Can knee exercises help prevent surgery?
Knee Pain

I’m sure you’ve heard the adage “move it or lose it!”. Especially when talking about pain, recovering from surgery, or even preventing surgery, active movement & exercise play a big role in living a healthy and engaged life. This holds true for knee pain as well.


But can exercise actually prevent knee surgery?


The answer, according to scientific research, seems to be a big, loud “yes”. In fact, some studies have shown that simply going to physical therapy to begin an exercise-based rehab program for knee pain can actually reduce a person’s willingness to undergo surgery [1]. We see that all the time here in the clinic…patients who were planning to go under the knife, stave off surgery, and sometimes even never have surgery, by completing a knee exercise program.


In those cases, the physical therapist has worked with the patient to develop a long-term and comprehensive exercise program aimed at building up the strength, stability, and endurance of the knee. The goal is to use the exercise program to help the patient get to the point where they’re able to do the things that are important to them, with as little pain as possible.


Exercise & Knee Surgery


When it comes to knee surgery, like total knee replacements (TKR), mounting evidence shows that exercise may delay the need for surgery. In fact, a study published in 2018 showed that patients who completed a physical therapy-based exercise program were able to delay having a TKR by about 2 years [2]. Now, delaying surgery by 2 years sounds like a great outcome to me!


Still, this doesn’t mean that any knee exercise will help delay or prevent knee surgery. You need to do the right exercises to get those effects. Luckily, there have been recent research studies published that point in the direction of which exercises are most effective.


The Right Knee Exercises


What if I told you there was one (1) exercise that could help delay or prevent knee surgery? Would that seem like something worth taking a look at?


Well, a recently published article called the QUADX-1 trial seems to show that one knee exercise can be enough [3]. What was that one exercise? Knee extension. More specifically, knee extension exercises using a resistive band, with each rep lasting 8 seconds — 3 seconds straightening the knee out, 1 second pause at the end, and 4 seconds slowly lowering the knee back down.


That’s it…done. No more exercises!


Diving Into the Research


Now, it’s worth pointing out that this is a preprint publication that hasn’t undergone peer review. That basically means the information and conclusions drawn from this study shouldn’t be the only thing we use to base clinical decisions on; because it hasn’t gone through the final steps for publication (mainly, a peer review and critique of the information). However, this study is in line with previous research that show that knee extension exercise helps improve function, reduce pain, and helps delay surgery [4].



Image Credit: https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/HANDI/Knee-Strengthening-exercises.pdf


Knee extension (quadriceps) exercises have been core components of therapeutic exercise programs for many years and are backed by a large body of scientific evidence. In fact, one study showed that eccentric quadriceps exercises helped decrease were shown to decrease knee pain and limitations [4]. Your quadriceps muscle is responsible for knee extension.


So, No More Exercise Needed?


The answer is, of course, no. This research really only covers knee pain, preventing surgery, and returning to normal movement after a knee injury. It doesn’t cover some pretty important things like heart health (cardiovascular), muscle mass, bone density, or even exercise’s effects on muscle tissue [5].


You certainly can’t expect to do only one exercise a couple of days a week and expect to become healthy, in shape, or fit. Doing this one exercise —for knee pain— can, however provide some benefits. As we’ve discussed here, humans are incredibly complex, and so is pain. In fact, the very definition of pain show’s how difficult it can be to understand:


An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage [6]


That’s pretty hard to wrap your head around, right? Basically, research has shown that pain is always real —again pain is always real!— but, pain doesn’t always mean that damage is actually happening to your body or tissues. It doesn’t mean that  the pain someone feels might just “be in their head”, but it does mean that sometimes we need to retrain the brain on what movements are safe. We need to show the brain that the body isn’t fragile…it’s strong, resilient, and that normal movement is healthy.


Doing this both helps build confidence in a person’s ability to use their knee; to walk, run, jump, or even dance. And, since arthritis and other causes of knee pain can cause people to become inactive, starting with this one simple exercise can increase strength, stability, and movement by challenging the nervous system and the brain and to help inform the body that knee movement is both safe and healthy.




At the end of the day, there is no one, magic bullet exercise that will miraculously take away knee pain…just like there’s no one-size-fits-all therapy program or protocol; for any condition. At the end of the day, the goal should be to get moving again; to show your nervous system & your body that movement isn’t harmful or dangerous, but healthy and needed.


Here at ProActive, we call it Empowering our patients to become drivers of their own health. And that’s what we want to do. We want you to overcome your pain and limitations so that you and get back to doing the things you love to do…and we want you to do that by building the strength, resilience, and skills to do it on your own.


Hopefully, this article provided some insight into how knee exercises can help decrease knee pain. If you are experiencing knee pain, and want healthcare guides that can empower you to take charge and overcome your knee pain, then reach out and speak to a member of our care team to learn about our services and how we can empower you to become the driver of your healthcare today.



[1] Dell’Isola A, Jönsson T, Rolfson O, Cronström A, Englund M, Dahlberg L. Willingness to undergo joint surgery following a first-line intervention for osteoarthritis: data from the BOA register. Arthritis Care Res (Hoboken). 2020 Oct 14. doi: 10.1002/acr.24486. Epub ahead of print. PMID: 33053273.

[2] Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S, Simonsen O. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis Cartilage. 2018 Sep;26(9):1170-1180. doi: 10.1016/j.joca.2018.04.014. Epub 2018 May 1. PMID: 29723634.

[3] Rasmus Skov Husted, Anders Troelsen, Henrik Husted, Birk Grønfeldt, KristianThorborg, Thomas Kallemose, Michael Skovdal Rathleff, Thomas Bandholm. Does one exercise a day make the knee stronger and keep surgery away? A randomized dose-response trial of home-based knee-extensor exercise in patients eligible for knee replacement (the QUADX-1 trial). 2021 April;07. 

[4] Jonsson P, AlfredsonSuperior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. 

[5] Harper C, Gopalan V, Goh J. Exercise rescues mitochondrial coupling in aged skeletal muscle: a comparison of different modalities in preventing sarcopenia. J Transl Med. 2021 Feb 16;19(1):71. doi: 10.1186/s12967-021-02737-1. PMID: 33593349; PMCID: PMC7885447.

[6] Raja, Srinivasa N; et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises, PAIN: September 2020 – Volume 161 – Issue 9 – p 1976-1982 doi: 10.1097/j.pain.0000000000001939

Are you dealing with pain?

We understand that struggling with the stress and strain of pain can be tough…Whether it’s waking up feeling stiff or severe tension after walking, running, or playing, no one wants to spend each day dealing with the soreness that pain brings. While many people choose surgery or injections for pain relief, at ProActive Rehabilitation & Wellness, we offer non-surgical therapies which prevents patients from going under the knife.


If you’d like to book a pain consultation now, with one of our top clinicians, click the button bellow or have your provider fax over a referral. We only book a limited amount of these consultations each month, so act quickly before they’re gone.

Rafi Salazar OT

Rafael E. Salazar II, MHS, OTR/L (Rafi) is the CEO & President of Proactive Rehabilitation & Wellness, as well as the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. He worked as the lead clinician in an outpatient specialty clinic at his local VA Medical center, where he worked on projects to improve patient & employee engagement and experience throughout the organization. He has experience as a faculty member at Augusta University’s Occupational Therapy Program, as a Licensed Board Member on the GA State OT Board, has served on several committees for the national OT Board (NBCOT), and as a consultant working for the State of Georgia’s DBHDD. He is also on the Board of Directors for NBCOT. Rafi also authored the book Better Outcomes: A Guide to Humanizing Healthcare