08 OCT 2026
Pilates for Knee Arthritis
If you live with knee osteoarthritis (OA), you’ve probably been told that exercise is important. And it is, exercise is the first-line treatment for knee OA in every major Australian and international guideline. But knowing you should exercise and knowing how to exercise when your knees ache are two very different things.
That’s where Clinical Pilates can be a great fit. At LOFT Pilates, our sessions are led by physiotherapists and trained instructors who understand knee OA, so you can build strength in a way that feels supportive rather than daunting.
Why strength matters for arthritic knees
Your muscles are your knees’ shock absorbers. When the quadriceps, hamstrings, hip and calf muscles are strong, they share the load and control how forces move through the joint. When they’re weak, more stress goes through the joint itself.
People with knee OA commonly have:
Weaker quadriceps, often by 20–40% compared with people without OA
Reduced hip strength, which affects how the knee tracks during walking and stairs
Reduced balance and confidence on uneven ground
Stiffness that limits how far the knee bends or straightens
The good news: all of these respond to training at any age.
What makes Clinical Pilates a good option
1. Adjustable load The reformer uses springs rather than body weight alone, so we can make exercises lighter or heavier to suit your knee on the day. Lying-down footwork on the reformer, for example, lets you strengthen your legs through a squat-like pattern without standing up — a great starting point if standing exercise is painful.
2. Low impact, high control Pilates emphasises slow, controlled movement and good alignment. This aligns with the “neuromuscular exercise” approach used in programs like GLA:D®, which focuses on how the knee lines up over the foot during everyday movements.
3. Whole-body approach Pilates doesn’t just work the knee. Hip, trunk, ankle and foot strength all influence how load moves through your knee. Improving them can make walking, stairs and getting up from a chair easier.
4. Mobility without strain Gentle, supported movements help maintain knee bend and straightening, reducing stiffness.
5. Confidence and self-efficacy Many people with knee OA have started to avoid movements they’re worried about. Gradually building those movements in a safe, supervised setting helps restore trust in your knees.
What does the research say?
Exercise therapy in general has strong evidence for reducing pain and improving function in knee OA. Smaller studies on Pilates-based programs for knee OA have reported improvements in pain, function and quality of life over 6–12 weeks. The key ingredients, progressive strengthening, neuromuscular control and consistency, are exactly what a well-designed Clinical Pilates program delivers.
What a session might include
Reformer footwork — strengthening the quads, hamstrings and calves with adjustable spring resistance
Bridging — glute and hamstring strength to support the knee
Side-lying leg series — hip abductor strength for better knee alignment
Standing work — supported mini squats, step-ups and balance
Knee mobility — gentle bending and straightening drills
Breathing and core control — so the whole body supports each movement
Each program is tailored. What feels great for one person’s knee may need modifying for another.
How to get started at LOFT Pilates
If you’re new to Pilates or living with knee OA, we recommend starting with an initial Clinical Pilates assessment or movement screen. Your instructor will look at your strength, range of motion and goals, and build a program that suits you. From there, you can continue with one-on-one sessions or join a small-group Clinical Pilates class.
Questions & Answers
Q: Is Pilates safe if I have knee arthritis?
A: Yes, when it’s tailored to you. Clinical Pilates is adjusted for your knee’s needs, using spring resistance and modified positions so you can strengthen safely.
Q: Can I do Pilates if kneeling hurts?
A: Absolutely. Many exercises can be done lying down, sitting or standing, and kneeling exercises can be modified with padding or swapped altogether.
Q: Is reformer Pilates better than mat Pilates for knee OA?
A: Both can help. The reformer is particularly useful for knee OA because the springs let us adjust the load precisely and support you in positions that might be difficult on the mat.
Q: How often should I do Pilates for knee arthritis?
A: Two to three sessions per week, alongside walking or other aerobic activity, is a good target for building strength. Even once a week combined with a home program can help.
Q: Will Pilates make my knee pain worse?
A: Some muscle soreness is normal when starting a new program. Mild knee discomfort (up to about 5/10) that settles within 24 hours is generally okay. We’ll adjust your program if your knee is more sensitive.
Q: Can Pilates help me avoid knee replacement surgery?
A: Pilates can’t reverse arthritis, but exercise-based care helps many people manage symptoms well enough to delay or avoid surgery. If you do need surgery, being stronger beforehand helps recovery.
Take-Home Tips
Start where you are — lying or seated exercises are a perfect starting point for sore knees.
Load is your friend — gradually adding resistance builds the strength your knees need.
Think hips and ankles too — the whole leg supports the knee.
Slow and controlled wins — quality of movement matters more than quantity.
Be consistent — 2–3 sessions per week for at least 8–12 weeks gives the best results.
Get it tailored — a Clinical Pilates assessment ensures your program suits your knee.
Want stronger, more confident knees? Book a Clinical Pilates assessment at LOFT Pilates and start a program designed for you. Call 0266764000
Author: Melissa Macdonald, Physiotherapist & Pilates Instructor. This article is general information only and does not replace individual assessment and advice from a qualified health professional.