I am 59, and just dia­gnosed with osteoarth­ritis in both knees. I have twice recently been crippled with pain, which improved with pain-​killers, rest and ice packs. The spe­cial­ist has advised swim­ming, aqua aer­obics etc. I walk quite well now and have a bike, but I feel very nervous about cyc­ling. Have you any other ideas?

Perhaps the best thing to be said about your unhappy knees is that you have a dia­gnosis – and there­fore a start­ing point to work out how to avoid unne­ces­sary grief and pain, and make the most of what your knees can do.

Osteo-​arthritis is usu­ally called the “wear and tear” con­di­tion – even though there is often a genetic ele­ment, and des­pite the fact that people who are act­ive (and there­fore use their joints a lot), do not suf­fer any more with arth­ritis than inact­ive people.

There is lots of good advice online for how to man­age your arth­ritic pain, such as at Arthritis Care. Read up on the con­di­tion so you under­stand bet­ter how it comes and goes and what may pro­voke your pain­ful flare-​ups.

When it comes to exer­cise the golden rule is that you should drop your activ­ity right back dur­ing a flare-​up, lim­it­ing your­self to gentle and reg­u­lar mobil­ity to stop your knees stiff­en­ing up, while not doing any­thing to aggrav­ate pain. The next rule, how­ever, is that when the knees “quieten down”, you should care­fully rein­tro­duce exer­cise – done right it will not worsen your con­di­tion and it could greatly help in sev­eral import­ant ways.

First, if you become inact­ive, other prob­lems tend to set in such as over­weight and heart dis­ease. Second, by strength­en­ing your legs and espe­cially the knee muscles, you are tak­ing strain off the joints, which may also reduce pain. Third, if you are going to need or want knee sur­gery in future, it will work bet­ter and you will recover more quickly if your legs and muscles are in good shape. And any­way, life will be very miser­able indeed if you stop doing all the nor­mal things you enjoy.

Cycling is pretty good for your dodgy knees because they don’t have to bear your body weight. Before you hit the road though, go to a good cycle shop and ask them to check your bike set-​up and rid­ing tech­nique (keep­ing your knees prop­erly in line when you pedal).

Swimming and aqua ses­sions are good for the same reason: the water sup­ports your body, thereby redu­cing the load on your knees. You should, how­ever, avoid frog-​kick action (eg breast-​stroke legs). Another excel­lent aqua altern­at­ive is run­ning (or walk­ing) in deep water, where your feet don’t touch the ground. Use an aqua belt for best res­ults.

Get into the habit of doing reg­u­lar knee-​strengthening exer­cises, whether at the gym using weights, or with home exer­cises. Avoid high impact (run­ning and jump­ing), deep bends and long kneels (eg, while garden­ing) and deep squat­ting or lunging. Regular walk­ing is good. If you’re wary about try­ing a new activ­ity, start very gently and wait a couple of days to see if you get a reac­tion. If not, con­tinue cau­tiously.