Hip and Knee Osteoarthritis, Part 2: Treatment and Active Management
- Dr. Brian Abelson
- 10 hours ago
- 14 min read
In Part 1, we examined how hip and knee osteoarthritis develops, how it may present, and how clinicians distinguish it from other causes of joint pain. Part 2 turns from understanding the condition to managing it.
There is no single treatment that works for everyone. Education and progressive exercise form the foundation of nonsurgical care, supported when appropriate by physical activity, weight management, medication, injections, and other interventions. The aim is not to make an arthritic joint look different on an X-ray. It is to reduce symptoms, improve physical capacity, and help the person remain engaged in daily life.
Manual therapy may also have a useful role. Joint mobilization, manipulation, and soft-tissue techniques may provide some people with short-term improvements in pain, stiffness, or movement. In clinical practice, these changes can create an opportunity to move more comfortably and participate more fully in exercise and meaningful activities. Manual therapy does not restore cartilage or reliably alter the structural progression of OA, and it is best viewed as an adjunct to active rehabilitation rather than a stand-alone solution.
The sections that follow examine joint mobilization, soft-tissue therapy, progressive exercise, and weight management. The procedures and exercises shown are examples, not universal prescriptions. Their selection and progression should reflect the individual’s symptoms, physical capacity, health, goals, and response to care.
Article Index
Joint Mobilization: Supporting Comfortable Movement
Joint mobilization uses graded, hands-on movements applied within or near a joint’s available range. For some people with hip or knee osteoarthritis, it may provide short-term improvements in pain, stiffness, or movement. This can make walking, exercise, and other daily activities feel more manageable.
Within Motion Specific Release, joint techniques are selected according to the individual’s examination findings, symptom sensitivity, available movement, health history, and goals. The approach has evolved beyond applying a standardized procedure to every patient. Treatment response is reassessed, and the technique, direction, and intensity are adjusted when necessary.
Mobilization does not restore lost cartilage, remove osteophytes, realign an arthritic joint, or reverse OA. Its most useful role is to support movement and participation in an active rehabilitation program.
Mobilizing the Hip Joint
In this video, Dr. Mylonas demonstrates Motion Specific Release procedures used to mobilize the hip.
Reduced hip mobility can affect walking, squatting, climbing stairs, and getting into or out of a chair or vehicle. It may also change how movement demands are shared across the pelvis, lumbar spine, knee, and ankle. Hip mobilization may be considered when restricted movement or discomfort is limiting these activities.
The procedure shown is one example. The direction, range, and force should be adapted to the person’s presentation and tolerance.
4 Point Knee Joint Mobilization
In this video, Dr. Mylonas demonstrates a four-point Motion Specific Release approach to knee mobilization.
Knee OA may restrict flexion, extension, patellar movement, or tolerance of weight-bearing activities. Mobilization can address different aspects of joint movement and may temporarily reduce stiffness or discomfort for some patients.
Any improvement should be connected to an active goal, such as walking more comfortably, improving a squat or step-up, or participating in strengthening exercises. The technique should be modified or discontinued if it produces increasing pain, swelling, or loss of function.
Soft-Tissue Therapy Within an Integrated Approach
Hip and knee function depends on more than the joint surfaces. Muscles, tendons, joint capsules, ligaments, and other connective tissues contribute to movement, strength, balance, and the ability to absorb and transfer force.
Pain and reduced activity can change how these tissues function. Muscles may become sensitive, movement may feel restricted, and strength or coordination may decline. Soft-tissue therapy may help some people experience short-term improvements in pain, perceived stiffness, or movement tolerance. These changes can be useful when they help the person walk, exercise, or perform daily activities more comfortably.
Within Motion Specific Release, soft-tissue procedures are not applied as a standardized sequence. They are selected and modified according to the patient’s history, examination findings, symptom response, movement limitations, and functional goals. Treatment may involve structures around the hip or knee as well as other regions that are relevant to the person’s movement pattern.
The videos below demonstrate only a small selection from the broader MSR hip and knee protocols. They are examples of clinical techniques, not complete protocols or recommendations for every person with osteoarthritis.
The Gluteus Maximus Release
The gluteus maximus contributes to hip extension, pelvic control, walking, stair climbing, rising from a chair, and transferring force through the lower extremity.
This video demonstrates an MSR procedure directed toward the gluteus maximus. The technique may be considered when examination identifies tenderness, reduced movement tolerance, or difficulty activating the muscle during functional tasks. Any short-term change should be followed by movement or exercise that helps the patient use the available range and develop strength.
The Quadriceps Release - MSR
The quadriceps are central to knee extension, shock absorption, stair climbing, squatting, and rising from a seated position. Knee pain and swelling can inhibit quadriceps activation, while reduced activity may contribute to weakness and decreased physical capacity.
In this video, Dr. Abelson demonstrates selected MSR procedures for the quadriceps. Treatment is guided by palpation, movement testing, symptom response, and the functional task being addressed. The objective is not to correct a presumed universal muscle imbalance, but to determine whether treating the area improves comfort or movement in that individual.
Fascial Expansion: MSR Hip Pain Protocol
Fascial Expansion procedures are one component of the evolving MSR system. They draw from clinical concepts involving connective tissue, kinetic-chain relationships, acupressure, and traditional Chinese medicine.
In this video, Dr. Abelson demonstrates selected procedures that may be incorporated into a broader hip treatment plan. The term Fascial Expansion describes the treatment framework and method of application. It should not be interpreted as evidence that fascia is permanently lengthened or that structural osteoarthritis is reversed.
Fascial Expansion: The MSR Knee Pain Protocol
This video demonstrates selected Fascial Expansion procedures used around the knee and related tissues, including areas associated with the quadriceps and iliotibial tract.
Lateral knee pain, iliotibial-band-related symptoms, and knee OA are not the same condition, although they may coexist. Assessment helps determine which tissues and movements are clinically relevant. The procedure may be used to explore whether treatment changes pain, movement tolerance, or performance of a specific task.
Treatment Should Lead Back to Movement
Soft-tissue therapy does not repair cartilage, remove osteophytes, or guarantee lasting change in tissue structure. Its practical value is determined by what follows: Does the patient move more comfortably? Can they perform an exercise more effectively? Are they better able to walk, use stairs, or participate in daily life?
When soft-tissue therapy creates a useful change, that opportunity should be reinforced through movement, progressive exercise, and appropriate activity.
Exercise: Building Capacity for Life
Exercise is one of the foundations of hip and knee osteoarthritis management. It cannot restore lost cartilage or remove osteophytes, but it can improve strength, mobility, aerobic fitness, balance, confidence, and the ability to meet the demands of daily life.
There is no single best exercise or universal dosage for OA. The appropriate starting point depends on the person’s symptoms, physical capacity, health, experience, and goals. A well-rounded program may include:
Mobility exercises to maintain or gradually improve comfortable movement
Strength training to increase the capacity of the muscles surrounding the hip and knee
Aerobic activity such as walking, cycling, swimming, or another tolerated activity
Balance and coordination training when stability or fall risk is a concern
Functional exercise that prepares the person for stairs, squatting, lifting, work, recreation, and other meaningful activities
Some discomfort during or after exercise does not necessarily mean the joint is being damaged. However, the program may need to be modified if pain increases substantially, swelling develops, function deteriorates, or symptoms remain noticeably aggravated.
The following videos demonstrate only a small sample of the exercises that may be incorporated into an individualized OA program.
Mobility
Mobility exercises should use a comfortable and controlled range. More movement is not automatically better, and the joint should not be repeatedly forced into pain. Frequency can vary from brief daily practice to less frequent sessions, depending on symptom response and the purpose of the exercise.
8 Great Mobility Exercises for Hip Osteoarthritis
This video demonstrates eight movements that may help maintain or gradually improve hip mobility. Not every movement will be suitable for every person, particularly when the hip is sensitive or substantially restricted.
Begin with a manageable range and number of repetitions. The exercises can be modified according to comfort, control, and the way symptoms respond during and after the session.
6 Great Mobility Exercises for Knee Osteoarthritis
This video demonstrates six exercises that move the knee through flexion and extension while involving surrounding muscles and tissues.
The objective is to maintain comfortable movement rather than force the knee through restriction. Exercise selection and frequency should reflect swelling, irritability, available range, and functional goals.
Strength
Strength training increases the capacity of the muscles that support and move the hip and knee. It can also improve balance, walking, stair use, and the ability to recover from unexpected physical demands.
Many people begin with two or three strength sessions per week on nonconsecutive days, but the appropriate frequency depends on training intensity, recovery, health, and previous experience. Resistance, repetitions, sets, and movement complexity can be progressed gradually.
Swiss Ball Squat
The Swiss-ball squat is an assisted squat variation that primarily develops lower-extremity strength. The ball provides support and may help some people practise sitting and rising mechanics with greater confidence.
Depth, foot position, resistance, and repetitions should be adjusted to the individual. A chair-supported squat or sit-to-stand may be a more appropriate starting point for some patients.
5 - Clam Exercises with a Theraband
Clam variations challenge the hip abductors and external rotators, including portions of the gluteal muscles. Different positions and band tensions change the muscular demand.
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These exercises may support hip and pelvic strength, but they do not automatically correct biomechanics. Their value depends on whether they address an identified limitation and contribute to improved performance of meaningful activities.
4 Point Band Leg Strengthening Exercise
This standing band exercise challenges the hip flexors, extensors, abductors, and adductors while the supporting leg contributes to balance and control.
Resistance and range should begin at a level that allows good control. Holding a stable support may make the exercise safer and more appropriate for people with reduced balance or confidence.
Peterson Step Up
The Peterson step-up is a progressive single-leg exercise that challenges the quadriceps, hip muscles, calf, balance, and control of the lower extremity.
It should not be viewed as an exercise that selectively isolates the vastus medialis oblique or guarantees correction of patellar alignment. Its practical value lies in developing the strength and control required for stairs, walking, and other weight-bearing activities.
Step height, hand support, range, and resistance can all be modified. Some people may need to begin with a standard step-up, supported weight shift, or sit-to-stand before progressing to this variation.
Progress Matters More Than Perfection
A successful program does not require a perfect exercise or rigid formula. It requires an appropriate starting point, a tolerable dose, regular reassessment, and gradual progression.
The goal is not merely to exercise the arthritic joint. It is to build a more capable person who can move with greater confidence and participate more fully in life.
Weight Management When Relevant
Weight management can be an important part of osteoarthritis care for people who are living with overweight or obesity, particularly those with knee osteoarthritis. Reducing body weight may decrease the load placed on the knees during daily activities and can improve pain, mobility, and physical function.
The evidence is strongest for knee osteoarthritis. Even modest weight loss may be beneficial, and greater weight loss is often associated with greater average improvements. However, individual responses vary, and weight loss cannot be guaranteed to slow or reverse the structural changes of osteoarthritis.
A Sustainable, Individualized Approach
Weight management is not simply a matter of willpower. Age, medical conditions, medications, sleep, stress, food access, and previous experiences with dieting can all influence a person’s ability to change or maintain their weight.
When weight loss is appropriate, a sustainable plan may include:
Nutritionally balanced meals that provide adequate protein, fibre, and essential nutrients
Regular aerobic activity, such as walking, cycling, swimming, or another activity the person enjoys and tolerates
Strength training to maintain or increase muscle mass
Gradual changes that can be maintained over time
Support from a physician, dietitian, exercise professional, or other qualified healthcare provider when needed
Exercise remains beneficial even when it does not produce weight loss. Improving strength, aerobic fitness, balance, and confidence with movement can support joint function and general health at any body weight.
The goal is not to pursue a particular number on the scale. It is to develop a realistic and respectful plan that supports health, mobility, and participation in daily life.
Principles of an Integrated Approach
Hip and knee osteoarthritis can affect people in very different ways. Effective management therefore begins with understanding the individual rather than applying the same treatment to everyone.
A comprehensive approach may include:
Individual assessment: A detailed history and physical examination help identify how pain, joint mobility, muscle capacity, neurological findings, general health, and daily activities influence the person’s presentation.
Education and self-management: Understanding osteoarthritis can reduce fear, correct misconceptions, and help people make informed decisions about activity, exercise, symptom management, and lifestyle.
Progressive exercise: Individualized exercise can improve strength, mobility, aerobic fitness, balance, and the capacity to perform meaningful daily activities.
Manual therapy when appropriate: Joint mobilization and soft-tissue procedures may provide short-term improvements in pain, stiffness, or movement tolerance. Within Motion Specific Release, these procedures are selected according to examination findings and used to support active rehabilitation.
Weight and general health management: When relevant, sustainable weight management, adequate sleep, nutritious food, and attention to associated health conditions may contribute to better overall outcomes.
Ongoing reassessment: Progress should be evaluated according to changes in symptoms, function, activity tolerance, and personal goals. The plan can then be modified as the person’s needs and capabilities change.
No single procedure can reverse osteoarthritis, restore lost cartilage, or guarantee freedom from pain. The purpose of treatment is to create the conditions in which a person can move more comfortably, build physical capacity, remain active, and participate more fully in life.
The most useful approach is not defined by one technique. It is guided by evidence, clinical reasoning, the person’s preferences, and a willingness to adapt the plan as progress unfolds.
References - Osteoarthritis Part 1 & 2
Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: Clinical effectiveness. Osteoarthritis and Cartilage. 2013;21(4):525-534.
Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis & Rheumatism. 1991;34(5):505-514.
Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis & Rheumatism. 1986;29(8):1039-1049.
Anderson DD, Chubinskaya S, Guilak F, et al. Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention. Journal of Orthopaedic Research. 2011;29(6):802-809.
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589.
Buckwalter JA, Anderson DD, Brown TD, Tochigi Y, Martin JA. The roles of mechanical stresses in the pathogenesis of osteoarthritis: implications for treatment of joint injuries. Cartilage. 2013;4(4):286-294.
de Boer TN, van Spil WE, Huisman AM, et al. Serum adipokines in osteoarthritis: comparison with controls and relationship with local parameters of synovial inflammation and cartilage damage. Osteoarthritis and Cartilage. 2012;20(8):846-853.
Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2000;132(3):173-181.
Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: the Framingham Study. Annals of Internal Medicine. 1992;116(7):535-539.
Gudbergsen H, Boesen M, Lohmander LS, Christensen R, Henriksen M, Bartels EM, et al. Weight loss is effective for symptomatic relief in obese subjects with knee osteoarthritis independently of joint damage severity assessed by high-field MRI and radiography. Osteoarthritis and Cartilage. 2012;20(6):495-502.
Hawker GA, Stewart L, French MR, et al. Understanding the pain experience in hip and knee osteoarthritis: an OARSI/OMERACT initiative. Osteoarthritis and Cartilage. 2008;16(4):415-422.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. The Lancet. 2019;393(10182):1745-1759.
Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021;325(6):568-578.
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72(2):220-233.
Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis & Rheumatism. 2004;50(5):1501-1510.
Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273.
National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE Guideline NG226. Published October 19, 2022.
Piva SR, Susko AM, Khoja SS, Josbeno DA, Fitzgerald GK, Toledo FGS. Links between osteoarthritis and diabetes: implications for management from a physical activity perspective. Clinics in Geriatric Medicine. 2015;31(1):67-87.
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Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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