By Marc Darrow, MD, JD
On my August 1, 2026 radio program, a caller described walking about 5,000 steps per day after knee treatment. Before treatment, he could walk, but it hurt. His experience illustrates an important cycle: when knee pain decreases, activity becomes easier; when activity increases safely, strength, balance, cardiovascular health, and confidence may improve.
Walking is treatment—but the dose should be individualized
Exercise is strongly recommended for knee osteoarthritis. Walking is accessible, requires little equipment, and can be divided into shorter sessions. But 5,000 steps is not a magic prescription. A sedentary patient with severe pain may need to begin well below that level, while another patient may tolerate considerably more.
International exercise recommendations emphasize baseline assessment, individual goals, gradual progression, adherence, and adjustment according to symptoms and function. (1)
A 2025 pilot randomized trial found that women receiving a digitally supported walking program improved their step counts, pain, and function more than those receiving education, smartwatch use, and a home exercise program alone. The study included only 30 participants, so the findings are encouraging but preliminary. (2)
Does walking wear out an arthritic knee?
Many patients fear that walking will “use up” the remaining cartilage. For most people with knee osteoarthritis, appropriate walking is beneficial rather than destructive. A 2025 UK Biobank cohort study found that more purposeful walking steps were associated with a lower incidence of symptomatic knee osteoarthritis. (3)
That does not mean more is always better. Pain that escalates during activity, swelling that persists into the next day, limping, or loss of function suggests that the current dose may be too high or that another problem requires evaluation.
A practical walking progression
A reasonable program may include:
- Establishing a comfortable baseline for several days
- Adding small amounts of time or steps rather than making sudden jumps
- Dividing walking into two or three shorter sessions
- Using flatter surfaces initially
- Adding strengthening for the quadriceps, hips, and calves
- Including balance and mobility work
- Reducing the dose temporarily after a flare rather than abandoning activity
Step count is only one measure. Walking speed, confidence, stair tolerance, swelling, sleep, and recovery also matter.
Weight management can reduce knee symptoms
For patients who are overweight or obese, weight loss is strongly recommended as part of knee and hip osteoarthritis management. (4) Reducing body mass decreases repeated load across the lower-extremity joints and may make movement more comfortable.
Nutrition should be individualized. No single diet is appropriate for every patient, and people with kidney disease, diabetes, eating disorders, or other medical conditions should make substantial dietary changes with appropriate clinical guidance.
Why the examination still matters
Not all knee pain in an older adult comes from joint-surface arthritis. Pain may arise from a degenerative meniscus, subchondral bone, pes anserine tendons, patellar tendon, bursae, collateral ligaments, or referred pain from the hip or spine.
The examination should evaluate swelling, alignment, range of motion, strength, stability, gait, and the location of tenderness. A locked knee, acute traumatic instability, suspected infection, fracture, or rapidly progressive deformity requires a different pathway.
Where injections may fit
JointRehab.com already has a detailed article on prolotherapy for knee osteoarthritis. Prolotherapy, PRP, and bone marrow concentrate should be considered separate interventions rather than grouped together as interchangeable “regenerative” injections.
PRP has a substantial knee osteoarthritis literature and may improve pain and function in selected patients. Prolotherapy research also reports symptom and functional improvement, although protocols vary. Bone marrow aspirate concentrate contains a small population of stromal/progenitor cells along with platelets and signaling proteins. A 2025 review found encouraging short- to mid-term BMAC outcomes but emphasized heterogeneous preparation methods and insufficient standardized long-term evidence. (5)
An injection does not eliminate the need for progressive movement. Its practical purpose may be to reduce symptoms enough for a patient to rebuild strength and activity tolerance.
Summary
Walking is one of the most useful activities for many people with knee osteoarthritis, but it should be progressed according to the individual—not an arbitrary step target. Weight management, strength training, balance, and recovery matter alongside step count. PRP, prolotherapy, or BMAC may be discussed when pain continues to limit rehabilitation, with realistic expectations and recognition that symptom improvement is not the same as proven cartilage restoration.
References
- Holden MA, Metcalf B, Lawford BJ, et al. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. Osteoarthritis Cartilage. 2023;31(3):386-396.
- Tığlı AA, et al. Effects of a Digitally Supported Physical Activity Intervention in Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Musculoskeletal Care. 2025;23(2):e70085.
- Dai Z, et al. Association of walking with incident knee osteoarthritis: a prospective cohort study using data from the UK Biobank. 2025.
- 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 Rheumatol. 2020;72(2):220-233.
- Park D, et al. Bone Marrow Aspirate Concentrate for Knee Osteoarthritis: A Narrative Review of Clinical Efficacy and Future Directions. Medicina (Kaunas). 2025;61(5):853.
Medical disclaimer: This article is for education only and does not provide a diagnosis or individualized treatment recommendation.