If you have knee osteoarthritis, you may have received two apparently contradictory pieces of advice:

“Your knee is worn out. Don’t overuse it.”

and:

“You need to exercise your knee.”

So which is correct?

For most people with knee osteoarthritis, appropriate exercise is an important part of treatment.

Singapore’s current clinical guidance identifies exercise as one of the mainstay management strategies for knee osteoarthritis, alongside patient education and weight management.

The important word is:

Appropriate.

Exercise for knee arthritis does not mean forcing yourself to run through severe pain.

It means finding an appropriate combination of:

• Strengthening
• Movement
• Functional exercise
• Aerobic activity
• Gradual progression

according to your symptoms and abilities.

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Why Exercise a Painful Knee?

It may seem logical that if a joint hurts, the safest thing is to stop using it.

Short periods of activity modification may sometimes be appropriate when symptoms flare.

But prolonged inactivity can have consequences.

When you move less, muscles can become weaker.

When muscles become weaker, everyday activities can become harder.

That can create a cycle:

KNEE PAIN

↓

LESS MOVEMENT

↓

MUSCLE WEAKNESS

↓

LOWER FITNESS

↓

EVERYDAY ACTIVITIES BECOME HARDER

↓

EVEN LESS MOVEMENT

The objective of exercise is partly to interrupt this cycle.

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Exercise Does Not Mean “Just Go Running”

When someone is told:

“You need more exercise.”

they may imagine:

• Running
• Jumping
• Squats with heavy weights
• Long walks
• Gym workouts

That can be intimidating if walking to the bus stop already hurts.

Exercise can begin at a much lower level.

For one person, exercise might mean cycling for 30 minutes.

For another, it may begin with learning to stand from a chair repeatedly.

The programme should fit the patient.

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What Types of Exercise Can Help Knee Osteoarthritis?

A knee arthritis exercise programme may include several categories.

1. Quadriceps Strengthening

The quadriceps are the large muscles at the front of the thigh.

They are important for:

• Walking
• Standing up
• Climbing stairs
• Controlling the knee
• Everyday movement

Strengthening these muscles is commonly incorporated into knee osteoarthritis rehabilitation.

Exercises might include variations of:

• Knee extension exercises
• Sit-to-stand
• Supported squats
• Step exercises
• Other progressive strengthening exercises

The appropriate exercise depends on the individual.

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2. Hip and Gluteal Strengthening

Your knee does not function independently from the rest of your leg.

Muscles around the hip and pelvis contribute to lower-limb control.

A rehabilitation programme may therefore include strengthening of:

• Gluteal muscles
• Hip abductors
• Hip extensors
• Other lower-limb muscles

This is one reason knee rehabilitation should not necessarily focus only on where the pain is felt.

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3. Functional Exercise

Patients generally do not come to a clinic because they want stronger quadriceps.

They come because they want to:

Walk without worrying about their knee.

Climb stairs.

Get out of a chair.

Go shopping.

Travel.

Work.

Exercise.

Spend time with their family.

Rehabilitation should therefore connect exercise with function.

Examples may include:

• Sit-to-stand
• Step-ups
• Walking exercises
• Balance exercises
• Stair-related exercises
• Functional lower-limb strengthening

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4. Aerobic Exercise

Aerobic exercise may also form part of knee osteoarthritis management.

Depending on the individual, this could include:

• Walking
• Stationary cycling
• Swimming
• Water-based exercise
• Other appropriate cardiovascular exercise

The best activity is not necessarily the one that looks most impressive.

It is often the one that the patient can perform consistently and progressively.

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5. Mobility Exercises

Some people with knee osteoarthritis experience stiffness or reduced movement.

Appropriate mobility exercises may therefore be incorporated into rehabilitation.

The goal is not necessarily to force the knee into painful positions.

It is to maintain or improve useful movement where appropriate.

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How Much Exercise Should I Do?

There is no single exercise prescription suitable for every knee.

Your programme may depend on:

• Age
• Current strength
• Current activity
• Pain severity
• Knee movement
• Other medical conditions
• Previous injuries
• Exercise experience
• Functional goals

Someone who currently walks 10,000 steps a day requires a different programme from someone struggling to walk around the supermarket.

The starting point should therefore be individualised.

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Should Exercise Hurt?

This is one of the most important questions.

People sometimes assume:

“Any pain means I am damaging my knee.”

That is not necessarily true.

Some people with osteoarthritis can experience discomfort during or after exercise without necessarily causing additional structural damage.

But that does not mean:

“Ignore severe pain and push through everything.”

The response to exercise should be considered in context.

Factors include:

• How intense the pain is
• How long it lasts
• Whether swelling increases
• Whether function becomes worse
• Whether symptoms settle afterwards
• Whether the exercise can be modified

If exercise repeatedly causes substantial or prolonged worsening, the programme may need to be adjusted.

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How Do I Know If I Am Exercising Too Much?

Possible signs that your programme needs review include:

• Major increases in pain
• Significant new swelling
• Persistent deterioration after exercise
• Increasing difficulty walking
• Repeated inability to complete the programme
• Symptoms that do not settle appropriately

The solution may not necessarily be to stop exercising completely.

It may be to change:

• Exercise type
• Resistance
• Repetitions
• Range of movement
• Frequency
• Duration
• Progression

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What If My Knee Hurts Too Much to Exercise?

This is where knee osteoarthritis management may require more than simply handing someone an exercise sheet.

If pain prevents meaningful rehabilitation, the doctor and physiotherapist can consider why.

Questions might include:

• Is the diagnosis correct?
• Is there significant inflammation?
• Is medication appropriate?
• Should the exercise programme be modified?
• Is another knee condition contributing?
• Would an additional treatment help the patient participate in rehabilitation?

The objective may be to reduce symptoms sufficiently to allow movement and strengthening to continue.

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Do I Need Physiotherapy to Exercise?

Not everyone with knee osteoarthritis requires long-term physiotherapy.

Some patients can exercise independently once they understand their programme.

Physiotherapy may be particularly useful when:

• You do not know where to start
• Exercise repeatedly aggravates symptoms
• You are significantly weak
• You have difficulty walking
• You struggle with stairs
• You are afraid of damaging your knee
• Previous exercises have not helped
• You need help progressing the programme

A physiotherapist can help establish a starting point and modify the programme according to your response.

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Check That Your Physiotherapist Is AHPC-Registered

Physiotherapy is a regulated profession in Singapore.

The Allied Health Professions Council (AHPC) regulates physiotherapists and maintains the professional register.

Patients should verify that their treating physiotherapist is appropriately AHPC-registered and authorised to practise.

At The Pain Relief Clinic, our physiotherapy team consists of:

Experienced, AHPC-Registered Physiotherapists

working alongside our doctors.

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What Should Good Knee Physiotherapy Look Like?

For knee osteoarthritis, physiotherapy should generally involve more than lying on a treatment bed.

Passive treatments may sometimes be used as adjuncts.

But an important objective is active rehabilitation.

A useful programme may include:

Assessment

What can you currently do?

Exercise Selection

Which exercises are appropriate?

Technique

Are you performing them correctly?

Dosage

How much should you do?

Progression

When should exercises become more challenging?

Functional Training

Can improvements translate into walking, stairs and daily activities?

Home Exercise

What can you continue independently?

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Don’t Measure Success Only by Pain

Pain matters.

But it is not the only outcome.

Suppose your pain changes only slightly, but you can now:

• Walk twice as far
• Climb stairs more easily
• Get out of a chair without using your arms
• Exercise for longer
• Return to work activities
• Go shopping
• Travel
• Play with your grandchildren

That represents meaningful improvement.

Useful measures include:

Pain

Strength

Walking ability

Stair climbing

Exercise tolerance

Daily function

Confidence

Quality of life

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What About Walking?

Walking can be a useful form of activity for many people with knee osteoarthritis.

But the appropriate amount depends on the individual.

If someone currently develops substantial pain after 15 minutes, immediately prescribing an hour-long walk may not be sensible.

A graded approach might involve finding a tolerable starting point and increasing gradually.

The goal is:

Progressive activity

rather than:

All or nothing.

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Is Cycling Good for Knee Arthritis?

Stationary cycling can be useful for some patients because it allows repetitive knee movement and aerobic activity without the same loading pattern as some weight-bearing exercises.

However, bike position, resistance and knee movement may need adjustment.

It is one possible exercise option rather than a universal prescription.

---

Is Swimming Good for Knee Arthritis?

Swimming and water-based exercise may be useful for people who find land-based activity difficult.

Water can reduce weight-bearing load while allowing movement and aerobic exercise.

But swimming is not compulsory.

Someone who dislikes swimming may be much more consistent with another appropriate form of exercise.

---

Are Squats Bad for Knee Arthritis?

Not automatically.

Squatting is a normal functional movement involved in activities such as:

• Sitting
• Standing
• Using the toilet
• Picking things up

The important questions are:

• How deep?
• How much resistance?
• How many repetitions?
• What technique?
• How does your knee respond?

A supported or partial squat may be appropriate for one patient while another requires a different starting exercise.

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Are Stairs Bad for Knee Arthritis?

Stairs commonly aggravate knee osteoarthritis symptoms.

But avoiding stairs forever does not necessarily improve the ability to climb them.

Rehabilitation may include progressive exercises designed to improve the strength required for stair climbing.

The exercise needs to match the person’s current ability.

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Should I Rest During a Knee Arthritis Flare?

Temporary modification of activity may sometimes be sensible when symptoms increase.

But there is an important difference between:

Reducing or modifying aggravating activity temporarily

and

Stopping all activity indefinitely.

The longer someone remains inactive, the harder it may become to regain strength and fitness.

---

What About Weight Loss?

Exercise and weight management are closely related.

For people who are overweight, weight management is another mainstay strategy for knee osteoarthritis.

But there is a common frustration:

“My doctor says lose weight.”

“My knee hurts when I exercise.”

“So how am I supposed to lose weight?”

This is why weight management should not simply mean telling someone to exercise more.

A more useful strategy may combine:

• Appropriate rehabilitation
• Activity modification
• Nutrition and lifestyle strategies
• Medical weight-management assessment where appropriate

At The Pain Relief Clinic, weight-management counselling can be incorporated into the knee arthritis pathway where relevant.

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Can Medication Help Me Exercise?

Sometimes.

Appropriate medication may help reduce symptoms sufficiently for a patient to:

• Walk
• Sleep better
• Exercise
• Participate in physiotherapy

Medication should therefore sometimes be viewed as a tool that supports rehabilitation.

It does not replace strengthening.

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What About Shockwave or TECAR?

Selected patients may receive additional treatment alongside active rehabilitation.

At The Pain Relief Clinic, options may include:

Shockwave Therapy

in selected appropriate musculoskeletal situations.

TECAR-Based Therapy

as an adjunct where clinically appropriate.

But these treatments should not automatically replace exercise.

For knee osteoarthritis, the exercise programme remains an important part of management.

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What If Exercise and Physiotherapy Aren’t Enough?

Do not simply assume:

“Physiotherapy doesn’t work.”

First ask why.

Possibilities include:

• The diagnosis was incorrect
• Exercise selection was inappropriate
• The exercises were not progressed
• Pain prevented meaningful rehabilitation
• Adherence was difficult
• Another condition is contributing
• Weight or other factors are important
• The arthritis is more functionally limiting than initially appreciated

A medical reassessment can help determine the next step.

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When Might an Injection Be Considered?

For persistent symptoms, additional medical treatment may sometimes be appropriate.

Singapore’s current knee osteoarthritis guideline recommends considering intra-articular corticosteroid injection for short-term symptom relief when symptoms persist despite appropriate medication and/or allied-health support.

The purpose may sometimes be to reduce pain sufficiently for the patient to continue moving and rehabilitating.

An injection does not itself strengthen the leg.

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What About Viscosupplementation?

Hyaluronic acid injections, sometimes called viscosupplementation, are offered by some clinics for knee osteoarthritis.

Evidence and recommendations are less consistent than for core strategies such as exercise.

Patients considering this option should discuss:

• Expected benefit
• Limitations
• Cost
• Risks
• Alternatives

It should not automatically replace an appropriate rehabilitation programme.

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When Is More Advanced Treatment Appropriate?

For selected patients with persistent significant symptoms despite appropriate conservative treatment, further options may include:

• Specialist pain-management assessment
• Pulsed radiofrequency in selected cases
• Specialist orthopaedic assessment
• Surgical treatment where appropriate

At The Pain Relief Clinic, visiting specialist doctors can assess selected patients for appropriate procedures when basic conservative treatment has not been sufficient.

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Do I Need Knee Replacement If Exercise Doesn’t Work?

Not automatically.

Failure of one exercise programme does not automatically mean surgery is required.

But repeated conservative treatment should also not continue indefinitely when someone has severe persistent functional limitation.

If appropriate treatment has been tried and the knee continues to substantially affect:

• Walking
• Stairs
• Work
• Sleep
• Daily activities
• Independence
• Quality of life

specialist surgical assessment may be reasonable.

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A Simple Knee Arthritis Exercise Pathway

At The Pain Relief Clinic, the pathway can look like this:

ASSESS

Understand the knee problem.

↓

START

Choose appropriate exercises.

↓

SUPERVISE

Use AHPC-registered physiotherapy where helpful.

↓

STRENGTHEN

Build lower-limb capacity progressively.

↓

PRACTISE

Continue the programme at home.

↓

PROGRESS

Make exercises appropriately more challenging.

↓

MEASURE

Track walking, stairs, strength, pain and function.

↓

REASSESS

If improvement is insufficient, determine why.

↓

ESCALATE IF NECESSARY

Consider additional medical or specialist options.

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$650 Knee Arthritis Rehab Programme

For suitable patients who want a structured starting point, The Pain Relief Clinic offers:

$650 Knee Arthritis Rehab Programme

including:

2 Doctor Consultations

For assessment, treatment planning and review.

2 Physiotherapy Sessions

With our experienced, AHPC-registered physiotherapy team.

Individualised Exercise & Rehabilitation Programme

Designed according to the patient’s needs.

Lifestyle Counselling

Where appropriate.

Weight-Management Counselling

Where appropriate.

Knee X-Ray

Where clinically indicated.

Medication

Where clinically indicated.

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Up to $500 MediSave Claimable in 2026*

For eligible patients:

Programme price: $650

MediSave: up to $500*

Cash payment: from $150*

*Subject to individual CDMP/MediSave eligibility, available annual withdrawal limit, sufficient MediSave balance, applicable co-payment requirements, clinical indication and eligibility of individual services.

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Frequently Asked Questions

Is exercise good for knee osteoarthritis?

Yes. Exercise is one of the mainstay management strategies recommended in Singapore’s current clinical guideline for knee osteoarthritis.

---

What is the best exercise for knee arthritis?

There is no single best exercise for everyone.

An appropriate programme can combine strengthening, functional exercise and aerobic activity based on the person’s symptoms, abilities and goals.

---

Can exercise make knee arthritis worse?

Appropriate exercise is generally part of recommended knee osteoarthritis management.

However, the programme may need modification if exercise causes substantial or persistent worsening of symptoms.

---

Should I exercise when my knee hurts?

Some discomfort does not automatically mean exercise must stop.

However, severe or persistently worsening symptoms should be assessed and the programme adjusted where necessary.

---

Should I walk with knee arthritis?

Walking can be appropriate for many people with knee osteoarthritis.

Distance and intensity may need to be adjusted according to symptoms and gradually progressed.

---

Is cycling good for knee arthritis?

It can be a useful option for some patients, particularly for aerobic exercise and repetitive knee movement.

---

Are squats bad for knee arthritis?

Not automatically.

The depth, resistance, repetitions and individual response matter.

---

Should I rest my arthritic knee?

Short-term activity modification may sometimes be useful during a flare, but prolonged inactivity can contribute to weakness and reduced fitness.

---

Do I need physiotherapy?

Not everyone requires long-term physiotherapy.

Physiotherapy can be particularly useful when you need assessment, exercise guidance, supervision or progression.

---

Are The Pain Relief Clinic’s physiotherapists AHPC-registered?

Yes.

Our physiotherapy team consists of experienced, AHPC-registered physiotherapists working alongside our doctors.

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Can MediSave be used for knee arthritis physiotherapy?

Eligible doctor-referred physiotherapy used as part of qualifying osteoarthritis management may be MediSave-claimable under CDMP, subject to prevailing requirements.

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What if exercise doesn’t help?

The next step should usually be reassessment rather than automatically repeating the same programme.

The diagnosis, exercise prescription, pain control and other contributing factors may need review.

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The Goal Is Not to Become Dependent on Treatment

For many people with knee osteoarthritis, one of the most useful outcomes of physiotherapy is learning:

What to do yourself.

A good rehabilitation programme should help you understand:

• Which exercises to perform
• How often to perform them
• How hard to work
• How to progress
• What symptoms to monitor
• When to seek reassessment

The ultimate objective is not simply:

“Come back for another treatment.”

It is:

Move better. Get stronger. Stay active.

And when that is not enough:

Reassess and consider the next appropriate treatment.

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Start With a Structured Knee Arthritis Programme

At The Pain Relief Clinic, our knee arthritis pathway combines:

Doctor-Led Assessment

Experienced AHPC-Registered Physiotherapy

Individualised Exercise

Progressive Strengthening

Lifestyle & Weight Management Where Appropriate

Medication & Investigation Where Clinically Indicated

Reassessment

Additional Medical or Specialist Treatment When Necessary

For suitable patients, ask about our:

$650 Knee Arthritis Rehab Programme

Up to $500 MediSave claimable in 2026*

Cash payment from $150*

*Subject to individual eligibility and prevailing MediSave/CDMP requirements.

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About the Reviewer

Reviewed by Dr Terence Tan
Founder, The Pain Relief Clinic
Singapore

Dr Terence Tan provides doctor-led assessment and non-surgical management of musculoskeletal conditions and works alongside The Pain Relief Clinic’s experienced, AHPC-registered physiotherapy team within an integrated care pathway.

Last reviewed: 3 October 2026

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Medical, MediSave & Insurance Disclaimer

This article provides general educational information and does not replace individual medical assessment, diagnosis or treatment.

Exercise should be individualised according to symptoms, medical conditions, physical ability and clinical assessment. Seek medical assessment for severe or rapidly worsening pain, significant swelling, inability to bear weight, fever, major trauma or other concerning symptoms.

MediSave eligibility depends on prevailing CDMP requirements, individual eligibility, clinical indication, annual withdrawal limits, co-payment requirements and applicable provider accreditation.

AHPC registration confirms professional registration but does not by itself establish MediSave or insurance eligibility.