You have knee osteoarthritis (gonarthrosis) and you are wondering if walking is good for bone on bone knee?
Does walking worsen arthritis and damage the cartilage more? Or does it relieve pain? If so, is there a specific type of walking to prioritize? What about frequency and intensity? Does walking from your car to buy bread count?
Perhaps arthritis is so bad ans you can’t walk. In that case, what can you do?
As a physical therapist, I encounter these questions almost every day. In this article, I address the most common inquiries based on my experience as a physical therapist and thorough research in scientific publications (references at the end of the article).
Happy reading 🙂!
Summary: Is walking good for knee osteoarthritis? Yes, everything suggests that walking does not worsen arthritis and may even alleviate symptoms if done frequently and for sufficient duration. However, it’s crucial to carefully manage the effort level.
Last update: September 2023
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What do we know about the benefits of walking for knee osteoarthritis?
Before explaining how to practice walking properly with knee osteoarthritis, let’s make sure it is indeed beneficial!
Ideally, we would compare walking to any other activity (or inactivity) that we could do instead: cycling, sitting and watching TV, doing household chores, practicing yoga…
Of course, it’s very challenging to compare walking to all imaginable activities.
That’s why I will focus here on what we know about walking compared to “doing nothing”: staying at home, sitting or lying down, or engaging in minimal tasks requiring little physical effort.
Theoretical benefits of walking for knee osteoarthritis
In theory, walking can have a positive effect on knee pain, discomfort, and osteoarthritis. Here are the main explanatory mechanisms:
- Walking strengthens the muscles around the knee joint, which can reduce pain and limit stress on the joint (thus slowing down the progression of wear and tear).
- It improves joint mobility.
- Walking increases blood circulation. Through blood circulation, nutrients and other molecules necessary for tissue repair are delivered to the body. This is especially important in cases of knee inflammation, which is common in osteoarthritis.
- It helps stabilize or even reduce body weight (compared to being sedentary). Excess weight can worsen pain and deterioration.
There are several coherent mechanisms that suggest walking is beneficial for knee osteoarthritis.
The benefits observed in people with knee osteoarthritis
I’m betting that at least 3 things interest you:
- Relieving your knee pain.
- Being able to do more without being limited by your knee osteoarthritis.
- Trying to slow down the progression of cartilage deterioration.
I will detail what we know about the effects of physical activity and walking on these 3 points. Not just in theory, but what happens to people with osteoarthritis who practice walking compared to those who do not or do so much less.
Walking to relieve knee pain? Yes
In people with knee osteoarthritis aged 50 years or older, brisk walking has been associated with less frequent development of knee pain, according to a study that followed over 1200 individuals.
Source: Lo 2022
Walking to be able to do more despite knee osteoarthritis? Yes
There are different ways to assess the amount of walking a person does. A commonly used measure is the number of steps per day, which can be easily obtained using a pedometer or a smartphone application.
For each additional 1,000 steps per day, there is a 16% and 18% reduction in functional limitations in knee osteoarthritis over a 2-year period (compared to individuals who walk only 1,000 steps per month).
1,000 steps is approximately equal to 650 meters, which is about ten minutes of walking. Generally, steps taken while at home or standing still are not counted.
Source: White 2014
Conclusion: People who walk the most despite knee osteoarthritis are the most likely to continue being able to perform daily activities.
Walking to limit knee cartilage wear? Yes
The study that followed over 1200 people aged 50 years and older with knee osteoarthritis also found that those who walked had a slower progression of cartilage degradation: the joint space narrowed less rapidly.
Source: Lo 2022
Does walking make knee osteoarthritis worse?
As always (even though it may be counterintuitive at times), even something as natural as walking can have negative effects, side effects, or undesirable outcomes.
Thus, walking can, in theory as well as in practice:
- Increase knee pain during or in the hours or days following the walk.
- Cause more damage to the cartilage and other components of the joint.
The challenge lies in evaluating whether, in your specific case, the potential benefits outweigh the potential risks. I believe that you are the best person to assess this personal benefit-risk balance. I will provide you with some guidance later in the article.
At the population level, the benefit-risk ratio of physical activity in general (not specifically walking) for knee osteoarthritis appears to be positive (Petrigna 2022).
Often, it is mainly a matter of finding the right dosage, quantity, and intensity of walking performed.
How far should you walk with osteoarthritis?
Are you convinced of the benefits of walking in your case? Do you want to know how to practice it more precisely to maximize the chances that it will be beneficial for your pain and other symptoms?
Here are some guidelines, based on recommendations from scientific publications and my experience with patients seeking help to manage their arthritis.
- Walking at least 6000 steps per day (approximately 2,5 miles) is a good threshold. But if this seems too much for you, know that an additional 1000 steps per day (0,4 miles) can make a difference.
- Ideally, you should walk at a fairly brisk pace, which causes slight breathlessness.
- If these distances are much too far compared to what you can do today, try to increase the distance by just a few tens or hundreds of meters on each outing.
- If walking is truly impossible, consider other physical activities such as exercises on the mat or standing, cycling, swimming, walking in water (known as longe cote), or exercises at the gym.
If you know that walking would be good for you, but you’re having trouble sticking to it over time, here are some tips I give to my patients in such cases:
- Use a pedometer (an app on your smartphone or a pedometer bought for less than 5 euros on Leboncoin or around ten euros at Decathlon) and record the number of steps you take each day.
- Propose walking with a friend or family member (family, neighbor, or friend).
- Join a local walking group organized by an association.
- Set very small goals. For example, aim to walk for 10 minutes per week (adjust according to your current level). Every little bit counts!
- Note the days you plan to walk in your agenda and cross them off when done.
- Identify the time of day when it’s easiest for you to go for a walk (often in the morning).
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If you are concerned that walking might trigger your pain, you can take note of your feelings after each outing. This will help you objectively assess the potential impact of walking on your pain.
And you may find that your pain fluctuates, whether you walk or not!
Walking sticks for knee arthritis sufferers?
If you are more drawn to Nordic walking than regular walking, feel free to adopt it!
Advantages of Nordic walking for knee arthritis
The main advantage of Nordic walking compared to regular walking is that the poles help relieve the weight you put on your painful knee.
This can help reduce pain and enable you to walk when you might not be able to without the poles. It also allows for longer walks or walking on uneven terrain, which may not be possible without the poles.
Nordic walking also provides a more intense workout as it involves using your arms in addition to your legs. This engages more muscles and activates your cardiovascular system.
For the same duration of exercise, you burn more calories and energy, which can be beneficial for managing your weight. Weight is a factor that can worsen arthritis and its symptoms.
Disadvantages of Nordic walking for knee arthritis
The main disadvantage is the cost of purchasing the walking poles. However, you can find used poles on platforms for around ten dollars.
Another downside is the difficulty in walking with poles if you are not used to it.
It is not certain whether walking with hiking/Nordic walking poles is significantly more effective than walking without poles for knee arthritis. Therefore, practice according to what inspires you the most!
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Arthritis so bad can’ ‘t walk: what should I do?
Have you tried gradually increasing your walking distance (starting with just a few tens of meters)? And really, despite trying other activities like cycling or swimming, your knee cannot tolerate even a few minutes of simple walking.
This is a situation that regularly occurs with my patients who are undergoing rehabilitation for a unicompartmental or total knee replacement.
Knee replacement surgery is an option proposed when “nothing else works” and individuals desperately want to walk longer distances again.
Some people are reluctant to undergo surgery and seek all possible natural treatments for knee arthritis. Unfortunately, the most likely effective natural treatment is… physical activity!
However, when someone truly cannot engage in any form of physical activity (even with alternatives like cycling or swimming), they feel stuck.
When a person seeks my advice regarding the relevance of knee surgery and knee replacement in their case, I try to:
- Assess all the measures they have already taken to alleviate their pain or improve their abilities.
- Understand their specific expectations and hopes regarding what the surgery could achieve for them.
- Present them with data on post-surgery outcomes for knee operations, including how pain typically evolves and what activities people are able to do on average after the surgery.
These pieces of information should help form the most informed opinion possible about what knee surgery can offer (or not) for highly disabling knee arthritis when nothing else works.
Here are some data on the subject while awaiting a more comprehensive article:
- Six months after the operation (not before), the walking speed of operated patients significantly increases to approach the “average” walking speed of people without symptomatic arthritis.
- However, one year after the surgery, the walking speed decreases again (Abbasi-Bafghi 2012).
- The surgery improves the ability to be consistently active in daily activities during the three to four years following the operation (Abbasi-Bafghi 2012).
- Patients tend to have overly optimistic expectations regarding functional recovery after arthroplasty and underestimate the recovery time (Abbasi-Bafghi 2012).
- 85.5% of individuals who undergo total knee replacement before the age of 50 are satisfied or very satisfied with the operation (Aujla, 2017).
Is treadmill walking good for arthritis?
Yes, treadmill walking can be beneficial for kneearthritis. Here are some reasons why treadmill walking can be advantageous:
- Customizable Speed and Incline: Treadmills allow you to adjust the speed and incline according to your comfort level and fitness goals. You can start with a slow pace and gradually increase it as you build strength and endurance.
- Stability and Safety: Treadmills provide handrails for support, making it safer and more stable for people with balance issues or joint discomfort.
However, it is not a magical tool to cure arthritis! And I bet you know at least one person in your circle who bought a treadmill with good intentions… and never used it regularly! For knee arthritis, walking is a good thing, whether it’s on a treadmill or not, with or without walking poles, with or without a pedometer: what matters most is consistency and intensity (= getting slightly out of breath)!
Here’s what I wanted to tell you about this! Do you have any comments or questions? Your comments are welcome 🙂 !
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Petrigna L, Roggio F, Trovato B, Zanghì M, Guglielmino C, Musumeci G. How Physical Activity Affects Knee Cartilage and a Standard Intervention Procedure for an Exercise Program: A Systematic Review. Healthcare (Basel). 2022 Sep 21;10(10):1821. doi: 10.3390/healthcare10101821. PMID: 36292268; PMCID: PMC9602429.
Grace et al. 2022. Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals With Knee Osteoarthritis: Data From the Osteoarthritis Initiative Cohort
White DK, Tudor-Locke C, Zhang Y, Fielding R, LaValley M, Felson DT, Gross KD, Nevitt MC, Lewis CE, Torner J, Neogi T. Daily walking and the risk of incident functional limitation in knee osteoarthritis: an observational study. Arthritis Care Res (Hoboken). 2014 Sep;66(9):1328-36. doi: 10.1002/acr.22362. PMID: 24923633; PMCID: PMC4146701.
Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med. 2019 Oct 24;8(11):1769. doi: 10.3390/jcm8111769. PMID: 31652929; PMCID: PMC6912819.
Garver MJ, Focht BC, Taylor SJ. Integrating lifestyle approaches into osteoarthritis care. J Multidiscip Healthc. 2015 Sep 15;8:409-18. doi: 10.2147/JMDH.S71273. PMID: 26396527; PMCID: PMC4576887.
Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D; Ottawa Panel. Ottawa panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis. Arch Phys Med Rehabil. 2012 Jul;93(7):1269-85. doi: 10.1016/j.apmr.2012.01.024. Epub 2012 Mar 12. PMID: 22421624.
Tanaka R, Ozawa J, Kito N, Moriyama H. Effects of exercise therapy on walking ability in individuals with knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2016 Jan;30(1):36-52. doi: 10.1177/0269215515570098. Epub 2015 Feb 17. PMID: 25691583.
Abbasi-Bafghi H, Fallah-Yakhdani HR, Meijer OG, de Vet HC, Bruijn SM, Yang LY, Knol DL, Van Royen BJ, van Dieën JH. The effects of knee arthroplasty on walking speed: a meta-analysis. BMC Musculoskelet Disord. 2012 May 6;13:66. doi: 10.1186/1471-2474-13-66. PMID: 22559793; PMCID: PMC3481434.
Aujla RS, Esler CN. Total Knee Arthroplasty for Osteoarthritis in Patients Less Than Fifty-Five Years of Age: A Systematic Review. J Arthroplasty. 2017 Aug;32(8):2598-2603.e1. doi: 10.1016/j.arth.2017.02.069. Epub 2017 Mar 3. PMID: 28456563.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.