Strength Training With Joint Pain: What The Research Says

Short Answer

For knee osteoarthritis, a Cochrane review of 54 studies found exercise reduced pain by about 12 points on a 0 to 100 scale; the evidence for the hip is weaker, and a 2019 guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends exercise for hip and knee osteoarthritis. This page summarises research and is not treatment: clear any plan with your clinician first.

Updated 7 October 2026

Does exercise reduce knee osteoarthritis pain?

A Cochrane review (Fransen and colleagues, 2015, PMID 25569281) extracted data from 54 randomised trials of land-based exercise in people with knee osteoarthritis. In 44 trials with 3,537 participants, exercise reduced pain by the equivalent of 12 points on a 0 to 100 scale, from about 44 points in the control groups. Physical function improved by about 10 points in 44 trials, and quality of life by about 4 points in 13.

The authors rated the pain evidence high quality and the function evidence moderate. They also noted that few trials blinded participants and that pain and function were self-reported, and the results were measured immediately after treatment, not years later.

Is the evidence the same for the hip?

Less clear. A 2026 Cochrane update on hip osteoarthritis (Hall and colleagues, PMID 42486497) included 18 trials with 1,368 participants. Against no treatment or usual care, exercise probably reduces pain slightly (by 7.19 points on a 0 to 100 scale, 9 studies, 449 participants, moderate certainty), though the authors judged the improvement unlikely to be clinically meaningful.

Against attention control or placebo, exercise may have little to no effect on pain, based on only two studies with 123 participants. Most studies were small and unblinded. The honest reading is that the trials so far show a small benefit on pain and function at the hip. They do not say exercise is useless for any one person.

What does the main US guideline recommend?

The 2019 guideline from the American College of Rheumatology and the Arthritis Foundation (Kolasinski and colleagues, PMID 31908163) covers osteoarthritis of the hand, hip and knee. Its voting panel included rheumatologists, an internist, physical and occupational therapists and patients.

It made strong recommendations for exercise, and for weight loss in people with knee or hip osteoarthritis who are overweight or obese. It made conditional recommendations for balance exercises and yoga. The guideline asks clinicians and patients to decide together, taking account of values, preferences and other health conditions. It is a guideline for treatment decisions, not a lifting program, and it does not name sets, reps or loads.

Should exercise be pain free?

A systematic review in the British Journal of Sports Medicine (Smith and colleagues, 2017, PMID 28596288) compared exercise where pain was allowed or encouraged with exercise kept pain free, in people with chronic musculoskeletal pain. It found nine papers from seven trials with 385 participants.

In the short term, painful exercise gave a small benefit for pain (effect size -0.27, 95% interval -0.54 to -0.05). For pain in the medium and long term, and for function and disability at every time point, there was no significant difference. The authors concluded that pain during therapeutic exercise need not be a barrier to success. It is not a reason to push through new, sharp or worsening pain, which belongs with a clinician.

How does a coach fit alongside your clinician?

A coach does not diagnose, treat or clear you to train. Your clinician sets the limits, and a plan is only as safe as those limits are accurate. Titan Forge states that its plans are built around real constraints, and limits from your clinician are the most important one. Ask your clinician or therapist to write down which movements, loads and symptoms to avoid, and bring that to your first conversation.

Steve "Doc" Ginevan, PhD reviews your goal, training history and schedule before any call. In-person sessions are at 9780 S Meridian Blvd, Englewood, CO 80112, and coaching is also online. The site also has a longer article on loading, tempo and exercise choice when a joint is sore.

Training around joint pain, the full article · In-person training in Englewood and Centennial · Apply for coaching

Titan Forge Fitness provides fitness and nutrition coaching. It is not medical care, and nothing here diagnoses, treats, or replaces advice from a physician or physical therapist. If you have joint pain, an injury, or symptoms that concern you, get clinical clearance before starting or changing a training program.