Physical Therapy for Knee Osteoarthritis: What to Expect

Key Takeaways

• Physical therapy is often the first recommended treatment for knee osteoarthritis and can significantly reduce pain
• Most PT programs last 6-12 weeks with 2-3 sessions per week, plus daily home exercises
• Medicare Part B covers physical therapy when medically necessary with a doctor’s referral
• Strengthening the muscles around your knee can take pressure off the joint and improve mobility
• PT works best when combined with other treatments like weight management and sometimes injections

If you’ve been diagnosed with knee osteoarthritis, your doctor has probably recommended physical therapy. Maybe you’re wondering what actually happens during those sessions, or whether it’s really worth the time and effort.

Physical therapy (PT) is one of the most effective treatments for knee arthritis—and research backs this up. Studies show that structured exercise programs can reduce pain by 40-50% and improve function for many people with knee osteoarthritis.

Let’s walk through what to expect if you start physical therapy for your knee pain.

Why Physical Therapy Works for Knee Arthritis

Arthritis wears away the cartilage cushioning in your knee joint. While physical therapy can’t restore that cartilage, it can strengthen the muscles around your knee to provide better support and stability.

Think of it like this: if your knee joint is weakened, the muscles surrounding it need to work harder to compensate. Strong thigh muscles (quadriceps) and hamstrings can absorb shock and reduce the load on your arthritic joint.

Physical therapy also helps you maintain range of motion. When your knee hurts, you naturally avoid moving it. But this can lead to stiffness and muscle weakness, creating a cycle that makes things worse. PT breaks that cycle.

Your First Physical Therapy Visit

Your first session is mainly an evaluation. The physical therapist will:

• Review your medical history and symptoms
• Ask about activities that cause pain (climbing stairs, walking, standing)
• Test your knee’s range of motion and strength
• Watch how you walk and move
• Discuss your goals (getting back to gardening, playing with grandchildren, etc.)

Be honest about your pain levels and limitations. This information helps your therapist create a program that’s right for you.

Most people are surprised that the first visit doesn’t involve much exercise. That comes next, once your therapist understands your baseline.

What Happens in Physical Therapy Sessions

A typical PT session lasts 30-60 minutes. Here’s what you might do:

Warm-Up

You’ll usually start with gentle movement to get blood flowing to your knee. This might be:

• Riding a stationary bike
• Walking on a treadmill
• Range-of-motion exercises

Strengthening Exercises

This is the core of knee arthritis PT. You’ll work on:

Quadriceps (front thigh muscles): These are crucial for knee stability. Common exercises include straight leg raises, seated leg extensions, and mini-squats.

Hamstrings (back thigh muscles): These balance out the quadriceps. You might do hamstring curls while standing or lying down.

Hip muscles: Strong hips help control knee alignment. Side-lying leg lifts and clamshells are typical exercises.

Calf muscles: These help with balance and walking. Heel raises are common.

Your therapist will start with exercises you can manage and gradually make them harder. Don’t be discouraged if you start with simple movements—building strength takes time.

Balance and Stability Training

Many people with knee arthritis develop balance problems. Your therapist might have you practice:

• Standing on one leg
• Walking heel-to-toe
• Using a balance board

Better balance reduces your risk of falls and improves confidence in daily activities.

Manual Therapy

Your therapist might use hands-on techniques to:

• Gently stretch tight muscles
• Mobilize your kneecap
• Release trigger points

Some people find manual therapy provides immediate (though temporary) pain relief.

Ice or Heat

Sessions often end with ice to reduce inflammation or heat to relax muscles.

Your Home Exercise Program

Here’s something important: what you do at home matters more than what happens in the clinic.

Your therapist will give you exercises to do daily at home. These are usually simpler versions of what you do in sessions. Most programs take 20-30 minutes per day.

The key is consistency. Research shows that people who stick with their home exercises get much better results than those who only exercise during PT sessions.

Your therapist will write everything down and may give you pictures or videos to reference. Don’t hesitate to ask questions if you’re unsure about form or technique.

How Long Does Physical Therapy Take?

Most knee osteoarthritis PT programs last 6-12 weeks. You’ll typically go to the clinic 2-3 times per week at first, then less frequently as you improve.

Some people notice improvement within 2-3 weeks. For others, it takes 4-6 weeks. The timeline depends on:

• How severe your arthritis is
• Your overall fitness level
• How consistently you do home exercises
• Whether you have other health conditions

If you’re not seeing any improvement after 8-10 weeks, talk to your therapist and doctor. You might need to adjust your program or consider other treatments.

Does Medicare Cover Physical Therapy?

Yes, Medicare Part B covers physical therapy for knee osteoarthritis when it’s medically necessary and prescribed by a doctor.

Here’s what you need to know:

Coverage details:

• You’ll pay 20% of the Medicare-approved amount after meeting your Part B deductible
• There’s no limit on the number of sessions, but Medicare reviews care after you reach a certain dollar amount ($2,230 in 2025)
• Your therapist will document your progress to justify continued treatment

What’s required:

• A written referral or prescription from your doctor
• Treatment from a Medicare-enrolled physical therapist
• Documentation showing you’re making progress

Medicare Advantage plans may have different rules, so check with your plan about coverage and any prior authorization requirements.

When Physical Therapy Alone Isn’t Enough

Physical therapy is highly effective, but it doesn’t work for everyone. You might need additional treatment if:

• You’ve completed a full PT program without significant improvement
• Your pain interferes with daily activities despite exercise
• You’re having trouble sleeping due to knee pain
• You’re avoiding activities you enjoy because of your knee

This doesn’t mean PT failed—it means your arthritis may need more comprehensive treatment.

Combining Physical Therapy with Other Treatments

PT often works better when combined with other approaches:

Weight management: Losing even 10-15 pounds can significantly reduce stress on your knees. Your PT can help you find exercises that work with your current fitness level.

Pain medications: Over-the-counter NSAIDs or acetaminophen can help you participate more fully in PT by reducing pain during exercise.

Hyaluronic acid injections: Many people find that HA injections (gel shots) reduce pain enough to make PT more effective. The injections provide cushioning while you build strength through therapy. Research suggests this combination approach can provide better long-term results than either treatment alone.

Bracing or orthotics: Special shoe inserts or knee braces might help you exercise more comfortably.

Assistive devices: A cane or walking stick can reduce knee stress during your recovery.

Tips for Getting the Most from Physical Therapy

Based on what works for people who succeed with PT:

1. Do your home exercises every day. Mark it on your calendar or set a phone reminder. Consistency matters more than intensity.

2. Communicate with your therapist. If an exercise causes sharp pain (not just discomfort), speak up. Your program should be adjusted to your needs.

3. Track your progress. Keep a simple journal noting your pain levels and what activities are getting easier. Progress can be gradual, and it helps to see how far you’ve come.

4. Be patient. Building muscle strength takes time, especially if you’ve been inactive due to pain. Expect gradual improvement, not overnight results.

5. Plan for long-term maintenance. Even after you finish formal PT, continuing some exercises at home can help maintain your gains.

Red Flags to Watch For

Stop exercising and contact your doctor if you experience:

• Sudden, severe pain in your knee
• Significant swelling after exercise
• Your knee “giving out” or feeling unstable
• Increased pain that doesn’t improve with rest

Some muscle soreness is normal when you start exercising, but sharp or worsening pain isn’t.

Making the Decision

Physical therapy requires time and effort, but for many people with knee osteoarthritis, it’s one of the most effective treatments available. It has no side effects, improves overall health, and gives you tools to manage your condition long-term.

The American Academy of Orthopaedic Surgeons strongly recommends exercise and physical therapy as first-line treatment for knee osteoarthritis. It’s worth trying before considering more invasive options.

If you’re ready to start, ask your doctor for a physical therapy referral. Look for a therapist who has experience treating knee arthritis and takes time to explain your program.

Your knees have carried you through life. Physical therapy can help keep them moving for years to come.

Frequently Asked Questions

How much does physical therapy cost?

With Medicare Part B, you’ll typically pay 20% of the cost after your deductible. Without insurance, sessions can range from $50-150 each, but many clinics offer payment plans.

Can I do physical therapy at home without going to a clinic?

While home exercise programs are important, working with a licensed physical therapist—especially at the start—ensures you’re doing exercises correctly and safely. Poor form can make knee problems worse.

Will physical therapy hurt?

You may feel some muscle soreness (like after any workout), but PT shouldn’t cause sharp or severe pain. Your therapist will adjust exercises if they’re too painful.

How soon will I see results?

Most people notice some improvement in 3-4 weeks, with more significant changes by 6-8 weeks. Results vary based on arthritis severity and how consistently you exercise.

What if I’ve tried exercise before and it didn’t help?

Physical therapy is more structured than general exercise. A therapist can identify which specific muscles need strengthening and ensure you’re using proper form. Many people who didn’t benefit from exercise on their own see better results with professional guidance.

---

The information provided is for educational purposes and should not replace advice from your healthcare provider. Always consult with a doctor before starting any new treatment program.

Last medically reviewed: February 2025