Gentle Exercises for Knee and Hip Pain

Before you start

Check with a doctor first if:

• you have not exercised for a long time and have heart disease, uncontrolled blood pressure, breathlessness, chest pain, dizziness, or diabetes on insulin;
• the pain is new, severe or sudden, follows a fall, or the joint is hot, red or very swollen;
• you have had joint replacement or fracture surgery (follow your surgical team's exercise plan and precautions; see knee replacement recovery equipment and hip replacement recovery equipment);
• you have osteoporosis with a recent fracture, or severe bone thinning, where certain bending and twisting movements are not advised; see exercise for osteoporosis;
• you have dizziness, balance problems or fall risk, where support and supervision are needed; see falls risk assessment at home.

Choose a safe setting. A sturdy chair with a firm seat and no wheels, placed against a wall or a table. Non-slip footwear or bare feet on a non-slip surface. Good light. A clear floor. Something to hold for standing exercises. Water to drink.

Time of day. When the joints are least stiff, often late morning or after a warm bath. Not right after a heavy meal. In hot weather, exercise indoors in the cool hours; see exercise in summer and monsoon indoors.

Warm up. A warm shower or a warm pack for 10 minutes loosens the joints; see heat or cold for joint pain. Then spend 3 to 5 minutes on gentle movements: march slowly on the spot sitting, rotate the ankles, shrug and roll the shoulders.

How hard? The pain rule

A sensible guide for arthritis exercise:

• Mild discomfort or stretch during exercise is acceptable.
• Sharp, stabbing or increasing pain means stop that movement.
• Pain that is worse than usual for more than one to two hours after exercise, or swelling the next day, means you did too much; reduce the number or range next time.
• Start with 5 to 10 repetitions of each exercise, once or twice a day, and build up slowly over weeks.
• Breathe normally; do not hold your breath.
• Move slowly and smoothly. No bouncing or jerking.
• Rest between exercises, and stop if you feel dizzy, breathless or have chest pain.

Seated exercises (chair)

Sit tall near the front of a firm chair, feet flat, back supported if needed.

1. Seated marching. Lift one knee a few centimetres, then lower, alternating. 10 to 20 times. Warms up hips and knees. 2. Ankle pumps and circles. Point toes up and down 10 times, then circle each ankle 10 times each way. Helps circulation. 3. Knee extension (seated leg lift). Slowly straighten one knee until the leg is out in front, hold for 3 to 5 seconds, tighten the thigh, lower slowly. 8 to 10 times each leg. Strengthens the front thigh (quadriceps), the key knee muscle. 4. Heel slides (seated). Slide one heel back under the chair, then forward, bending and straightening the knee gently. 10 times each. Keeps the knee moving. 5. Hip abduction (seated). Place a light band or nothing around the thighs, and slowly open the knees apart a little and return. 10 times. Strengthens outer hips; use a resistance band only later; see resistance bands guide. 6. Seated hip flexion hold. Lift the knee slightly and hold for 5 seconds, then lower. 5 to 8 times each leg. 7. Seated hamstring stretch. Place one heel forward on the floor with the knee straight, and gently lean forward from the hips, back straight, until you feel a mild stretch behind the thigh. Hold 20 seconds, twice each side. 8. Sit-to-stand. Sit near the front edge, feet hip-width, lean forward, push up through the legs to stand, then lower slowly. Use the arms if needed. 5 to 10 times. This is a very functional exercise; make it easier with a higher seat or a cushion; see choosing a chair for an older person and helping an elderly parent stand from a chair.

Lying exercises (bed or mat)

Lie on a firm bed or a mat on the floor if getting down is safe; see yoga mat and floor exercise safety. If lying flat is uncomfortable, use a pillow under the head.

1. Static quadriceps (quad sets). Lie with the leg straight, a rolled towel under the knee. Press the back of the knee into the towel, tightening the thigh muscle, hold for 5 seconds, release. 10 times each leg. 2. Straight leg raise. Lie on the back with one knee bent and the other straight. Tighten the thigh of the straight leg and lift it a short way, hold for 3 seconds, lower slowly. 8 to 10 times. 3. Heel slides. Lying on the back, slowly slide the heel towards the buttock, bending the knee, then straighten. 10 times each leg. 4. Bridging. Lie on the back with knees bent and feet flat. Gently lift the hips a few centimetres by squeezing the buttocks, hold 3 seconds, lower. 8 to 10 times. Avoid if it hurts the back or knees. 5. Side-lying leg lift (hip abduction). Lie on one side, bottom knee bent, top leg straight, and lift the top leg a short way, keeping the toes pointing forward. 8 to 10 times, then switch sides. Strengthens outer hip. 6. Hip and knee hugs. Lying on the back, gently draw one knee toward the chest with the hands behind the thigh, hold 10 seconds. Not if you have a hip replacement or severe hip pain, unless allowed. 7. Gentle knee rolls. With knees bent and feet flat, let the knees fall gently to one side and then the other, in a small range. Not after hip replacement unless allowed.

Standing exercises (with support)

Hold the back of a sturdy chair or a kitchen counter. Do these only if balance is reasonably good.

1. Standing heel raises. Rise onto the toes slowly, hold, lower. 8 to 10 times. Strengthens the calf and ankle. 2. Mini squats. Hold the support, bend the knees a little, as if starting to sit, keeping the knees over the toes and back straight, then rise. 5 to 8 times, a small range only. Avoid deep squats if painful. 3. Standing hip abduction. Lift one leg out to the side a short way, keeping the body upright, hold, lower. 8 times each leg. 4. Standing knee bends (hamstring curls). Bend one knee, lifting the heel towards the buttock, and lower. 8 times. 5. Standing hip extension. Take one leg slightly back, tightening the buttock, and return. 8 times. 6. Marching on the spot, holding on. 7. Weight shifts. Shift weight from one foot to the other slowly. 8. Balance practice. Stand on one leg for a few seconds while holding a support, later without; see balance exercises for seniors and balance pad guide.

Low-impact aerobic activity

Strength work goes best with gentle activity: level walking in supportive shoes with a stick if needed (see walking programme for older adults and choosing shoes for older feet), a pedal exerciser while seated, warm-water exercise or gentle tai chi with a trained instructor. Aim for 20 to 30 minutes most days, in short bouts if needed; see exercise at home for seniors: starter guide.

Stretching

Stretch after exercise or when warm, holding each stretch 20 to 30 seconds without bouncing: calf, hamstring and, if easy, front thigh and hip; see stretching for stiff older bodies.

Sample routine

A 15 to 20 minute routine, once or twice a day: warm up for 3 to 5 minutes; seated knee extensions and heel slides; sit-to-stand 5 to 8 times; lying quad sets and straight leg raises; side-lying leg lifts; standing heel raises and mini squats with support; calf and hamstring stretches; then slow breathing to cool down. Progress slowly, adding repetitions or a second set after two to three weeks, and add bands or weights only after advice.

What to avoid

• High-impact activity, jerky movements and twisting on a planted foot.
• Deep squats, kneeling and cross-legged sitting if they provoke pain.
• Exercising through sharp pain, or on a hot, swollen joint.
• Exercising on slippery floors, or in socks, or when unwell.
• Holding the breath.

Making it a habit

Link the exercises to a routine such as after morning tea, exercise with a spouse or friend (see motivating a parent to exercise), keep a simple tick chart, and celebrate small gains. Strength builds over weeks to months, so be patient.

Pain relief around exercise

Heat before and cold after if sore (see heat or cold for joint pain); medicines only as advised (see painkillers and older adults). For a fuller home plan, see knee osteoarthritis at home and exercise with arthritis.

When to stop and see a doctor

Stop exercising and seek medical advice if you have:

• chest pain, pressure, breathlessness out of proportion, palpitations, fainting or severe dizziness (call emergency help);
• sudden severe joint pain, a joint that gives way, locks or cannot bear weight;
• a hot, red, markedly swollen joint, or fever;
• new numbness, tingling or weakness in a leg;
• a swollen, painful calf;
• pain after a fall;
• pain that keeps getting worse over days despite reducing exercise.

When to ask a professional

A physiotherapist is the best person to assess your joints, strength and balance, and prescribe an individual exercise programme, with progression. A doctor should check new or severe pain and suitability for exercise if you have heart or other conditions. An occupational therapist can help with daily tasks and home aids. A dietician can help with weight and nutrition. Ask about supervised classes or group programmes in your community.