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Person sat cross legged on the floor with their hand on their foot

Managing knee pain with axial SpA (AS)

It’s common for people with axial spondyloarthritis (AS) to experience knee pain, but there are lots of potential causes for this.

  • The condition itself can cause inflammation in the knee joint (arthritis).
  • The tendons of muscles that attach around the knee can get inflamed (enthesitis).
  • If you’re experiencing pain that limits your activity, local muscle weakness can aggravate the pain when you’re trying to be active.
  • Unfortunately, people with axial SpA (AS) can also have a knee injury just like anyone else, so it can sometimes be difficult to work out what’s causing the pain. If needed, speak to your doctor or physiotherapist for guidance and advice.

When to speak to your doctor

It’s essential you speak to your doctor if your knee is visibly swollen, red or hot to touch. If you have swelling and tightness in your calf, then seek care immediately.

It’s also important to speak to your rheumatologist if you feel your axial SpA (AS) is generally poorly controlled, for example getting lots of episodes of pain or joint swellings. They may alter medication or give advice to settle things down.

It can be helpful to take photos of swollen joints when they happen, so that you’re able to show your doctor at appointments.

What can you do?

After speaking to your doctor or physiotherapist to work out what’s causing the pain, they will give you advice about what to do to help. If you’re experiencing inflammation in the knee, your doctor will discuss options that may include exercise, medication and possibly a local steroid injection.

Other things that may help knee pain include:

  • Exercises to improve the movement of the knee and the strength of the muscles surrounding the joint (to provide support). Download our gentle knee exercises.
  • Maintaining a healthy weight. The NHS has some great resources and your GP may be able to refer you someone to help.
  • Applying hot or cold locally can help relieve the pain temporarily, which can be particularly useful before or after exercising.

If using heat, use a wheat bag or a hot water bottle wrapped in a towel on the front of the knee for around 10-minutes, up to three times a day.

For cold, use a cold pack or bag of frozen peas wrapped in a tea towel and placed on the front of the knee for 5-10 minutes, up to three times a day.

It’s really important to keep the hot or cold wrapped in a towel to protect the skin and not to leave it on the area for too long. Setting a timer can be helpful, especially if you are resting and may fall asleep.


Movement is really effective at loosening stiff joints and it’s important to keep the muscles surrounding the knee strong. While the knee is painful, low impact exercise will allow you to be more active without aggravating the pain. For example:

  • Walking, Nordic walking.
  • Cycling (outdoors or a static bike).
  • Hydrotherapy or walking in water.
  • Swimming (sometimes twisting the knee can be uncomfortable, so it may help to only do front crawl legs to begin with).

Helping you to be more active

Sometimes the difficulty is that when you start increasing your activity, the pain flares up for a short time. There are a number of ways to reduce the likelihood of this happening, such as:

  • Speaking to a physiotherapist or occupational therapist about using a knee support or sports tape when you are being active.
  • Considering a walking stick, Nordic walking poles or a walking aid. If using an aid allows you to be more active with less pain, therefore strengthening the muscles, it can help speed up the improvement and allow you to do more.
  • Supportive footwear can really help your legs and back, so speak to a podiatrist about any particular footwear that would suit you.
  • Pacing your activities and putting in regular breaks.


Pacing is an important part of managing axial SpA (AS) in general, but it can be especially helpful when trying to be active with a painful knee. Track your activities in a diary and then see if you need to break larger activities down into smaller tasks or schedule more rest breaks.

You can download our guide to fatigue and use the example activity diary.


  • Speak to your doctor or physiotherapist if you’re experiencing knee pain.
  • Try to keep active with low impact exercises.
  • Gradually strengthen the muscles surrounding the knee.
  • Consider changes such as footwear, mobility aids, joint supports, maintaining a healthy weight, hot/cold therapy and pacing.