You may have heard quad exercises for strength can be helpful for knee osteoarthritis relief but it can be hard to find the best exercises that don’t make your knees angry. Why is quad or thigh exercise strength so important? Why do you feel weaker if you have knee osteoarthritis. It’s time to find some answers to these questions!Â
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Through the research and likely from your own personal experience, you may have noticed that quadriceps (thigh muscle) weakness tends to coincide with knee osteoarthritis and the symptoms involved.
Your thigh muscles are responsible for straightening your leg. For example, when you are standing up from a chair, you are trying to straighten your legs- hence your quads are working hard every day!
Why is quad strength so important when discussing knee pain? Let’s take a look at the research.
"The significant association of quadriceps muscle strength with knee pain remained after adjustment for age, BMI, gender and knee OA...The quadriceps muscle is the principal dynamic stabilizer of the knee joint; thus, quadriceps muscle weakness leads to instability of the knee, which may be one of the reasons for knee pain"
As you can see, quad muscle strength can actually be correlated with knee pain severity. On average, less muscle strength can be a contributor to higher pain levels in patients knee osteoarthritis.
The thought process then is, increase quad strength and decrease pain.
How to increase quad strength
There are a few ways you can increase the muscle strength of your thighs.Â
Exercise is a clear first solution that can help you build strength and what this article is about.Â
I did want to mention another way to increase muscle strength which is actually managing knee swelling. Swelling can make it harder for muscles to contract how they should. Here’s what the research says:Â
"Swelling is known to trigger the spinal inhibitory mechanism of quadriceps motor neurons, and to reduce muscle activity, thereby decreasing proprioception"
This is basically a way of say that swelling can interfere with processes that are crucial for the muscle to contract how it needs to.Â
Controlling swelling can be another way to help you make strength gains with knee osteoarthritis. One way to do that is with compression sleeves. I have a blog post on those here.
The best quad exercises for strength from a physical therapist
There are lots of exercises out there claiming they can help you build the strength of your thighs. Some of these though, may not bring you as much benefit as you think.Â
So which quad exercises for strength should you focus on? Which are the best to get started with?Â
As a physical therapist and osteoarthritis specialist, I have treated hundreds of people with knee osteoarthritis and have found these exercises build strength without flaring up pain.Â
Even if you don’t have knee osteoarthritis- these exercises can be extremely helpful towards feeling strong.
These exercises are set up in a progressive fashion, starting with the easiest and working up in difficulty.
Table of Contents
1. Seated Knee Extension
According to a research study, this exercise had one of the higher rates of contractions in your quads compared to some other exercises like a leg press in the gym (Jakobsen et al. 2019)
All you need is a longer resistance band, my favorite set here, and a chair.
The idea is to do enough repetitions where you start to feel fatigue in the muscle but this doesn’t equate to pain. This exercise is not meant to hurt.Â
I would recommend also trying another variation to increase the difficulty and quad muscle activation.
You can always modify by increasing/decreasing the resistance using a different color resistance band.
This is one of the better quad exercises for strength to start with, especially if you are new to exercise or are dealing with higher levels of pain.Â
Complete 10-20 repetitions and repeat 2-3 times as able.
2. Straight Leg Raise
In the research study I just mentioned, this straight leg raise did show a little less quadriceps activation than some of the other exercises it was compared to (squats, leg extension). I did include it though because it is easy to do at home and usually doesn’t flare up pain.
In this video I am sitting on the ground but you can absolutely do this on a couch or a bed. I do have a video to help you get up and down from the ground though 🙂
The goal is to sit up as straight as you can against a stable surface like a wall, bed frame, chair/couch arm, etc. This helps to cut out the hip flexors and focus more on the quads.
You may experience a muscle cramp when first trying it but shaking your leg out and stretching can help. That means this is an exercise you should work on!Â
The goal is to complete 5-8 reps on each side, holding for 3-5 seconds if you can. If you aren’t able to hold at first, just lift it up and down for the same amount of reps. Complete for 2 sets as able.
3. TRX Squat
Sit to stands can be one of the BEST exercises for thigh strength. This is because it is a movement you have to be able to do but also requires you to move your entire body weight from a lower range of knee bending.
If you have knee osteoarthritis, squats can be difficult (here’s more on why). TRX or suspension straps can be a great way to add support so you can move through the full range of motion without flaring up pain. You can find my favorite set here.Â
Of course, squats are a major part of the list of quad exercises for strength so here is the first modification.Â
If you aren’t experiencing pain, these TRX straps can still be useful! The chair is optional when completing.
Try for 10-15 reps here, going as low as you feel comfortable with.Â
4. Stomp Chair Squat
Next on the list is another chair squat variation but it adds a little more impact and speed. This is one of my favorite exercises because it is a quad exercise for strength but also gets your heart rate up!Â
If you have osteoporosis, or are over the age of 50- you may be more at risk for your bones weakening. If you have osteoarthritis you are also at risk for osteoporosis (podcast episode on that here).
This exercise helps to get a little momentum with standing up. I find this particularly helpful if you have a hard time standing out of a low chair.Â
Try for 10-15 reps and see how it feels. If it feels fairly easy- you can move onto the next one!Â
5. Goblet Squat
I couldn’t make a list of the best quad exercises for strength without including the goblet squat. A goblet squat is another squat variation where you add some weight and keep it close to your chest.
This of course has lots of flexibility in difficulty based on the weight you choose. I typically start clients out on the conservative side of a 5 lb kettlebell, especially if newer to exercise.
Here is an article that shows more information on kettlebells if you’re interested.
Start with 5-8 repetitions and increase the weight as you are able. Since you aren’t able to use your hands, make sure you are standing from a surface height that you don’t need to use your hands for.
Here is my favorite kettlebell. I have an article here that shows other simply yet effective things I recommend to include in a home gym.Â
6. Medicine Ball Squat Toss
This exercise is another squat variation but adds both speed and resistance. These medicine balls weigh varying amounts and can make it easy to modify or progress the exercise.
I also have clients who use pillows or other objects to throw as well. What this exercise does is focus on quad power, meaning you have to contract your quads quickly to stand up then throw the object in the air. Here is one of my favorite medicine balls to use for this because it is easier if they are soft.
For this one, focus on standing up as quickly as you can and launch the object a couple feet in the air, catch and repeat.
Try to complete 10-15 of these, using a bench behind you is optional but can be helpful if you have knee pain.
7. Supported Single Leg Squat
This single leg supported squat is next up in the progression of quad exercises for strength. Once you have mastered a chair squat, this is the next step. The one-legged squat has some of the highest quadriceps activation but it can be difficult to complete at first.
This is a modification I use ALL the time and highly recommend mastering. This exercise is also helpful when it comes to stair climbing as well.Â
Start on a higher sitting surface and put one foot in front of the other. The further out the front foot is, the harder this exercise will be. Complete 8-10 repetitions on each side and complete 2-3 times as able.Â
8. Weighted Single Leg Supported Squat
This exercise is very similar to above but now adds weights into the mix. You do want to make sure you can do at least 20 reps without pain or swelling before starting to add weight.Â
I usually recommend starting with two 5lb weights to start, up to 10lb weights as you’re able.Â
With weights, typically it is normal to reduce the number of repetitions, especially as the weight increases.Â
9. Tempo Squat
Lastly, mastering a slow squat without support can be one of the best quad exercises for strength.Â
This exercise adds an extra component of eccentric strength. This means you are working the muscle as you are lengthening it on the way down to the bottom of a squat.Â
This eccentric control can be very helpful when it comes to going down stairs and hills.Â
If you notice knee pain during this exercise or significant difficulty with it, you can go back to any of the above exercises and continue building strength to work up to this one. It can be quite challenging.
The goal is to aim for 5-6 reps, making sure you are in control.Â
What it comes down to...
The best quad exercises for strength are the ones you will do consistently. Strength takes time to build and requires a commitment around 3-4 days per week for at least 2-3 months to see significant progress.
There are lots of different ways to challenge your thigh strength but these can be some of the best when getting started.Â
If you are looking for a program that provides follow along workouts as well as other ways you can manage osteoarthritis and inflammation all in one place- I highly recommend the Arthritis Adventure Blueprint to help you get started towards pain relief.
Alyssa Kuhn
Disclaimer: This post is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Kuhn and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this post, video or site
References:
- Jakobsen, T. L., Jakobsen, M. D., Andersen, L. L., Husted, H., Kehlet, H., & Bandholm, T. (2019). Quadriceps muscle activity during commonly used strength training exercises shortly after total knee arthroplasty: implications for home-based exercise-selection. Journal of experimental orthopaedics, 6(1), 29. https://doi.org/10.1186/s40634-019-0193-5
- Kim, D., Park, G., Kuo, L. T., & Park, W. (2018). The effects of pain on quadriceps strength, joint proprioception and dynamic balance among women aged 65 to 75 years with knee osteoarthritis. BMC geriatrics, 18(1), 245. https://doi.org/10.1186/s12877-018-0932-y
- Muraki, S., Akune, T., Teraguchi, M., Kagotani, R., Asai, Y., Yoshida, M., Tokimura, F., Tanaka, S., Oka, H., Kawaguchi, H., Nakamura, K., & Yoshimura, N. (2015). Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study. BMC musculoskeletal disorders, 16, 305. https://doi.org/10.1186/s12891-015-0737-5Â
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