"I feel it coming with the humidity before the weather forecast does." It is one of the most common remarks in physiotherapy studies, and it is not fantasy: the sensation is real and should be taken seriously. What the studies do not confirm is the next step, namely that it is the cold that makes the knee worse. When researchers compared days of pain with weather data for those same days, the link shrank to little or nothing.
It is worth knowing, because it changes where you put your energy. If the culprit is the thermometer, the only strategy is to wrap up and wait for spring. If the culprit is something else, and the data say it almost always is, then there are things that really work, and winter becomes a manageable problem instead of a seasonal sentence.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
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First of all: when it is not the cold and you need a visit
Blaming everything on the climate is convenient, and that is exactly why it can waste time. Some conditions need to be looked at quickly, whatever the temperature outside:
- A knee that is hot, swollen and red, especially with fever or feeling unwell. In an acutely painful and swollen joint, recognising septic arthritis early substantially reduces permanent damage and mortality: joint pain, swelling and fever are the signs that appear most often, but fever is present in only a little over half of cases, so its absence is no reassurance (Margaretten et al., JAMA 2007). If you have a knee prosthesis, a recent operation or diabetes, the threshold for getting seen drops even further.
- The knee locks and you cannot straighten or bend it fully.
- Giving way: the leg "goes" under your weight, with the feeling that you cannot trust it.
- Recent trauma (a twist, a fall, a knock) followed by rapid swelling in the first hours.
- Night pain that wakes you, pain at rest that does not settle, or weight loss or general malaise for no clear reason.
None of these is managed with a hot water bottle.
What the studies really say about cold and the knee
The evidence here is mixed, and it is worth looking at all of it instead of choosing the study that confirms the feeling.
The study that measured flare-ups. An Australian group followed people with knee osteoarthritis confirmed on X-ray for three months, asking them to report online every episode of increased pain. They then compared the weather on the day of a flare-up with the weather on four control days for the same person: a "case-crossover" design, which in effect uses each patient as their own control and removes individual differences. Among 171 people and 1,425 observations, temperature, humidity, atmospheric pressure and rain were not associated with the risk of a flare-up (Ferreira et al., Osteoarthritis and Cartilage 2016).
The larger study, using smartphones. The British project Cloudy with a Chance of Pain collected the daily pain of 2,658 people over fifteen months, cross-referencing it with local weather. Here an association does exist, but the authors themselves describe it as modest, and it concerns relative humidity, pressure and wind speed: temperature is not among the factors found to be associated with pain (Dixon et al., npj Digital Medicine 2019).
The synthesis of all the studies. A 2023 systematic review with meta-analysis gathered 14 observational studies: overall, a relationship between weather and osteoarthritis pain emerges, with temperature correlated in the inverse direction (colder, a bit more pain). But the numbers are small and rest on very few works: the estimate for temperature comes from only three studies, and the correlation with humidity is practically nil (r = 0.086, with a confidence interval that includes zero) (Wang et al., Annals of Medicine 2023).
Put simply: if a climate effect exists, it is small, inconsistent, and does not demonstrate a causal link. Correlation and cause do not coincide here, because in winter much more changes than the temperature: you move less, go out less, sleep worse, and mood dips. And memory plays its part too: we vividly remember the rainy day when the knee hurt, much less the rainy day when we felt fine.
The mechanisms you read about everywhere: what holds and what does not
The physiological explanations that circulate are plausible on paper, but they are not backed by solid clinical evidence. It is fair to call them hypotheses:
- Synovial fluid thickening in the cold. An effect of temperature on viscosity exists in the laboratory, but it has never been shown that inside a joint at 37 degrees, protected by skin, fat and muscle, this translates into pain.
- Tighter muscles. In the cold, the muscles stiffen and we move more cautiously. This is true, and perhaps the most concrete part, but it is a consequence of behaviour, not an injury to the joint.
- Barometric pressure. This is the most cited hypothesis and the one studies have tested most. Ferreira finds nothing, the meta-analysis finds a weak correlation. Not enough to build a strategy on.
None of these hypotheses indicates that cold damages the knee or makes osteoarthritis progress. At most, cold makes an existing problem noisier.
What really works: movement
Here the picture changes completely, because the evidence exists and it is of a different order altogether.
The international OARSI guidelines list patient education and a structured programme of land-based exercise, with or without weight management through diet, among the core treatments for knee osteoarthritis: they are the foundation on which everything else is built (Bannuru et al., Osteoarthritis and Cartilage 2019).
Honesty about the numbers, however. The most recent Cochrane review gathered 139 studies and 12,468 participants: exercise improves pain, function and quality of life in the short term, but with evidence of low to moderate certainty and improvements whose clinical relevance remains uncertain. In the most rigorous comparison, pain falls by about 8.7 points out of 100 (Lawford et al., Cochrane Database of Systematic Reviews 2024). It is not a cure, and it is right to know that. It is, however, the intervention with the best balance of benefit, risk and cost that we have, and in the same review no type of exercise proved superior to the others: what matters is that you do it, not which one you choose.
This is the point that turns the winter argument around. The problem of the cold months is not the thermometer: it is that between November and February the only thing that has a proven effect on your knee, moving it, is exactly what gets dropped.
How to organise winter, in practice
Do not interrupt your strengthening programme. If you are working on the quadriceps, hamstrings and glutes, winter is when you need more continuity, not less. If you do not yet have a programme, our guide to the knee muscles and how to strengthen them is a good starting point.
Move the activity indoors, do not drop it. Stationary cycling at low resistance, walking at home or in a shopping centre, bodyweight exercises. The aim is to maintain your weekly volume, not to replicate exactly what you did in September.
Give the knee a few minutes before asking anything of it. Before getting out of bed, do twenty or thirty slow flexions and extensions under the covers. It is the same morning stiffness as always, but in winter the cold room makes it more obvious and easier to mistake for a worsening.
Warm up for longer before activity. Five or ten extra minutes, with intensity rising gradually, are a reasonable investment when the temperature is low.
Progress in steps. A load that increases little by little is tolerated better than one that doubles after two weeks off. If you miss ten days because of flu, restart below the level you had reached.
Weight, the most underrated lever
In the IDEA study, 454 adults aged 55 and over, overweight or obese, with documented knee osteoarthritis, were followed for 18 months. Those who combined diet and exercise lost an average of 10.6 kg (11.4% of body weight) and achieved less pain and better function than those who did only diet or only exercise; diet alone also reduced the compressive forces on the knee (Messier et al., JAMA 2013). It is the only combination that acts together on the load and on the capacity to bear it.
On supplements, by contrast, caution: turmeric, ginger and omega-3 are often presented as anti-inflammatory solutions, but they do not appear among the recommended core treatments for knee osteoarthritis, where education, exercise and weight management remain. If they make you feel better there is no reason to stop them, but they do not replace the rest.
And in summer, with air conditioning?
If winter cold does not hold up as a cause, artificial cold holds up even less: no study has measured air conditioning, and the 2024 meta-analysis found no association between temperature and knee pain. The only exception that emerged concerned gout, and it pointed in the opposite direction: high temperatures with low humidity.
A knee that hurts in summer is usually a knee whose load has changed: you start walking a lot again, you return to cycling, you begin running again after months, you climb stairs and trails on holiday. It is the same lever as in winter seen from the other side: in winter the problem is that you move too little, in summer that you restart too quickly.
Only one sensible precaution remains, and it concerns a direct draught more than the temperature: do not keep the knee under an air vent for hours. The full discussion of the relationship between climate and pain is in back pain and cold: what the studies really say.
Heat, knee sleeves and blankets: what to expect
Local heat, such as a hot water bottle, a heating pad, or a warm shower in the morning, often gives temporary relief, relaxes the muscles and makes movement less unpleasant. The same goes for a thermal knee sleeve or simply keeping the knee covered.
These are legitimate tools, as long as you ask them the right thing: they do not change the course of the problem, they make it possible for you to do what does change it. A quarter of an hour of heat before exercises is a good use. A quarter of an hour of heat instead of exercises is a poor bargain. Be careful with high temperatures and prolonged application if you have reduced skin sensitivity, circulatory problems or diabetes.
Being followed without leaving home
There is an irony in all this: just when going to a clinic is most of a burden, more continuity would be needed. This is why telerehabilitation works well in this season, and not only for convenience.
A randomised study of 415 people with knee osteoarthritis and overweight compared two video-delivered programmes, exercise alone and exercise plus a dietary intervention, with online information alone: both improved pain and function compared with the control at 6 months, with results maintained at 12 months, and adding diet gave an additional benefit (Bennell et al., Annals of Internal Medicine 2022).
With Ri-Hub, a physiotherapist assesses your situation, builds a tailored programme and follows its progress over time, at 29,90€ per session. The part that matters is not the video link: it is having someone who adjusts the loads when the knee complains and keeps you on track in the months when it is easiest to give up.
In summary
That the knee "feels" the cold is a widespread and real experience. That the cold makes it worse is a different matter, and the studies do not confirm it: the most rigorous study finds no association, the largest finds a modest one linked to humidity rather than temperature, and the meta-analysis confirms small effects based on few data.
The good news is that the levers with solid evidence are others, and they are in your hands: keep moving, strengthen, increase loads in steps, manage weight. Heat and a knee sleeve remain useful, as a means to keep doing these things, not as a substitute. And if a hot, swollen knee appears with fever, locking, giving way or a trauma, the weather has nothing to do with it: that needs looking at straight away.
You might also be interested in:
Knee Osteoarthritis: What to Do, Complete Guide to Treatment Running Knee Pain: Causes, Prevention and How to Keep Running Knee Replacement: Exercises to Do at Home After Surgery
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Sources
- Ferreira ML et al., The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis: a case-crossover study, Osteoarthritis and Cartilage, 2016
- Dixon WG et al., How the weather affects the pain of citizen scientists using a smartphone app, npj Digital Medicine, 2019
- Wang L et al., Associations between weather conditions and osteoarthritis pain: a systematic review and meta-analysis, Annals of Medicine, 2023
- Lawford BJ et al., Exercise for osteoarthritis of the knee, Cochrane Database of Systematic Reviews, 2024
- Bannuru RR et al., OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis, Osteoarthritis and Cartilage, 2019
- Messier SP et al., Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial, JAMA, 2013
- Bennell KL et al., Comparing video-based, telehealth-delivered exercise and weight loss programs with online education on outcomes of knee osteoarthritis: a randomized trial, Annals of Internal Medicine, 2022
- Margaretten ME et al., Does this adult patient have septic arthritis?, JAMA, 2007
Last check of the sources: August 2026.
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