Stretching away the pain: How do different stretching exercises compare for knee osteoarthritis?

The Bottom Line

  • Knee osteoarthritis impacts 365 million people worldwide and is associated with symptoms like pain and stiffness, which can reduce independence and well-being.
  • Different stretching exercise programs can help improve pain, stiffness, and physical function disability in older adults living with knee osteoarthritis.
  • Speak with your healthcare team about the symptoms you would like to manage and the stretching exercise program options available. 

Osteoarthritis is a condition marked by the deterioration of cartilage in the joints, such as the knees, hips, hands, and spine (1;2). Between 1990 and 2019, the number of people living with osteoarthritis increased by a whopping 113% to around 528 million worldwide. In sixty-nine percent of cases, or 365 million, the knee is the affected joint (1).

The health of our knees holds important implications for our independence and well-being (3;4). This is no surprise given that they are critical to our ability to walk (3;5). For instance, imagine having to be mobile and perform daily activities of living like getting out of bed, reaching the bathroom, showering, getting dressed, and transporting yourself to the kitchen to make breakfast all while experiencing symptoms of knee osteoarthritis such as pain and stiffness (3-8).  

A variety of treatment and management options are available to help people living with knee osteoarthritis. But initial recommended strategies are those which are non-invasive—meaning they do not involve breaking of the skin or entering of the body—and are not medication-based (3;9). Exercise programs, including resistance, aerobic, and stretching exercises, are a great example of this (3;9;10). Zeroing in on stretching exercises, we see that evidence of their effectiveness in managing symptoms of knee osteoarthritis remains uncertain.

To help us learn more about this strategy and compare different stretching exercises, let us look at a recent systematic review that examined the effects of stretching exercise programs on pain management, stiffness, and physical function disability in older adults with knee osteoarthritis. These strategies were compared to control groups consisting of no stretching exercise, an exercise program with no stretching, health education, acupuncture, or usual care (3). 

What the research tells us

To start, stretching exercise programs within the review consisted of one of the following: 1) static stretching (e.g., get into stretch position and hold), 2) proprioceptive neuromuscular facilitation stretching (e.g., assisted stretching or muscle contraction against resistance), 3) mind-body exercises—like Tai Chi, yoga, Qigong, and Baduanjin—plus lower-limb stretching, and 4) multi-component exercise programs with a stretching element.  

The review found that different stretching exercise programs can be effective in improving symptoms of knee osteoarthritis, but success varies by program and symptom.

For example, all four stretching exercise programs assessed pain. In comparison to the control group, proprioceptive neuromuscular facilitation and mind-body exercise appeared to reduce pain by a large amount, while multi-component exercise did so by a moderate amount. Static stretching was not effective, but the results were based on just one study, and as such need to be interpreted carefully. Additionally, when compared to one another, proprioceptive neuromuscular facilitation was found to be superior to multi-component exercise programs; helping to reduce pain by a large amount. 

When it comes to stiffness and physical function disability, mind-body exercise and multi-component exercise looked at these symptoms in comparison to the control group. Here, we saw that only mind-body exercise was effective in reducing stiffness by a large amount and only multi-component exercise was effective in reducing physical function disability by a large amount (3).

All in all, there appears to be multiple stretching exercise programs that folks living with knee osteoarthritis can explore with their healthcare team. Discussions should include what symptoms patients are looking to manage, and the pros and cons of the different program options available in relation to that person’s needs and abilities. 

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Author Details


  1. Ng CT, Tan MP. Osteoarthritis and falls in the older person. Age Ageing. 2013; 42:561-566.
  2. World Health Organization. Osteoarthritis. [Internet] 2023. [cited January 2024]. Available from:
  3. Zhu GC, Chen KM, Belcastro F. Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis. Arch Phys Med Rehabil. 2023; 17:S0003-9993(23)00405-7. doi: 10.1016/j.apmr.2023.07.001.
  4. Briggs A, Cross M, Hoy D, et al. Musculoskeletal health conditions represent a global threat to healthy aging: A report for the 2015 World Health Organization World Report on Ageing and Health. Gerontologist. 2016; 56(Suppl 2):S243-255.
  5. Barbour K, Helmick C, Boring M, et al. Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013-2015. Morb Mortal Wkly Rep. 2017; 66:246.
  6. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: A review of community burden and current use of primary health care. Ann Rheum Dis. 2001; 60:91.
  7. Suzuki Y, Iijima H, Tashiro Y, et al. Home exercise therapy to improve muscle strength and joint flexibility effectively treats preradiographic knee OA in community-dwelling elderly: A randomized controlled trial. Clin Rheumatol. 2019; 38:133-141.
  8. Elbadawy M. Effectiveness of periosteal stimulation therapy and home exercise program in the rehabilitation of patients with advanced knee osteoarthritis. Clin J Pain. 2017; 33:254-263.
  9. Block J. OA guidelines: improving care or merely codifying practice? Nat Rev Rheumatol. 2014; 10:324-326.
  10. Baker K, McAlindon T. Exercise for knee osteoarthritis. Curr Opin Rheumatol. 2000; 12:456-463.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.