Knee Osteoarthritis
Physiotherapy is first-line care for knee osteoarthritis — stronger evidence for managing pain and function than imaging-led approaches alone.
Common symptoms
- Aching knee pain that worsens with activity
- Morning stiffness lasting under 30 minutes
- Reduced range when bending or straightening
- Crepitus (creaking) and occasional swelling
Common causes
- Cartilage thinning over time
- Previous knee injury (e.g. meniscus tear)
- Repetitive overload (work or sport)
- Body composition and muscle weakness
When to seek help
Knee osteoarthritis is one of the most common reasons people in Sydney see a physio in their fifties, sixties and seventies. The pain is usually achy, worse with activity, and stiffens up after sitting for a while. Mornings often start stiff and ease within fifteen or twenty minutes.
Book in when:
- getting up from a chair is harder than it was a year ago
- stairs are starting to need a handrail
- you’re avoiding things you used to enjoy — bushwalks, gardening, longer shopping trips
- paracetamol and pottering aren’t cutting it anymore
- you’ve been told you need a knee replacement and want to know whether to delay
How we treat knee osteoarthritis
The strongest evidence for managing knee OA isn’t surgery — it’s loading the knee progressively, strengthening the muscles around it, and adjusting how you move under load. A well-run twelve-week strength program will outperform almost anything else short of a joint replacement.
We often start with the GLA:D® framework: two assessment sessions and a six-week group or individual strength program designed specifically for hip and knee OA. Most people delay or avoid surgery on this pathway. The ones who do end up needing a knee replacement go in stronger and recover faster.
Why exercise actually works for OA
Osteoarthritis isn’t simply "wear and tear" — that phrase has done more damage to patient understanding than just about any other in modern medicine. The joint adapts to load. Reasonable loading actually keeps the cartilage healthier than inactivity does. People who exercise consistently with knee OA report less pain and better function than people who rest the joint.
The trick is loading the knee in a way it can tolerate. Too little, and the joint deconditions and gets weaker. Too much too fast, and it flares for days. The sweet spot is progressive — start where your knee can manage today, build a bit at a time, and let the joint adapt.
When to have the surgery conversation
Knee replacements are excellent operations and an appropriate choice for many people with severe OA. They’re also a significant surgery with months of rehab, so it’s worth being sure the alternatives have been properly tried. The Australian Orthopaedic Association generally suggests considering surgery when:
- pain is severe and consistently affecting daily activities and sleep
- a structured strength program (typically three months or more) hasn’t given enough relief
- imaging confirms advanced osteoarthritis matching the clinical picture
- the patient is otherwise fit enough for the operation and post-operative rehab
If you’re already on a waiting list, the pre-operative period is when "prehab" matters most. Stronger quads going in means a faster, smoother recovery coming out.
Living with knee OA, day to day
Most people with knee OA have good days and bad days. Some weeks feel like things are getting worse; the next week is fine. That pattern is normal and not a sign the joint is failing — pain in arthritic joints fluctuates with sleep, stress, weather and how much load you put through the leg the day before.
The skill is learning to keep going on the bad days without overdoing it. Walking shorter distances rather than skipping a walk altogether. Doing the exercises on a Tuesday because you didn’t feel like it Monday. Most progress in OA happens through consistency, not intensity.
Common questions about knee osteoarthritis
Is it safe to exercise with knee OA?
Yes — and probably necessary. The fear that exercise damages an arthritic knee isn’t supported by the evidence. Progressive strength and aerobic exercise consistently improve pain and function in people with knee OA.
Will an MRI help?
For most people with classic OA, an X-ray gives all the information needed. MRIs often pick up extra findings (meniscal degeneration, small effusions) that don’t change the management plan and can occasionally make people more worried rather than less.
What about cortisone injections?
Cortisone can give short-term relief, sometimes useful when you’re trying to start an exercise program through a painful flare. The benefit is usually weeks to a few months. Long-term cortisone use isn’t recommended for OA because of cumulative effects on cartilage.
Will losing weight help?
For people with extra weight, yes — and meaningfully so. Even modest weight loss reduces knee load and pain. It’s rarely the whole answer, but it’s a useful piece of the puzzle alongside strength work.
How long until exercise actually helps?
Most people notice some improvement in six to eight weeks of consistent strengthening. By twelve weeks, the change is often substantial. That timeline is one of the reasons we tend to commit people to a structured program rather than ad hoc visits.
Begin your journey to a healthier you.
Book online in under two minutes — or call our team to talk it through first.