I have knee arthritis: can physio help me? 

Lucy Macdonald, Physiotherapist at the Octopus Clinic in Central London, gives her expert opinion on the role of physiotherapy both as a treatment for knee arthritis, and also as an important aspect of properly preparing oneself for actual knee replacement surgery.


Intro by Lucy Macdonald

Your physiotherapist will be able to improve your pain to enable you to do the things that you want to do in your life. They will do this by getting a detailed picture of all activities, hobbies, exercise and sports that you enjoy and tailoring a treatment programme to achieve those things. This will include the following:

1. Correcting alignment and biomechanics

Improving the alignment or ‘biomechanics’ of your knees. To do this your physio will first analyse your movements. They will then show you how to adjust your movement to make sure the forces that are put through the structures of the knees are spread in a way that reduces pain. This can sometimes result in immediate reduction in your pain in daily activities like walking, getting up from sitting and going up and downstairs. Here is an example to get you started:

2. Muscle strengthening

Strengthening the muscles that support your knees like the quadriceps at the front of the knee, hamstrings at the back of the knee and the calf muscles too. This helps to make sure that the muscles take as much load as possible rather than the knee joint and cartilage. Your physio will make sure that you work your muscles in a way that keeps them flexible as well as strong. It is often better to lengthen your muscles with ‘eccentric’ muscle activities rather than with passive stretching. Here is an example of this:

3. Exercise advice

Give you exercises to improve the strength of the stability muscles of your back, hips and feet. If these muscles are working properly then the knees are more efficient and less painful. Here is an example of one of these exercises:

4. Addressing secondary issues

Assess and treat any other secondary issues that have arisen in combination with the knee arthritis that may be causing you pain, for example a tendinopathy (previously known as tendinitis) or an ITB problem. Physiotherapy treatment for these things is highly effective. Here is a video on the physio management of tendinopathies:

5. Pain management

Show you ways of reducing the pain and swelling yourself. For example, explaining when to use ice or heat, telling you what knee support or braces would be useful for you and showing you how to apply tape to reduce your pain.

6. Empowerment to take control of your symptoms

Empower you to take control of your pain and plan your activities short and long term. To do this your physio will show you how to use an activity diary to make sure you are being steady with the amount of load the knees are taking. The knees love to be loaded steadily and in small increments and will not respond well to sporadic exercise or sudden increases or decreases in exercise. Your physio will explain to you how you know when you are doing too much or too little and the difference between good and bad pain.

7. Dietary advice

Explain what foods are good for reducing pain and inflammation and, if you need to, how you can lose weight healthily.

8. Stress reduction

Help you with other things that will enable optimal healing like stress reduction, general exercise and sleep improvement.

9. Hands-on manual therapy

Provide hands on treatment like massage, acupuncture, joint mobilisations that can reduce your pain short term and enable you to do the exercises which will give you longer term relief.

10. Education

Help you to understand the recovery process after surgery if this is what you and your consultant decide is the best way forwards.

Contact Lucy

For more information on knees and to access the Octopus Clinic exercise video library for free please go to or contact Lucy Macdonald by email or phone 02075838288.