Osteoarthritis Clinic · Home exercise program

Knee osteoarthritis

After a Durolane (hyaluronic acid) injection

Gentle exercises and simple aftercare to follow at home after your viscosupplementation. Start slowly, build up as comfort allows, and stop anything that causes sharp pain.

ViscosupplementationDurolane (hyaluronic acid gel)
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Reviewed
Reviewed. The exercises, repetition counts, hold times, and order of the exercises on this sheet have been checked by Dr. Mahendira against the clinic's printed handout.
SMH Osteoarthritis Clinic · Knee osteoarthritis · Viscosupplementation (Durolane (hyaluronic acid gel))
Reviewed by Dr. Mahendira against the clinic handout.

Your injection

Durolane is a single-injection viscosupplement made of non-animal stabilized hyaluronic acid (NASHA). It restores the natural cushioning and lubricating properties of healthy joint fluid, reducing pain and improving knee mobility. Unlike corticosteroids, it does not suppress inflammation directly. It supplements the joint fluid.

After your injection

What to expect

  • Mild pain, swelling, or warmth at the injection site is normal and may last 24 to 48 hours.
  • Durolane works gradually. Noticeable improvement typically begins within 1 to 4 weeks.
  • Benefits may last up to 6 months. Response time and duration vary from person to person.

First 24 hours

  • Rest the knee. Avoid running, jumping, prolonged standing, and heavy lifting for 48 hours.
  • Apply ice wrapped in a cloth for 15 to 20 minutes every 2 to 3 hours if swelling occurs.
  • Keep the injection site clean and dry. A small bandage may be removed after a few hours.
  • Take acetaminophen (Tylenol) as needed for discomfort. NSAIDs may be used if directed.

Days 3 to 14

  • Gradually resume light walking and daily activities as comfort allows.
  • Avoid high-impact activities (running, jumping, heavy squats) for at least 1 week.
  • Begin gentle range of motion and strengthening exercises.
  • Wear a knee sleeve or brace during activity if it provides comfort and stability.

Important reminders

Durolane should not be injected into a knee with an active infection or significant effusion. Durolane is a non-animal (synthetic) hyaluronic acid made by bacterial fermentation, so there is no bird, egg, or feather allergy concern. Unlike a steroid injection, Durolane supplements the joint fluid rather than suppressing inflammation. A repeat injection may be given after 6 months if needed.

Your exercises

Begin gently after about 48 hours if you are comfortable. Move slowly and stay within a mild, pain-free range. The counts below are a guide for how much to do.

1

Quad sets (isometric)

Most important

Sit or lie with your leg straight. Tighten the muscle on top of your thigh by pressing the back of your knee into the floor. Hold 5 seconds, relax.

3 sets of 10 reps, 2 to 3x daily

You should see your kneecap move slightly upward.

2

Straight leg raise

Lie on your back with one knee bent and the other leg straight. Tighten your quad, then lift the straight leg to the height of the opposite knee. Hold 3 seconds, lower slowly.

2 sets of 10 reps, 2x daily

Keep your core engaged and back flat.

3

Heel slides

Lie on your back with both legs straight. Slowly slide your heel toward your buttock, bending the knee as far as comfortable, then slide back out.

2 sets of 10 reps, 2x daily

Use a towel under your heel to reduce friction.

4

Standing hamstring curl

Stand holding a chair for balance. Slowly bend one knee, bringing your heel toward your buttock. Hold 3 seconds, then lower slowly. Keep thighs parallel.

2 sets of 10 reps each leg, 2x daily

Avoid arching your lower back.

5

Seated knee extension

Sit in a sturdy chair with feet flat. Slowly straighten one knee until the leg is extended. Hold 3 to 5 seconds, then lower slowly. Control the motion throughout.

2 sets of 10 reps, 2x daily

Add a light ankle weight after week 3 if pain-free.

6

Calf raises

Stand holding a chair for balance. Rise onto your toes, hold 3 seconds, then lower slowly. Strengthens the calf muscles that support knee stability.

2 sets of 12 reps, 2x daily

Keep weight even across both feet.

7

Mini wall squat

Start after week 2

Stand with your back against a wall, feet shoulder-width apart and about 12 inches from the wall. Slowly slide down to a partial squat, no more than 45 degrees. Hold 5 to 10 seconds, slide up.

2 sets of 8 reps, 1 to 2x daily

Start after week 2. Do not squat past 45 degrees.

Exercise guidelines

  • Stop any exercise that causes sharp or increasing pain in the knee.
  • Mild discomfort is fine. Sharp pain is not. Use the 0 to 3 rule: stay at 3 out of 10 or below.
  • Apply ice for about 15 minutes to the knee after exercising if it feels warm or swollen.
  • Progress slowly. Increase reps before adding resistance or depth.

Protecting the area every day

  • Maintain a healthy weight. Every pound lost removes roughly 4 pounds of stress from the knee joint.
  • Wear supportive, cushioned footwear. Avoid high heels and worn-out shoes that alter knee alignment.
  • Use a cane or walking stick on the opposite side if needed to offload the affected knee.
  • Avoid prolonged kneeling, squatting, or sitting cross-legged. These positions increase joint pressure.
  • Take the stairs one step at a time. Lead with the stronger leg going up and the affected leg going down.
  • Break up long periods of sitting. Stand and gently move every 20 to 30 minutes to prevent stiffness.
  • Apply ice for 10 to 15 minutes after activity if the knee feels warm or achy. Use a cloth barrier.
  • Consider a knee sleeve or brace for additional support during walking or exercise.

Low-impact activity

Swimming, cycling, water aerobics, and elliptical training are excellent for knee osteoarthritis. They build strength and endurance while minimizing joint impact. Aim for 150 minutes of activity per week.

Tracking your progress

Tick a box each day you complete your exercises, and circle how the area feels.

 MonTueWedThuFriSatSun
Week 1
Week 2
Week 3
Week 4
Pain level today (circle one)
012345678910
0 = none10 = worst
!When to call your doctor. Contact the clinic or seek care if you notice any of the following: Increasing pain, swelling, or redness in the knee lasting more than 48 to 72 hours after injection; Fever above 38C (100.4F), which may indicate joint infection (septic arthritis). Seek care urgently; Inability to bear weight on the leg, or a sensation of the knee giving way or locking; Rash, hives, itching, or swelling elsewhere, which may indicate an allergic reaction to the hyaluronic acid; A large amount of fluid or new tightness behind the knee (possible Baker's cyst); Known allergy or prior reaction to a hyaluronic acid injection. Tell your provider before injection; No improvement in pain or function after 4 to 6 weeks.
This is general information, not medical advice. Your exercises and recovery depend on your own situation, and your clinician will guide you.

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