated decision about what is best for your situation.

Knee OA…what options do you have?

1. Ignore the pain

This can be an effective strategy in the beginning. Ignoring the pain and getting on with things can be actually be quite helpful.

This usually works particularly well when you are young and resilient.

Our bodies are masters at compensating and this means you can still do what you want in the short-term as your body may be able to transfer load from the knee into the hip or lower back.

As you get older though (around the age of 30+), this strategy has less effect as the compensatory patterns have a limited capacity.

As your body runs out of options and strategies, you will eventually find yourself not recovering like you did before and the stiffness and pain starts to get stronger.

2. Rest the knee and avoid using it

Advice to rest and avoid pain is commonly provided to people with knee and other joint pains - advice that is often wrong, and harmful.

Unfortunately the majority of people with knee OA reduce moving due to fear they will wear the knees out and make things worse.

This leads to a downward spiral of pain, weakness and a loss of confidence.

Interestingly, we know that weak thigh muscles are one of the biggest risk factors for ongoing knee pain. When you stop moving and become inactive, muscle loss accelerates significantly.



At some point in your 30's you naturally start to lose muscle mass and function.

Physically inactive people lose an average 3-5% of their muscle loss per decade after the age 30. The technical name for this is sarcopenia.

The picture above demonstrates the dramatic consequences of an inactive lifestyle and severe muscle wasting.

Adipose tissue refers to the fat layer around the muscles.

Clearly, avoiding movement is not going to be your best solution.

What about running, won’t that lead to increased OA?

Interestingly, recreational runners (3.5% risk) had a lower occurrence of developing knee OA compared with non-runners (10.2%).

One of the main ways running protects you from arthritis is by maintaining you at a healthy weight. This leads us to our next point.

3. Weight Loss

Obesity is a strong risk factor for knee pain and increases the risk of symptomatic knee osteoarthritis.

Women who are overweight are four times more likely to develop knee OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.


But losing even a small amount of weight can be beneficial. For people who are overweight, every 5 kg of weight loss can reduce the risk of knee OA by more than 50 percent.

4. Medication

Medications such as panadol and anti-inflammatories have their place when you have an acute flare-up of knee pain.

But they are not designed for long-term use, due to their side effects on the liver and gastro-intestinal system.

5. Arthroscopic Surgery

Traditionally, arthroscopic surgery has been performed for chronic knee pain. Over the past few years however the research has indicated that for people with degenerative knee pain (including meniscal lesions), performing arthroscopic surgery does not improve outcomes.

The evidence refuting arthroscopy to treat meniscal degeneration and knee osteoarthritis (OA) is now clear and compelling. In Australia, the number of arthroscopies for degenerative knee pain has halved since 2011.

If the knee pain and degeneration is severe, conservative measures have been tried and you are having difficulty functioning day to day, then a Total Knee Replacement would be a logical thing to consider in consultation with your doctor.

However, the point being made here is that arthroscopic surgery is not required for degenerative knees.

Of course with any surgery there is the risk of infection and blood clots forming in the leg, as well as post-op recovery and rehabilitation for a few months afterwards.

6. Exercise therapy: the treatment of choice for Knee OA

Exercise therapy has the best evidence providing both short and long term benefits to people with knee OA.

High-quality evidence suggest that land-based therapeutic exercise provides benefits in terms of reduced knee pain and improved quality of life (Bennell et al 2015). This benefit can be sustained for 2-6 months after cessation of formal treatment.

Exercise therapy involves a combination of supervised sessions with a health professional to target:

  • strength

  • cardiovascular fitness

  • flexibility

  • neuro-muscular retraining

Getting all the pieces of the puzzle to get you back to doing what you love.

Getting all the pieces of the puzzle to get you back to doing what you love.

As you begin an exercise program, you may need to allow a period of 'body tuning' i.e. using manual therapy, taping, massage and dry needling to improve tissue quality and joint alignment.

Similar to playing an instrument, tuning up before hand makes things perform much better and reduces pain and tightness.

This is where are a good Physio comes in, who has a deep understanding of knee pain and a passion for helping people overcome it.

We do that everyday of the week and you can find out more about us here.


We know that movement and exercise can be what truly helps knee pain.

The evidence is compelling.

It addresses all of the modifiable factors that can get you out of reactive mode, and into building your foundation.

But what type of exercise specifically helps?


If you have any questions in the meantime, please feel free to contact us.

If you'd like to see how we can help set you up with a plan of attack to overcome your knee pain, please use our easy online booking system to schedule an initial appointment.


Mitchell HL, Hurley MV. Management of chronic knee pain: a survey of patient preferences and treatment received. BMC Musculoskelet Disord. 2008 Sep 18;9:123

Exercise for osteoarthritis of the knee: a Cochrane systematic review.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL.

Br J Sports Med. 2015 Dec;49(24):1554-7

The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J.

J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390.

"Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis, The New England Journal of Medicine, 2013"

10 Alternatives to Running When You're Injured


Sometimes injuries are a blessing in disguise.  They force you to re-examine your training style and open you up to other possibilities in the way you go about doing things. 

Unfortunately running injuries are common and being forced into a lay off for a few weeks/months can be quite daunting.  Being told you can't run can be a serious blow to a runner's sense of self.  You suddenly realise how addicted you are to the physical and emotional payoffs that running brings. 

Most runners tell me that there is nothing else quite like the endorphin buzz that running gives you.

Why runners are vulnerable to injury

One of the downfalls of running is that it's very repetitive and demanding on certain parts of the body that are vulnerable to overload.  Common areas include: knees, hips, ITB's, achilles, calf muscles and hamstring issues. 

Most runners generally have very good pain thresholds.  This comes as a blessing AND a curse.  Niggles that are ignored over a long period of time tend do have a tendency to develop into something more serious. 

If you are in pain, there is a good chance your Physio will recommend taking a short break from training to allow your tissues to recover and heal properly.


To help you get through your injury, try the following exercises, which are designed to:

1.  Maintain your cardio-vascular fitness

2.  Encourage blood flow and oxygen to assist the healing process

3.  Re-build your foundation so that you come back better and stronger that before

DISCLAIMER** Of course check with your physio to get the green light before trying any of these exercises**

Nutritious Movement

If you compare exercise to eating, running is like eating dessert and your foundation exercises (below) are like your main course. 

It's not healthy to only be eating dessert - running should be a part of wide base of 'nutritious movement'. 

This approach will sustain you and help you find longevity in your running career. 

1.  Swimming

We all know the benefits of getting in the water: the non-weight bearing movement of your body that helps decompresses the joints and allows you a full body workout without the stress of gravity wearing on your body. 

Try and build up to some intervals, for example 10 x 100m.  This will really help optimise your breathing and cardio-respiratory performance.

Even if you don't like swimming, just being in the water will be beneficial, assisting recovery.  Standing in the cold water at the beach in the middle of winter is refreshing and surprisingly therapeutic. 


2.  Kettlebell Strength Workout

A solid kettlebell workout is the closest thing I've come to experiencing the high that matches up with a good run.  Everyone should own a kettlebell or two.  If you have never tried, find a good personal trainer and get them to show you the basics over a few sessions.  Try swings, squats, lunges and other variations to get your body moving and re-build your capacity


3.  Pilates

Research tells us the biggest risk factor for an injury is a previous injury.  Pain and injury leads to compensatory movement patterning that helps us get through the short term but isn't an ideal long term solution.  Pilates help you to learn the principles of dynamic core alignment, so you will create a solid foundation that naturally leads to optimal performance in sport and life. 

Term 3 Pilates kicks of July 26th - Reserve your place here


4.  Stair workout

Stronger glutes = better running and lower risk of re-injury.  Stairs will also send your heart rate sky rocketing, boosting your VO2 max.



5.  Hiking

Hiking some trails in the great outdoors has a few benefits for runners:

  • build better balance on uneven terrain
  • breathe some fresh air
  • learn how to 'slow down' and enjoy the scenery
  • get to know your running friends better - talking is easier when you're not struggling to breathe!


6.  Boxing

Stressed?  Angry?  Let your fists do the talking.  Boxing will challenge your cardio-vascular system like nothing else.  Working with a trainer will quickly fine tune your power and precision and bring an intensity to your workout that may rival your running training.

7.  HIIT (High Intensity Interval Training)

Try something like the 7 minute workout or ask your local personal trainer to design you a program.  Add a challenge by using a foam roller or Swiss Ball to your workout.  Try a combination of burpees, squats, step-ups and mountain climbers for starters.


8.  Yoga

Reset your fundamental movement patterning, connect with your breathing and jump start your healing process by activating the para-sympathetic nervous system.  Most runners could benefit from finding a little bit more flexibility.  Restorative / yin yoga is particularly recommended for runners to keep their bodies balanced.

9.  Stand-Up Paddle-boarding

Stand-up paddle boarding is an ideal way to strengthen your core (obliques in particular that are important for runners) and also gives your quads a nice burn.  Also will improve your balance (especially if you find some fun waves to have a go at!).

10.  Elliptical / Cross Trainer

Minimal weight-bearing, using the elliptical machine is an nice way to get your blood and oxygen flowing.  It's also an easy way to keep an eye on your heart rate and push some challenging intervals sessions...crank up the resistance!


11.  Bonus Tip: Avoid Cycling

Despite it's popularity, I DON'T advise cycling as a good alternative to running as cycling strongly activates the hip flexors, and can mess up your muscle balance around your hip, knee and lower back. 

I would advise your to either choose cycling or running as your main form of exercise.  If you are triathlete, there are some specific exercises you can do to help reduce the negative effects of cycling.  You can email directly and I will give you the details.

Over to you...

What form of exercise have you found most beneficial when you can't run? 

I'd love to hear your thoughts below.