What Exercises Should You Avoid With Arthritis? (And What To Do Instead)

If you’ve been diagnosed with arthritis, there was probably a point where you felt confused, lost and unsure on what to do next. Every day I see 3 or 4 patients who's main symptoms are as a result of their arthritis, whether that be osteoarthritis or one of the many inflammatory variations like rheumatoid or psoriatic. We discuss things such as pain relief, positional relief and navigating daily or occupational tasks whilst in the pain and discomfort that arthritis produces. However, often the most confusing facet of managing arthritis involves exercise. Reasons it's confusing include; movement can be painful with arthritis, but movement can also make arthritis feel better. There are times when arthritis would benefit from rest, and times it would benefit from training. We're told that we should protect the joint through the old rest, ice, compression, elevation guidelines (RICE) and in the same breathe we're told to we need to ensure that we exercises to improve arthritic outcomes. This makes the whole idea of exercising to benefit arhtritis very difficult to navigate.

What The Research Says About Strength Training and Arthritis

The American College of Rheumatology (ACR) strongly recommends exercise including resistance training, as a core treatment for knee, hip and hand osteoarthritis (Kolasinski et al., 2020). Similarly, the National Institute for Health and Care Excellence (NICE) guidelines in the UK state that therapeutic exercise should be offered to all people with osteoarthritis, regardless of age or severity (NICE, 2022).

Systematic reviews show resistance training:

• Reduces pain

• Improves function

• Improves muscle strength

• Enhances quality of life

(Fransen et al., 2015; Goh et al., 2019)

Avoidance is not protective. Gradual loading is.

First: Very Few Exercises Are Truly “Bad”

For most people with osteoarthritis (knee, hip, shoulder or hand), joints benefit from:

• Gradual loading

• Muscle strengthening

• Controlled range of motion

• Consistency

  
  

Avoidance leads to:

• Muscle loss

• Reduced joint stability

• Increased stiffness

• Greater long-term pain sensitivity

  
  

Instead of banning movements, we modify them.

What Exercises Should You Avoid With Arthritis?

Deep Loaded Knee Flexion (Too Much, Too Soon)

For knee arthritis, jumping straight into deep squats or heavy lunges can flare symptoms if tolerance isn’t built first. That doesn’t mean squats are harmful. Research shows that stronger quadriceps are associated with improved knee function and symptom reduction in osteoarthritis (Øiestad et al., 2015). OsteoFit's light programme focuses on avoiding these deep range, intensive exercises by modifying them to still allow for muscle, confidence and joint development. The intermediate programme then builds to full depth squats, lunges and split squats to continue to progress.

What To Do Instead

Chair-Assisted Squats

These:

• Reduce depth initially

• Provide support

• Build confidence

They allow progressive loading without overwhelming the joint.

You can then progress to:

Isometric Squat Holds

Isometric exercise has been shown to reduce pain and improve tendon load tolerance in various musculoskeletal conditions. For irritated joints, static holds can be a useful bridge between rest and dynamic loading.

High-Impact Activity During Flare-Ups

Running and jumping aren’t automatically forbidden long-term. However, during symptomatic flare-ups, high-impact loading may temporarily aggravate pain.

Clinical guidance recommends adjusting load during symptom spikes rather than stopping movement entirely.

What To Do Instead

• Slow, controlled sit-to-stand patterns

• Isometric so that the muscles are loaded but the joint isn't required to move far

• Tempo and pause controlled strength work

• Progressive resistance training

  
  

The goal is graded exposure, not total avoidance.

Twisting Under Heavy Load (Especially Early On)

Fast rotational movements under load can feel unstable in early-stage strengthening.

Instead of removing rotation permanently, build a base of:

• Low resistance spinal mobilisations like the seated OsteoFit thoracic figure of 8

• Anti rotation exercises which create the force of rotation without the actual movement, like the wall resisted anti rotation

• Slower tempo rotational strength work

The spine is designed to rotate, side bend, extend and flex. Even with arthritis

Overhead Work With Irritable Shoulder Arthritis

Many people avoid pressing movements entirely. However, long-term avoidance can reduce functional capacity. Certain arthritic joints like that of the acromioclavicular (AC) joint will naturally reduce the ability of the shoulder to reach it's end range comfortably. This is why, receiving a thorough diagnosis via your local osteopath or physiotherapist is key.

What To Do Instead

Broom Handle Press

Low-load overhead patterning:

• Restores confidence

• Encourages joint mobility

• Allows gradual reloading

Once tolerated, resistance can be progressed safely.

Pain During Exercise: What’s Acceptable?

Research suggests that mild, tolerable pain during strengthening (for example up to 4–5/10) that settles within 24 hours is generally safe when building load tolerance in osteoarthritis populations (Skou et al., 2018).

The key markers are:

• Pain does not progressively worsen

• Symptoms settle within a day

• Function gradually improves

Arthritic joints are rarely “fragile.” They are often under-loaded and deconditioned.

What Most People With Arthritis Actually Need

Evidence-based management typically includes:

• 2–3 strength sessions per week

• Progressive overload

• Lower limb strengthening

• Upper body push/pull patterns

• Lighter options during flare ups

• Long-term consistency

Final Thought

The question isn’t: “What should I avoid?”

It’s: “How do I build strength safely and progressively?”

That’s exactly why OsteoFit programmes use:

• Chair-assisted squats

• Isometric squat holds

• Controlled tempo movements

• Gradual weekly progression

• Structured programming

If you want a guided, home-based programme designed specifically for arthritis and osteoporosis, you can start a free week of training here

Build capacity. Reduce fear. Move better.

References

Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (1), CD004376.

Goh, S. L., Persson, M. S. M., Stocks, J., Hou, Y., Lin, J., Hall, M. C., & Doherty, M. (2019). Relative efficacy of different types of exercise for treatment of knee and hip osteoarthritis: network meta-analysis. British Journal of Sports Medicine, 53(7), 417–425.

Kolasinski, S. L., Neogi, T., Hochberg, M. C., et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis. Arthritis Care & Research, 72(2), 149–162.

National Institute for Health and Care Excellence (NICE). (2022). Osteoarthritis in over 16s: diagnosis and management (NG226).

Øiestad, B. E., Juhl, C. B., Eitzen, I., & Thorlund, J. B. (2015). Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. Osteoarthritis and Cartilage, 23(2), 171–177.

Skou, S. T., Roos, E. M., Laursen, M. B., et al. (2018). A randomized controlled trial of total knee replacement. New England Journal of Medicine, 373, 1597–1606. (Pain monitoring principles referenced in exercise-based OA care models.)