Question explored with the scientific record
Conversation so far
- 1 With regards to my knee will this OA get better, become worse or stay the same if I employ physical therapy? + a private exchange
- 2 How much exercise /therapy is too much or too little? + a private exchange
- 3 Is walking a form of knee therapy
Answered on this page ↓
Is walking a form of knee therapy
Walking is not a standalone therapy for knee osteoarthritis, but it is a necessary part of rehabilitation that works best when combined with targeted strengthening.
The evidence shows that walking alone produces modest benefits. A 2011 randomized trial found that a four-week walking program improved dual-task performance and executive function in older adults with knee OA, but the change in the Japanese Knee Osteoarthritis Measure score was small (54.4 to 51.9) [2]. A 2025 study comparing clinic-supervised physiotherapy to a home exercise program found that the supervised group improved walking endurance by about 16 meters on the six-minute walk test, while the home group improved by only about 4 meters [1]. The home program included walking but lacked the progression and supervision of the clinic program.
What works better is combining walking with specific strengthening. A 2025 core-activation program (CARE-KOA) that included walking as a warm-up produced large reductions in pain during activity (from 6.3 to 3.9 on a 10-point scale) and improved KOOS scores by 10 to 12 points [3]. A 2022 quasi-experimental study found that adding hip abductor strengthening to a walking routine reduced pain significantly (p<0.001) while walking alone did not [4]. The 2000 manual therapy trial showed that a combined program including walking improved six-minute walk distance by 170 meters more than placebo [5].
The mechanism matters: knee OA alters gait mechanics at the hip and ankle, not just the knee [7, 8]. Walking without addressing the muscle weakness that drives those compensations may reinforce abnormal loading patterns. A 2014 study found that hip abductor strength explained only about 9% of the peak knee adduction moment during walking [6], meaning strengthening alone does not fully correct gait.
My call: walking is a useful component of knee OA management but is not sufficient as a sole therapy. The evidence supports combining it with supervised strengthening, particularly of the hip abductors and quadriceps. Confidence: moderate—the studies consistently show that combined programs outperform walking alone, but no trial directly compared walking-only to no treatment over a long period.
Sources used 8
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Effect Of Clinical Based Supervised Physiotherapy V/S Home Exercise Program On Osteoarthritis Of Knee Joint-A Comparative study Study.
Clinic-based supervised physiotherapy produced greater improvements in pain, stiffness, and physical function (WOMAC) and walking endurance (six-minute walk test) than a home exercise programme among knee osteoarthritis patients.
DOI: 10.36948/ijfmr.2025.v07i03.47426 -
A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial
This randomized controlled trial demonstrates that a four-week walking exercise program significantly improves dual-task performance and executive function in older adults with knee osteoarthritis.
DOI: 10.1177/0269215511421028 -
Effectiveness Of The Core Activation And Rehabilitation Exercises For Knee Osteoarthritis - Program (CARE -KOA©) Among Patients Diagnosed With Knee Osteoarthritis.
In a single-group pre-post study of 15 patients with knee osteoarthritis, the 4-week CARE-KOA© core activation program was followed by significant improvements in pain, KOOS scores, physical function, and core endurance, with only partial knee strength gains.
DOI: 10.12688/f1000research.163321.3 -
Reduction of pain in patients with knee osteoarthritis by using hip abductor strengthening exercise
A quasi-experimental study found that hip abductor strengthening exercise significantly reduced pain and increased muscle strength in patients with knee osteoarthritis at Kendal Health Center 1, while the control group showed no significant changes.
DOI: 10.26714/mki.5.1.2022.33-42 -
Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee
This randomized controlled trial evaluates the effectiveness of manual physical therapy combined with exercise in improving function and reducing pain in patients with osteoarthritis of the knee, demonstrating significant benefits over a placebo treatment.
DOI: 10.7326/0003-4819-132-3-200002010-00002 -
Hip abductor function in individuals with medial knee osteoarthritis: Implications for medial compartment loading during gait
In individuals with medial knee osteoarthritis, the study assessed how hip abductor strength and gluteus medius activation relate to knee adduction moment (KAM) waveform during self-paced gait, finding hip abductor strength explains only about 9% of peak KAM variance and gluteus…
DOI: 10.1016/j.clinbiomech.2014.03.009 -
Biomechanical analysis to characterize the impact of knee osteoarthritis on hip, knee, and ankle kinematics
This study uses 3D gait analysis to show that knee osteoarthritis not only alters knee mechanics but also induces measurable adaptations in hip and ankle kinematics during walking, suggesting a multi-joint consideration for knee OA management.
DOI: 10.5430/jbei.v3n2p36 -
Effects of Knee Osteoarthritis on Hip and Ankle Gait Mechanics
The study demonstrates that knee osteoarthritis (KOA) alters gait not only at the knee but also reduces hip and ankle range of motion and coronal motion arcs, increases ankle varus moment and knee adduction moment (KAM), and thereby highlights a coupled, distal impact of KOA on …
DOI: 10.1155/2019/9757369