Physical therapy is one of the most effective treatments for arthritis in the hip and knee. It is not a passive treatment where someone fixes you. It is an active process where you build the strength, flexibility, and movement patterns that protect your joints and reduce pain.
Dr. Leo Zalikha recommends physical therapy as a first-line treatment for nearly every patient with hip or knee arthritis. In many cases, a structured therapy program provides enough relief to delay or avoid surgery altogether. Even for patients who eventually need joint replacement, pre-operative strengthening (prehabilitation) improves surgical outcomes and speeds recovery.
It seems counterintuitive: a painful joint should rest, not work. But the evidence is clear. Regular, targeted exercise reduces arthritis pain and improves function. Here is why:
The muscles around the hip and knee act as shock absorbers. When they are strong, they take stress off the joint surfaces. When they are weak, the bone and cartilage bear more force with every step. Strengthening the quadriceps (for the knee) and the gluteal muscles (for the hip) is one of the most impactful things you can do for an arthritic joint.
Articular cartilage does not have its own blood supply. It gets its nutrients from synovial fluid, which is pumped into the cartilage during joint movement. Regular motion keeps the cartilage as healthy as possible.
Moderate physical activity has systemic anti-inflammatory effects. It lowers levels of inflammatory markers in the blood, which can reduce the inflammatory component of arthritis pain.
Arthritis often leads to compensatory movement patterns (limping, favoring one side, avoiding certain motions) that create secondary problems. A physical therapist can identify and correct these patterns.
The quadriceps is the most important muscle for knee function. Straight leg raises, terminal knee extensions, mini squats, and step-ups are foundational exercises
Balancing the muscles on the front and back of the thigh improves knee stability
Maintaining the ability to fully straighten and bend the knee prevents stiffness from becoming permanent
Cycling, swimming, water aerobics, and walking on flat surfaces maintain cardiovascular fitness without excessive joint stress
Arthritis affects proprioception (your sense of joint position). Balance exercises reduce fall risk and improve confidence
The gluteus medius and maximus are critical for hip stability and walking mechanics. Side-lying leg raises, clamshells, bridges, and standing hip abduction exercises target these muscles
Tight hip flexors are common with hip arthritis and contribute to a flexed posture and shortened stride
A stable core supports the pelvis and reduces compensatory stress on the hip
Gentle stretching and mobility work to maintain hip flexibility
Exercising in a pool reduces joint loading while allowing full range of motion and resistance training
A typical course of outpatient physical therapy for arthritis involves visits one to three times per week for six to twelve weeks. The therapist will also prescribe a home exercise program that you perform on your own between sessions.
The home program is the most important part. Patients who consistently perform their exercises at home see significantly better results than those who rely solely on in-clinic sessions.
Physical therapy is not a one-time fix. The strength and flexibility gains you achieve must be maintained with ongoing exercise. Dr. Zalikha encourages patients to transition from formal physical therapy to a long-term independent exercise routine.
Physical therapy has limits. It cannot rebuild cartilage, correct severe deformity, or fix bone-on-bone contact. If you have completed a thorough course of therapy and your symptoms remain significantly limiting, it may be time to discuss other options, including injections or joint replacement.
However, “physical therapy didn’t work” often means “I did a few sessions and stopped” or “I was given generic exercises that didn’t target my problem.” Before concluding that therapy has failed, Dr. Zalikha ensures the program was appropriate, adequate in duration, and followed consistently.
For patients who are heading toward surgery, physical therapy before the procedure (prehabilitation or “prehab”) has documented benefits:
Dr. Zalikha’s pre-operative planning includes guidance on prehabilitation exercises tailored to whether you are preparing for hip or knee replacement.
Not all physical therapy is the same. Dr. Zalikha recommends working with a therapist who has experience treating hip and knee arthritis patients and who develops an individualized program rather than using a one-size-fits-all approach.
If you need help finding a therapist in the Long Beach, Los Angeles, or Orange County area, Dr. Zalikha’s office can provide referrals to trusted local providers.
Schedule a consultation with Dr. Zalikha or call (562) 362-5024.
