The Best Balance Exercises for Hip and Knee Arthritis

Are you having trouble walking, climbing stairs, or standing up from a chair.  Is your knee or hip pain interfering with these activities?  Are you losing muscle strength because of painful arthritis?  Most daily activities not only require muscle strength but also good standing balance. Balance problems are very common in people with arthritis.  Balance problems lead to an increased risk of falls and poor mobility. Therefore, standing balance exercises are an essential part of any exercise program to improve the lives of people with hip and knee arthritis.

A Proven Approach: The Otago Balance Exercise Program

The Otago Exercise Program (OEP) is a proven falls prevention program for older adults.  The OEP is especially beneficial for adults 75 years and older.  A 2018 clinical trial looked at the OEP to improve balance, fear of falling, and falls risk in older fallers with knee arthritis.

Older adults performed the OEP 3 times per week in their own home.  After 6 months, those who were consistent with performing their exercises showed significant improvements in balance and reduced their fear of falling.  This study provides a framework to build your own home exercise program.

The Basics of Balance Exercise

Physical therapy for balance

Balance exercises can be easily performed in your own home or under the guidance of a physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.  These exercises will only take you about 20 minutes to perform.  This investment in time and energy is well worth the reward.  For safety, start by performing each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Toe and Heel Walking

Stand on your tip toes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.   If this is not difficult for you, try walking backwards on your toes and backwards on your heels.  

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.  Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.


Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.


Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Shuttle Walk

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.  Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Get Started with Improving Your Balance

Arthritis pain causes you to change your activities and lifestyle.  You may start to avoid long walks, avoid stairs, or limit your social outings because of pain. The more you change or reduce your activities, the weaker your muscles become and the more your balance is affected.  You can change this.  Home strengthening exercises and balance exercises is the safest and most effective way to overcome limitations from arthritis.

If you don’t feel like you can do it alone, call your physical therapist.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health and quality of life.


How to Avoid Falling: Start a Home Exercise Program

More than 30 percent of people 65 and older fall each year. This increases to 50 percent for those in their 80’s.  Two-thirds of those who fall will fall again within 6 months.  Those who fall are more likely to move into a nursing home.  Worse, falls are the leading cause of injury, deaths, and hospital admissions for traumatic injuries in people 65 and older.  Falls and problems with balance will not resolve on their own.  If you are feeling unsteady or you have already experienced a fall, the time is now to do something about it.

Falls in older adults

The Answer: An Exercise Program Proven to Reduce Falls

Researchers from New Zealand developed the Otago home exercise program to reduce falls in older adults.  This fall prevention program improves strength and balance and reduces falls and fall-related injuries among older adults.  Completing the exercise program has been proved to reduce falls by an astounding 46%!  Results have been even better in adults over the age of 80.   Besides these exercises being beneficial for reducing fall risk, most participants find them enjoyable.  In fact, 70% continued exercising after one year.  This is very important because any effective exercise program must be maintained in order to sustain any benefits.

Balance Exercises within Your Own Home

The Otago exercise program is composed of strengthening exercises, balance exercises, and a walking program.  The exercises are performed 3 times per week over course of a full year.  The strengthening and balance exercises take about 30 minutes total to complete.   These can be performed at once or spread over the course of the day.

The walking program includes 30 minutes of walking at least twice per week.  If needed, the walk can be broken up into 2 or 3 smaller walks.  For example, instead of walking continuously for 30 minutes, you could spread 3 10-minute walks out over the course of your day.

The program is very flexible but is designed to become more challenging as your strength and balance improve.  The following 5 videos show examples of some of the exercises included in the program.

The Role of Your Physical Therapist

 Your exercise program is prescribed after your physical therapist performs an assessment of your balance.  This includes evaluation of your walking, ability to stand from a chair, and a four-stage balance assessment.  It is important that you start with the most appropriate exercises.  Beginning with exercises that are too easy for you will result in little improvement.  Also, beginning with exercises that are too challenging may be dangerous.  An individualized assessment helps identify the exercises which are right for you.  A list of standardized exercises is rarely effective.

After the initial assessment, you are provided with instructions for your home exercise program.  You will follow up with your physical therapist every few weeks in order to assess your progress and advance your exercises.  Your physical therapist guides you in the right direction.  However, results are dependent on your ability to remain consistent with the program.

Get Started Right Away

The doctors of physical therapy at BSR have extensive experience working with older adults who have experienced falls in the past.  Many have benefited greatly.  Still, some people attempt to justify or explain away their fall.  Some say, “The curb was too high.”  Others say, “The floor was wet.”  Denial of your balance problem only magnifies the danger.  A fall is a fall.  Once you have experienced one, no matter what the cause, your risk for another rises exponentially.  Take charge of your own balance, your health, and your freedom.  Get started with an exercise program that is right for you.  Give us a call and your physical therapist will help you begin and stay on track.


Neck Pain and Dizziness

Each year many people suffer from neck pain and dizziness. The number of patients who visit their doctor and the emergency room for dizziness is on the rise.  Dizziness accounts for 7% of doctor visits for people over the age of 45 and is the leading reason to see a doctor in those over the age of 65.  Most people with dizziness are looking for a straightforward diagnosis.  However,  those who present to the emergency department only receive a confirmatory diagnosis in 49.2% of cases.  The purpose of this article is to describe how a physical therapist examines a person suffering from one particular form of dizziness called cervicogenic dizziness.

Cervicogenic dizziness occurs as a result of pain originating from the neck or cervical spine. This occurs because of faulty signaling from the neck to the brain about where your head is in space.  This faulty signaling results in the sensation of dizziness. There is no gold standard test for this type of dizziness.  Instead, the diagnosis is made by excluding other causes of dizziness ranging from cardiovascular causes to metabolic causes, and inner ear causes.

Examination of the Patient with Dizziness

When performing an examination for a person with dizziness there is a 5 step process.  Part 1 includes listening to the patient’s history and determining if their symptoms are consistent with cervicogenic dizziness . Next, part 2 includes testing to see if this patient is appropriate for physical therapy.  Part 3 includes testing the inner ear. The inner ear, or vestibular system, consists of structures connecting with your brain which tell your head where it is in space.  Finally, steps 4 and 5 involve testing the cervical spine.

Testing of the cervical spine may include testing range of motion of the neck, strength of deep neck muscles, and performing a variety of special tests. These tests may include tests for motor control, the neck’s awareness of position sense and the mobility of each vertebra in your neck.  Oftentimes, an examination of one spinal vertebra (shown below) will reproduce the person’s complaints of dizziness.  A treatment plan is developed based on the results of these tests.

neck pain

Treatment of Neck Pain and Dizziness

There are various research papers showing manual physical therapy and exercise reduces neck pain and dizziness. The videos below illustrate two of these exercises.  Thankfully, research shows a year after physical therapy patients who complete these programs are able to maintain their improvements.

Final Thoughts on Neck Pain and Dizziness

Cervicogenic Dizziness is a condition described as neck pain and dizziness originating from the cervical spine. The diagnosis is made by first ruling out other problems.  Successful treatment includes manual physical therapy and exercise.  Thankfully, when a proper diagnosis is made by your physical therapist, this simple approach significantly reduces neck pain and dizziness.  Contact us today if you have neck pain and dizziness or simply have questions about which treatments are right for you.

Afraid of Falling? Try These Balance Exercises

Almost 10 million Americans report problems with balance.  About 40% of people over the age of 60 years experience problems with their balance.  One-third of adults in this age group and over half of people over the age of 75 years fall each year. Men and women are affected about equally.  Loss of muscle and changes in the vestibular and nervous systems are partly responsible for increasing falls as with age.  Thankfully you can do things to improve your balance and reduce your risk of falls.

Your eyes, inner ear, joints, and muscles all relay information to your brain.  Your brain interprets all the incoming information to determine where you are in your environment.   The brain then coordinates your response in order to maintain balance.  This is accomplished through pathways from your brain to your nerves and on to your muscles.  Existing pathways can be strengthened and new one can be created.  Performing exercise which is at an appropriate level to challenge and develop these pathways will improve your balance.  Below are 3 examples of such exercises.

Step Taps

Stand in front of a step or small step stool.  Place your hands on your hips or across your chest.  Place one foot gently on top of the step.  It is best to alternate steps with each foot.  The aim is to place the foot on the step as softly and quietly as possible without looking at your feet.  Begin by performing 10 slow repetitions with each foot.  Progress the exercise by using a higher step.

4-Square Stepping

Make 4 squares on the floor with objects such as clothing, rope, or yard sticks.  Step forward then to the side, then backwards, and then back to the starting square.  After a brief pause, reverse the direction.  Alternate directions with each reach repetition.  It is best to perform the exercise without looking at your feet.  Your stability is compromised then they head is held down.  Perform 5 repetitions in each direction.

Tandem Walk

Stand with the arms across your chest.  Step with a narrow base of support as if walking on a tightrope.  The heel of one foot touches the toes of the other foot.  Take 5 to 10 steps then pause in the narrow stance position for 5 seconds.  For a greater challenge perform the exercise both forward and backwards.  It is best to perform this exercise in a narrow hallway or near a counter in case you begin to lose your balance.

Closing Thoughts on Balance Exercises

Balance exercises must be performed frequently in order to influence your nervous system.  With consistent practice over time, balance and reaction time will improve slowly.   Don’t expect a rapid change in a few days.  In order to continue to make improvements, the challenge of each exercise is progressed over time.  Balance exercises work best when performed in conjunction with strength training.  See your physical therapist to determine which exercises are best for you.