Gentle stretching is a core part of most arthritis treatment programs. For people with arthritis of the knee, there are four target muscle groups for stretching:

  • Hamstrings (in the back of the thigh)
  • Quadriceps (in the front of the thigh)
  • Hip flexors (hip muscles)
  • Calf muscles (lower leg muscles)

The stretches described below can be done once or twice a day. When doing the stretches, it is important to maintain the right form to avoid straining joints, using modifications if necessary.

Hamstring stretches

The hamstring muscle is located on the back of the thigh. If the hamstring muscle is tight it can cause knee pain. These stretches can be felt on the back of the thigh.

Hamstring stretches should generally be done twice daily, such as once in the morning and once in the evening.

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Forward fold stretch
Figure 1:
Forward fold
stretch

Forward fold stretch: Stand with legs shoulder-width apart and slowly start to fold forward, bending from the hips and keeping legs as straight as possible. Be sure to keep the lower back and legs as straight as possible, and keep the movements smooth and controlled with no bouncing. Maintaining good form is more important to stretch the hamstrings than touching the floor.

Forward fold stretch modification
Figure 2:
Forward fold
stretch modification

Modification: For those who are unable to touch even their ankles, a slight modification may make the stretch more comfortable. Instead of reaching for the floor, reach for a chair seat (pillows or cushions may be added to make the chair seat even higher, if necessary). Over time the stretch may become easier and less modification may be needed.

Hold the stretch for 20 to 30 seconds and repeat three times.

Supine Leg Raise
Figure 3:
Supine Leg Raise

Supine leg raise: Pain and stiffness in the lower back may make forward fold stretches too uncomfortable. A supine leg raise is a gentler alternative. Begin the stretch by lying on the back with both legs extended. Bending the left knee, bring the left foot flat on the mat in front of the buttocks. You may use a strap (such as a rope or belt) as support around the ball of the foot, behind the toes, of the leg that is being lifted to stretch (here, the right leg). Hold the strap in both hands. Keep the right knee straight and locked. Slowly begin to raise the right foot to the sky, keeping the right leg as straight as possible. The right leg should be raised only as far as it will go while still keeping the back flat against the floor.

To help keep the back flat and also engage the core muscles, contract the gluteus and abdominal muscles, pulling the belly towards the floor. This stretch should be repeated three times on each side, holding legs in the air for 20 seconds each time.

Quadriceps Stretches

The large muscle group located on the front of the thigh, the quadriceps muscles are the strongest muscles in the body and control the extension of the knee.


Figure 4:
Standing quadriceps stretch

Standing quadriceps stretch: Begin by placing the left hand on a wall or a chair for balance, then bend the right knee and bring the right foot back. Reaching back with the right hand, grab the ankle. Pull the ankle up and back, away from the buttocks, rather than toward the buttocks, which can cause stress on the knee. This stretch can be felt in the front of the right thigh.



Figure 5:
Standing quadriceps stretch modification

Modification: A person may make this stretch easier by placing a chair behind him or her. Instead of reaching for the ankle with the right hand, bend the right leg until the shin rests on the seat of the chair.

Repeat the stretch twice on each side, holding each leg for 20 seconds.

Hip Flexor Stretch

The hip flexors are located above the quadriceps on the front of the thigh, and are involved in any upward movements of the knees.


Figure 6:
Kneeling hip flexor stretch

Kneeling hip flexor stretch. Kneel on the floor with the left knee below and right leg extended forward, keeping the knee bent at 90º, the right foot will be flat on the floor along with the left shin. Rest hands on right knee and lean body forward. Do not let the right knee extend forward past the toes of the right foot. This stretch can be felt in the left hip flexor while the right knee is forward. Engaging the core muscles will help to keep the body stable and upright.

Repeat the stretch three times on each side, holding each leg for 20 seconds.

Calf Muscle Stretch

The calf is located at the back of the lower leg and is made up of two paired muscles, the gastrocnemius and the soleus. The calf muscles are essential for all active movements including walking and running.


Figure 7:
Standing calf muscle stretch

Standing calf muscle stretch. This stretch is done two ways to properly stretch both calf muscles.

To stretch the gastrocnemius muscle: Face a wall and stand about 2 paces away from the wall. Extend both arms, placing hands on the wall at or just below shoulder height. Step the right leg slightly forward with the right knee bent, keeping the left leg straight and angled back. Lean the body forward using the wall for support, while at the same time stretching the left heel toward the floor. This should produce a stretch in the back of the left leg. To increase the stretch, move back from the wall a little more.

To stretch the soleus muscle: Same stretch as above, but bend the left knee slightly to isolate the soleus muscle during the stretch.

Repeat both stretches three times on each leg, holding for 10 to 20 seconds each.

As a general rule, never hold the breath while stretching – continue to breathe throughout the stretch. Keep movements smooth and avoid bouncing or straining.

While the above knee stretches are generally appropriate for anyone with knee arthritis, it is always advisable to discuss any stretching exercises with one’s treating physician.

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