Is Walking Good for Bone on Bone Knees?

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What the Research Actually Says

For years, people with bone-on-bone knee pain have received conflicting advice about walking. Some doctors say to stop walking to “protect” the joint. Others say to walk through the pain. The research now gives us a clearer answer.

A landmark 2022 study published in Arthritis & Rheumatology followed over 1,200 adults aged 50 and older with knee osteoarthritis. The researchers found that people who walked for exercise had less frequent knee pain compared to those who did not walk regularly. Even more striking, among people who already had frequent knee pain at the start of the study, walking for exercise was associated with a reduction in the frequency of pain over time.

This study built on earlier findings from the Osteoarthritis Initiative, a large NIH-funded project that has tracked thousands of adults with or at risk for knee OA. The consistent finding across multiple analyses is that moderate walking does not accelerate cartilage loss and is associated with better pain outcomes.

The 2019 OARSI international guidelines recommend exercise — including walking — for all stages of knee osteoarthritis, including the most severe.

Why Walking Helps Bone on Bone Knees

It Strengthens the Muscles That Protect Your Joint

Walking activates the quadriceps, hamstrings, calf muscles, and hip muscles. These are the same muscle groups that act as shock absorbers for your knee. Stronger muscles mean less force transmitted directly through the bone-on-bone surfaces. The strengthening effect is gradual, but research shows measurable improvements in leg muscle strength with consistent walking programs.

It Nourishes Remaining Cartilage

Cartilage does not have its own blood supply. It relies on joint fluid to deliver nutrients and remove waste products. This fluid exchange happens through a process called imbibition — when you load and unload the joint during walking, fluid is pumped in and out of the cartilage like squeezing and releasing a sponge. Without this regular loading, remaining cartilage tissue becomes less healthy.

It Manages Body Weight

Walking burns approximately 80 to 100 calories per mile at a moderate pace. Over weeks and months, a consistent walking program contributes to weight management. Since every extra pound adds roughly 4 pounds of force across the knee, even modest weight loss from regular walking compounds the benefit.

It Reduces Stiffness

One of the most frustrating symptoms of bone-on-bone knees is the stiffness after sitting or inactivity. Regular walking keeps the joint fluid moving, maintains range of motion, and prevents the progressive tightening that comes from a sedentary lifestyle. Many patients report that their stiffness is worst on the days they do not walk.

It Improves Mood and Mental Health

Chronic knee pain takes a toll on mental health. Walking triggers the release of endorphins, improves sleep quality, and provides a sense of accomplishment and independence. A study in the British Journal of Sports Medicine found that walking programs reduce symptoms of depression and anxiety in adults with chronic pain.

How to Walk Safely With Bone on Bone Knees

Start Where You Are

Do not compare yourself to what you could do five years ago or to what someone else can do. Start with a distance you can complete comfortably — even if that is just to the end of the driveway and back. The starting point matters far less than the consistency.

Beginner guideline: Start with 5 to 10 minutes of continuous walking on flat ground. If that is comfortable, maintain that duration for 1 to 2 weeks before increasing.

Increase Gradually

The 10% rule is a sensible approach: increase your walking time or distance by no more than 10% per week. If you walked 10 minutes this week, aim for 11 minutes next week. Small, steady increases allow your muscles and joint to adapt without triggering a flare-up.

A reasonable progression:

• Weeks 1-2: 5 to 10 minutes, flat terrain, 3 to 5 days per week
• Weeks 3-4: 10 to 15 minutes
• Weeks 5-8: 15 to 20 minutes
• Weeks 9-12: 20 to 30 minutes
• Long-term goal: 30 minutes most days (can be split into two 15-minute walks)

Choose the Right Surface

Surface hardness matters for bone-on-bone knees. Ranked from most to least knee-friendly:

1. Smooth, flat dirt or cinder paths — some natural shock absorption
2. Asphalt — slightly more forgiving than concrete
3. Grass — softer but can be uneven, which is a fall risk
4. Concrete sidewalks — hardest surface, most impact
5. Avoid: uneven terrain, steep hills, gravel (fall risk and instability)

Indoor walking on a treadmill with a cushioned deck is an excellent option for consistent, controlled walking. Set the incline to zero or 1 percent.

Wear the Right Shoes

Footwear is one of the most impactful and most overlooked factors. For bone-on-bone knees, choose shoes with:

• Generous cushioning in the midsole to absorb impact
• Good arch support to maintain proper alignment
• A low, wide heel for stability
• A rocker sole if tolerated, which reduces the range of motion required at the knee
• Enough room in the toe box to avoid crowding

Replace walking shoes every 300 to 500 miles, or every 6 months for regular walkers. Worn-out shoes lose their cushioning ability even if they still look fine.

Consider an Unloader Brace

If bone-on-bone changes are primarily on one side of the knee, an unloader brace can shift weight to the healthier compartment during walking. Many patients report significantly more comfortable walks when wearing an unloader brace. These are covered by Medicare with a prescription.

Use a Cane If Needed

A cane used in the opposite hand (opposite from the painful knee) reduces forces across the knee by 20 to 30 percent. There is no shame in using a cane. It is a tool that protects your joint and allows you to walk farther with less pain. Adjust the cane height so your elbow is bent at about 15 to 20 degrees when holding the handle.

What to Do Before and After Your Walk

Before walking:

• Apply heat for 10 to 15 minutes if the knee is stiff
• Do 2 to 3 minutes of gentle range-of-motion exercises (ankle pumps, seated knee bends)
• Start the first 2 to 3 minutes of the walk at a slower pace as a warm-up

After walking:

• Apply ice for 15 to 20 minutes if the knee is warm or puffy
• Elevate the leg for 10 to 15 minutes
• Do gentle stretching for the quadriceps, hamstrings, and calves

Use the 24-hour rule: If your knee is more painful or swollen 24 hours after your walk than it was 24 hours before, you walked too far or too fast. Scale back next time. Some mild discomfort during and immediately after walking is normal and acceptable. A significant increase in symptoms the next day means you exceeded your current capacity.

Warning Signs to Stop Walking

Stop your walk and rest if you experience any of the following:

• Sharp, stabbing pain in the knee
• A sudden increase in swelling during the walk
• Your knee gives way or buckles
• Pain changes from a dull ache to a sharp or burning sensation
• You develop a significant limp

Occasional mild achiness during walking is normal for bone-on-bone knees and does not mean damage is occurring. But the symptoms above may indicate you are exceeding what your joint can tolerate that day.

Walking Alternatives for Tough Days

Some days, your bone-on-bone knee will not cooperate with a walking plan. On those days, substitute with lower-impact activities that maintain fitness:

• Pool walking or swimming — reduces body weight on the joint by 50 to 90 percent
• Stationary cycling — maintains cardiovascular fitness with minimal knee impact
• Seated exercises — chair-based strengthening to maintain muscle mass
• Upper body exercise — keeps you active without stressing the knee

Having alternatives prevents the all-or-nothing mindset that leads to prolonged inactivity after a bad day.

Frequently Asked Questions

How far should I walk with bone on bone knees?

Start with whatever distance you can walk comfortably, even if it is only 5 minutes. Increase by about 10% per week. The long-term goal for most patients is 20 to 30 minutes of walking most days of the week. This can be split into shorter walks if needed. The right distance is one that does not cause a significant increase in pain or swelling the following day.

Will walking make bone on bone knees worse?

Research consistently shows that moderate walking does not accelerate cartilage loss or worsen knee osteoarthritis. The 2022 Arthritis & Rheumatology study found that walkers actually had less frequent knee pain than non-walkers. The important caveat is “moderate” — walking should be done at a comfortable pace, on flat surfaces, with appropriate footwear. Walking through significant pain, on hills, or without adequate rest breaks can temporarily increase symptoms.

Is it better to walk or rest with bone on bone knees?

Both are important. The worst approach is extended inactivity, which leads to muscle weakening, stiffness, and weight gain — all of which increase knee pain. The second worst approach is pushing through pain without rest breaks. The best approach is regular, moderate walking combined with adequate rest. Activity pacing — walking for 10 to 15 minutes, resting for 5 to 10 minutes, then walking again — allows you to accumulate more total walking time with less joint stress.

What time of day is best to walk with arthritis?

Many patients find that late morning or early afternoon works best. By then, morning stiffness has resolved, and the body’s natural cortisol levels are still relatively high, providing anti-inflammatory protection. Avoid walking first thing in the morning when the knee is stiffest, and avoid late evening walks when cumulative daytime inflammation has peaked. However, any time you can walk consistently is the right time.

Should I use a treadmill or walk outdoors?

Both are good options. A treadmill offers a controlled, flat surface with consistent cushioning and the ability to precisely control speed. It is also weather-independent. Outdoor walking provides fresh air, scenery, and natural terrain variation that can engage stabilizing muscles. If joint protection is the priority, a treadmill with a cushioned deck at zero incline is slightly easier on the knees than concrete sidewalks.

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