Knee pain making stairs, walking or exercise harder?

What is knee osteoarthritis?

The knee joint is formed by the thigh bone, shin bone and kneecap. The ends of these bones are covered by smooth cartilage, which helps the joint move and distribute load.

Knee osteoarthritis describes changes that can develop across the whole joint over time. These changes may involve the cartilage, bone and surrounding tissues, but they do not mean the knee has simply “worn out”.

You may hear osteoarthritis described as “bone on bone”. This can be misleading. Even when an X-ray shows reduced joint space or more advanced changes, it does not tell us exactly how much pain you will have or what you will be able to do.

Cartilage is only one part of how well the knee copes with load. Muscle strength, joint movement, balance, confidence and overall fitness also contribute to knee capacity, and these can often be improved.

That means people with osteoarthritis can still make meaningful gains in walking, stairs, exercise and day-to-day function, even if the changes seen on a scan remain the same.

The aim of treatment is not to replace missing cartilage. It is to help the knee and the rest of the body cope better with the demands of daily life.

Can physio help with knee pain and osteoarthritis?

Yes. Physiotherapy is a recommended part of non-surgical care for knee osteoarthritis, particularly when it includes education, tailored exercise and support to stay active.

Physio can help you understand what may be contributing to your symptoms, find an appropriate starting point and progressively rebuild the strength and capacity needed for everyday life.

Depending on your situation, physio may help you:

• reduce pain and stiffness
• improve knee, hip and calf strength
• become more comfortable with stairs, hills and longer walks
• return to exercise or the gym with a clear progression
• manage flare-ups without stopping everything
• improve confidence in a knee that feels weak or unreliable
• understand what your scan results do and do not mean

At Fitness Physio, we do more than provide a generic exercise sheet. We assess your movement, strength, daily demands and goals, then build a plan around the activities you want to keep doing or return to.

A good rehab plan usually helps you build confidence as well as strength.

Common symptoms

You may notice:

• an ache around the front, inside or general area of the knee
• stiffness after sitting, driving or resting
• discomfort walking, especially on hills or uneven ground
• pain with stairs, squatting or getting out of a chair
• reduced movement when bending or straightening the knee
• a feeling that the knee is weak, unreliable or difficult to trust
• mild swelling, fullness, clicking or grinding around the joint

Knee noises are common and do not automatically mean the joint is being damaged. Their importance depends on the rest of your symptoms and how the knee is functioning.

What can contribute to gradual knee pain?

There often is not one single cause.

Knee osteoarthritis involves changes within the joint over time, but symptoms can also be influenced by how the knee is coping with current demands.

What may be contributing to your symptoms can include:

• a recent increase in walking, work, exercise or training
• reduced strength through the thigh, hip or calf
• reduced knee movement or tolerance to bending
• doing less activity after a previous flare-up
• changes in body weight or overall load on the knee
• poor sleep, stress or limited recovery
• reduced confidence after pain, a scan or previous advice

For some people, symptoms increase because the knee has temporarily been asked to do more than it is ready for. For others, a long period of avoiding movement can reduce strength and make normal activities feel more demanding.

The amount of change seen on an X-ray does not always match how much pain or restriction someone experiences. Knee pain is not determined by the joint alone. Sleep, stress, general health, activity levels and confidence with movement can all affect symptoms and recovery.

That is why the assessment needs to focus on the person, not just the scan.

What current evidence suggests

Current evidence generally supports physiotherapy-led education, tailored exercise and ongoing physical activity as core treatments for knee osteoarthritis.

Australian clinical guidance recommends helping people stay active, set appropriate exercise goals and access programs suited to their priorities and preferences. A physiotherapist can help turn that advice into a practical plan by assessing your starting point, adjusting activity during flare-ups and progressively rebuilding strength and function.

There is also direct trial evidence for physiotherapy. In a randomised study of 156 people with knee osteoarthritis, those who received physical therapy reported less pain and functional difficulty at one year than those who received a corticosteroid injection. This does not mean injections are never appropriate, but it shows that physiotherapy can offer meaningful longer-term benefits.

For people with more advanced symptoms, knee replacement can provide greater average improvement than non-surgical care, but it also carries surgical risks. A structured trial of exercise, education and activity management is therefore an important step before surgery, and can also help prepare you physically if an operation is eventually needed.

GLAD for knee osteoarthritis

Fitness Physio offers the GLAD exercise and education program for people with knee osteoarthritis.

The program combines supervised exercise with practical education about osteoarthritis, activity and symptom management. It is designed to help you improve strength, function and confidence in your knee while building habits you can continue beyond the program.

GLAD may suit people who want more structure and supervision than a home exercise program alone. Your physio can assess whether the program is appropriate for you or whether a more individual treatment plan would be a better starting point.

Find out more about GLAD here

Can physio help me avoid or prepare for knee replacement?

Not everyone with knee osteoarthritis needs a knee replacement.

For many people, a structured program of education, strengthening, activity management and general exercise can improve pain and function enough to delay surgery or make it unnecessary at that stage.

Knee replacement can be a helpful option when pain and loss of function remain severe despite appropriate non-surgical care.

Physio can still play an important role by helping you:

• understand whether you have completed a reasonable trial of non-surgical care
• improve strength, fitness and confidence before deciding on surgery
• prepare physically if a knee replacement is already planned
• maintain function while waiting for a surgical appointment
• plan rehabilitation after your operation

The right next step depends on your symptoms, function, goals, general health and response to treatment—not simply the appearance of an X-ray.

How we assess knee pain

In your first session, we will look at how the problem developed, what currently aggravates it and what you want to get back to.

Your assessment may include:

• your symptoms, medical history and previous knee injuries
• recent changes in work, walking, sport or gym training
• knee movement, swelling and areas of sensitivity
• strength through the knee, hip and calf
• walking, balance, squatting or getting up from a chair
• relevant work, sport, gym and daily tasks
• whether further investigation or medical review may be appropriate

We will explain what may be contributing to your symptoms and give you a plan for what to keep doing, what to modify and how to begin rebuilding capacity.

Not everyone with gradual knee pain needs a scan. In many cases, the history and physical assessment provide enough information to begin treatment. Imaging may be useful when the diagnosis is unclear, symptoms are unusual or the result is likely to change management.

How we treat knee pain and osteoarthritis

Depending on what we find, your treatment plan may include:

• hands-on physio to help reduce pain or improve movement
• education and advice about osteoarthritis and flare-ups
• individual exercise rehabilitation
• knee, hip and calf strengthening
• balance and movement-control exercises
• gradual walking, gym or fitness progression
• load management for work and daily activity
• return-to-work, return-to-gym or return-to-sport planning
• supervised rehabilitation in our onsite gym

Hands-on treatment may help some people feel more comfortable, particularly during a painful or stiff period. It is usually used to support active rehabilitation rather than replace it.

Your program should match your starting point and goals. Someone wanting to walk comfortably around the block may need a different plan from someone aiming to return to golf, tennis, running or regular strength training.

We will also help you understand how to respond when symptoms fluctuate. A temporary increase in soreness does not necessarily mean you have harmed the knee, but it may mean the amount, intensity or recovery between activities needs to be adjusted.

What to expect from your first appointment

Your first appointment is about getting a clear explanation and a useful plan.

We will discuss when your symptoms began, how they have changed and which activities are becoming difficult. We will also ask about work, exercise, previous injuries, general health and any scans or medical advice you have already received.

Your physio will assess your knee movement and strength, then look at relevant tasks such as walking, squatting, stairs, balance or getting up from a chair.

By the end of the session, we aim to give you:

• a likely explanation for your symptoms
• advice on what you can keep doing
• guidance on what to reduce or modify temporarily
• a starting treatment and exercise plan
• a clear idea of how rehabilitation may progress
• advice about whether medical review or imaging is needed

The plan should give you more than a diagnosis. It should help you understand what to do next.

Common concerns about knee osteoarthritis

Does the amount of arthritis on an X-ray determine how much pain I will have?

Not necessarily.

Scan findings and symptoms do not always match closely. Some people have significant changes on imaging with few symptoms, while others have considerable pain despite relatively modest changes.

Your function, strength, activity, sleep, recovery and confidence with movement can also influence how your knee feels.

Is osteoarthritis just wear and tear?

“Wear and tear” can make it sound as though the knee is simply wearing out and movement will make it worse. That is usually not a helpful way to understand osteoarthritis.

Joint changes can be influenced by age, genetics, previous injury, strength, activity and other health factors. Appropriate movement and strengthening are generally part of management, not something that needs to be avoided.

Should I rest when my knee hurts?

Reducing or modifying an irritating activity can be useful during a flare-up, but prolonged rest can reduce strength and make everyday activity harder.

The aim is usually to find a manageable level of movement, then gradually build from there.

Does pain during exercise mean I am damaging my knee?

Not always.

Some discomfort can occur when beginning a new exercise or increasing activity. The amount of pain, how long it lasts and how the knee responds afterwards all matter.

Your physio can help you judge whether the exercise level is appropriate or needs adjusting.

Why choose Fitness Physio?

At Fitness Physio, we help people with knee pain return to the activities that matter to them.

Your treatment can combine hands-on physio with evidence-based exercise rehabilitation and strength and conditioning. Our onsite rehab gym allows us to progress beyond basic exercises and prepare you for the demands of walking, work, the gym, sport and daily life.

Our Newcastle and Merewether physiotherapists focus on giving you:

• a clear explanation of what may be contributing
• treatment that reflects your individual situation
• practical guidance about movement and activity
• progressive rehabilitation rather than random exercises
• support returning to work, training and everyday life