Knee Osteoarthritis: Key Treatments and Physical Therapy Recommendations

Knee Osteoarthritis: Key Treatments and Physical Therapy Recommendations

Knee osteoarthritis (OA) is a chronic, progressive condition that increasingly affects people around the world—largely due to longer life expectancy and rising obesity rates. The article “Knee Osteoarthritis: Key Treatments and Implications for Physical Therapy,” published in the Brazilian Journal of Physical Therapy, outlines the most effective and evidence-based treatments available today, with an emphasis on the critical role of physical therapists and the need to raise awareness among both healthcare professionals and patients.

This summary highlights key insights from that article, along with current approaches, expert opinions, and practical advice for people living with knee OA.

AUDIO:

What Patients Need to Know

What is Knee Osteoarthritis? OA is the most common form of arthritis. It is a chronic, degenerative joint disease that develops gradually and eventually affects the entire joint. Early symptoms may be mild, but they tend to worsen over time.

What Structures Are Affected?

• Cartilage: The smooth surface covering the ends of bones wears down and deteriorates.

• Bones: Structural changes occur, including the formation of bone spurs (osteophytes) and irregular joint surfaces.

• Synovium: Inflammation of the joint lining may increase fluid production, leading to swelling.

• Muscles and Tendons: Muscles around the knee may weaken, and tendons can become less stable over time.

Common Symptoms

• Pain: Typically worsens with activity and improves with rest; in advanced stages, pain may occur even at rest or at night.

• Stiffness: Often felt in the morning or after prolonged inactivity, usually lasting less than 30 minutes.

• Muscle Weakness: Especially in the thigh and lower leg muscles.

• Limited Mobility: Difficulty bending, straightening the knee, climbing stairs, or getting up from a chair.

• **Swelling, clicking or popping sounds (crepitus), and sensations of instability or “giving way.”

• Deformity: The knee may change shape in advanced stages of OA.

Impact on Daily Life

• Difficulty walking, standing, sitting, climbing stairs, or carrying heavy objects.

• Reduced ability to perform daily tasks, leading to decreased physical activity, social withdrawal, and a higher risk of depression.

• Lower quality of life due to pain, disrupted sleep, and loss of independence.

Why Early Treatment Matters

OA is a progressive disease. Starting treatment early can significantly slow its progression, reduce pain and functional limitations, and help patients maintain independence and an active lifestyle for longer.

Primary Treatment Approaches (Strongly Recommended Interventions)

Patient Education

• Understanding the nature of OA, its progression, and treatment options is essential.

• Debunking common myths—for example, that OA inevitably leads to severe disability, or that all movement should be avoided.

• Empowering patients to make informed decisions and take an active role in their care by creating personalized treatment plans.

• Learning pain management strategies, activity modification, and how to avoid overuse or injury.

Physical Activity and Exercise

Exercise is the cornerstone of OA treatment! It helps relieve pain, strengthen muscles, improve joint function, and slow disease progression.

The most effective programs combine:

• Aerobic exercises: walking, swimming, cycling

• Strength training: focusing on the thigh and gluteal muscles

• Flexibility and balance training

Exercise should be regular, gradually progressed, and tailored to each person's abilities and preferences. Mild discomfort during exercise is acceptable; severe pain is a sign to consult a healthcare provider.

Weight Management

Excess weight is a major risk factor for developing and worsening OA.

• Losing even 5–10% of body weight can significantly reduce knee pain and improve function.

• Combining a healthy diet with regular exercise yields the best results.

Secondary Treatments (Additional or Targeted Interventions)

Assistive Devices

Using braces, canes, orthotic shoes, or inserts can reduce joint stress—especially in more advanced cases or when instability is present. The appropriate device should be selected in consultation with a healthcare professional.

Medications

• Topical NSAIDs (gels, creams): Preferred for their localized effect and fewer side effects.

• Oral medications: Used cautiously and only under medical supervision due to potential risks.

• Opioids: Generally avoided because of limited effectiveness, high risk of side effects, and potential for dependence.

• Supplements like glucosamine or chondroitin: Not recommended—there is no strong evidence supporting their benefit.

Surgery

Considered only when all other treatments have failed and the pain and loss of function severely impact quality of life.

• Most common procedures: total or partial knee replacement (arthroplasty).

• Surgery is typically preceded by at least six months of intensive conservative treatment.

Key Takeaways

• Patients should be well-informed, actively involved in their care, and work collaboratively with their medical team.

• Modern treatment focuses not on “miracle cures,” but on proven, safe, and sustainable strategies that allow for long-term disease management and preservation of quality of life.

Practical Tips for Living with Knee Osteoarthritis Stay Active — Movement Is Medicine!

Engage in Moderate Aerobic Activity

Aim for at least 150 minutes of moderate physical activity per week — that’s about 20–30 minutes a day, five days a week. Great options include brisk walking, cycling, swimming, dancing, light aerobics, or even activities like gardening or nature walks.

Incorporate Strength and Balance Exercises

At least two times a week, include exercises to strengthen the muscles around your knee (especially the thighs and glutes), and to improve balance and coordination. Some simple examples:

• Chair squats

• Toe raises

• Sit-to-stand from a chair

• Standing on one leg

• Gentle yoga or tai chi

Try to move every day, even in small ways — housework counts, too!

Don’t Avoid Movement Just Because of Pain

Pain during activity is expected — and usually not harmful. Mild to moderate discomfort during physical activity is common with OA and does not mean you're making your condition worse. Learn to distinguish between "working pain" (normal) and sharp, sudden, or lingering pain (which may require professional advice).

Start slow and increase gradually. If you haven’t been active in a while, begin with light activity and short sessions. Increase intensity and duration at your own pace.

If pain becomes intense or doesn’t go away after rest, talk to your doctor or physical therapist.

Set Realistic Goals and Track Your Progress

Try simple self-checks to monitor your improvements:

• 30-second chair stand test: How many times can you sit and stand from a chair in 30 seconds?

• 6-minute walk test: How far can you walk in 6 minutes on flat ground or in a hallway?

• Balance test: How long can you stand on one leg without support?

Keep a journal of your exercises, pain levels, and challenges — it helps you see progress and set achievable goals.

Celebrate small wins! Any improvement in movement or pain reduction matters.

Manage Your Weight

Weight makes a big difference. Even modest weight loss (just 5–10% of your body weight) can lead to significant reductions in pain and better knee function.

Focus on gradual, sustainable weight loss through healthy eating and regular activity:

• Eat more vegetables, fruits, and whole grains.

• Cut back on fried, sugary, and processed foods.

• Simple swaps go a long way — for example, switch soda for water or skip that extra piece of bread at dinner.

If you're struggling, consider speaking with a registered dietitian or joining a weight-loss support group.

Avoid Ineffective or Outdated Treatments

Supplements like glucosamine and chondroitin: Research has shown little to no consistent benefit. Save your money and your hopes for more effective options.

Therapies like ultrasound, electrical stimulation, or laser treatments: These may sound appealing, but evidence for their effectiveness is limited. Use only under a healthcare provider’s recommendation and with clear expectations.

Be cautious of “miracle cures” or treatments lacking scientific support.

Be Proactive — Take Charge of Your Care

Ask questions during your appointments.

• What activities are safe for me?

• Which exercises are most helpful for my condition?

• Are there any new, evidence-based options I should know about?

Share your concerns and observations — open communication helps your care team guide you more effectively.

Request information in plain language, and don’t hesitate to ask for clarification or repetition if something isn’t clear.

Take Care of Your Mental Health and Seek Support

Living with OA can be challenging, especially if it limits your daily activities. Social support and a positive mindset can make a real difference.

If you’re feeling overwhelmed, isolated, or experiencing symptoms of depression, don’t hesitate to seek help — whether from a mental health professional, a support group, or someone close to you.

The Bottom Line:

You are the most important player in managing your osteoarthritis. With small but consistent steps — and the right information and support — you can reduce pain, improve function, stay active, and enjoy life to the fullest.

What’s Unclear, Conflicting, or Poorly Supported?

Heat and Cold Therapy (Compresses, Cryotherapy)

What it involves: Heat therapies include warm compresses, heating pads, or thermal wraps, while cold therapies involve ice packs, cold compresses, or cooling gels (cryotherapy).

Scientific evidence: Current research shows limited and low-quality evidence that heat or cold therapy provides long-term relief of pain or improves function in knee osteoarthritis. Studies are often small, with mixed outcomes and methodological flaws.

Personal experience matters: Despite the lack of strong data, many patients report short-term relief using heat or cold. For some, warmth helps reduce stiffness; for others, cold can relieve swelling and pain. This makes these treatments more about personal comfort and preference.

Important safety tip: If you choose to use heat or cold, always do so safely—never apply directly to the skin, limit sessions to 15–20 minutes, and avoid use on areas with reduced sensation.

Laser Therapy, Ultrasound, Electrical Stimulation, Manual Therapy, Taping, Acupuncture

What they involve: These are widely used physical therapy techniques:

• Low-Level Laser Therapy (LLLT): uses low-intensity laser light to stimulate tissue

• Therapeutic Ultrasound: applies high-frequency sound waves to target areas

• Electrical Stimulation: uses electrical currents to relieve pain or activate muscles

• Manual Therapy: includes joint mobilizations, manipulations, and massage

• Taping (Kinesio Taping): applies special tape to support joints or muscles

• Acupuncture: involves placing fine needles at specific points on the body, based on traditional Chinese medicine

Scientific evidence: Leading international guidelines and systematic reviews do not support strong, lasting benefits from these methods for knee OA.

• Laser and ultrasound therapies have shown inconsistent and often minimal effects.

• Electrical stimulation lacks enough high-quality research.

• Manual therapy, taping, and acupuncture have not consistently outperformed placebo.

Recommendation: If you're offered one of these therapies, ask for clear information on:

• Expected benefits

• Potential risks

• Costs

• Scientific support

These treatments may be used as supplements, but they should not replace first-line strategies such as exercise, education, and weight management.

Your choice matters: If you decide to try these, do so with informed expectations—not with the hope of a “miracle fix.”

Opioids (Strong Prescription Painkillers)

What they are: Opioids like codeine, morphine, and tramadol are medications that act on the central nervous system to relieve severe pain.

Scientific evidence: Large clinical studies have found that opioids offer little to no meaningful improvement in pain or function for knee osteoarthritis. They carry significant risks:

• Nausea

• Dizziness

• Constipation

• Drowsiness

• Dependence

• Life-threatening complications in some cases

Recommendation: Opioids are not recommended for long-term management of knee OA. In rare cases, they may be used short-term and under strict medical supervision—but only when other options have failed.

Joint Supplements (Glucosamine, Chondroitin, and Others)

What they are: These are marketed as “natural remedies” to support joint health and are sold in capsules, powders, drinks, and more. Glucosamine and chondroitin are the most popular.

Scientific evidence: Major expert organizations like OARSI and ACR do not recommend routine use of these supplements. Meta-analyses have shown that they perform no better than placebo in reducing pain or improving function. They may also interact with other medications and are often a waste of money.

Recommendation: Do not start taking joint supplements without speaking to your doctor. Be skeptical of advertisements claiming they can “rebuild” or “reverse” joint damage.

Why Critical Thinking and Health Literacy Matter

The challenge: With so many treatment options (some helpful, others misleading), it’s easy to feel confused or tempted to try everything—especially when in pain.

The rule: Always consult a trusted healthcare provider. Rely on evidence-based sources, and be cautious of anything promising “quick fixes” or “miracle cures.”

While it's natural to want to explore all options, the best-supported approach to managing knee osteoarthritis remains: ✔ Regular movement and exercise ✔ Education and understanding the condition ✔ Healthy weight management ✔ Open communication with your care team

Everything else should be approached with caution, awareness, and realistic expectations.

Expert Opinions and Key Takeaways

Dr. Timothy McAlindon, Chief of Rheumatology, Allergy and Immunology at Tufts Medical Center in Boston, emphasizes the importance of avoiding outdated, ineffective, and poorly supported therapies—such as the routine prescription of pain medications, dietary supplements, or passive treatments. Instead, he urges both physicians and physical therapists to adopt modern, research-based approaches, and encourages patients to seek and demand science-backed information.

“There is an urgent need for healthcare professionals to move away from low-quality, ineffective treatments and to educate and empower patients with evidence-based best practices,” says Dr. McAlindon.

The authors of the Brazilian Journal of Physical Therapy article echo this view, stating:

“High-quality evidence shows that combining patient education and exercise can lead to long-term improvements in knee osteoarthritis symptoms and reduce overall healthcare costs.”

They emphasize that the cornerstones of modern treatment are patient education—fostering awareness of the condition and teaching self-management strategies—and physical activity, specifically through personalized exercise programs. These approaches not only reduce pain and improve mobility, but also help avoid unnecessary procedures and medications, easing the burden on both patients and the healthcare system.

Exercise Is Essential—Not Optional

Regular physical activity and tailored exercise programs have been shown to:

• Relieve pain

• Slow disease progression

• Improve daily functioning

There is strong international consensus that movement is not only safe but essential for managing OA. However, it’s crucial that exercise be personalized to each individual’s needs and abilities—there is no one-size-fits-all solution. A customized approach leads to greater motivation, better outcomes, and higher long-term adherence to treatment.

The Power of Collaboration

A positive, respectful relationship between patients and healthcare providers is central to successful treatment. When patients feel heard, informed, and actively involved in decision-making, they’re more likely to engage in their care and experience better results. This highlights the importance of shared decision-making and ongoing communication throughout the course of treatment.

Surgery and Strong Pain Medications: Last Resorts

Procedures like arthroscopic surgery or strong opioids should be considered only after all conservative (non-surgical) treatments have been exhausted. This careful approach helps protect patients from unnecessary risks, side effects, and disappointment—especially since these interventions rarely offer lasting benefit in managing knee OA.

The Bottom Line from Global Experts

Modern knee osteoarthritis treatment should be rooted in proven strategies. The primary pillars include:

• Patient education

• Regular physical activity

• An individualized care plan

Other tools—such as medications, physical therapy modalities, or surgery—may still have a role but should be used selectively and with well-informed consent.

Ultimately, patients should be empowered participants in managing their condition. Staying informed, engaging in open dialogue with care providers, and prioritizing sustainable lifestyle changes are the most effective ways to reduce pain, maintain mobility, and improve quality of life.

Questions & Answers

1. What is knee osteoarthritis, and what are the most common symptoms?

Knee osteoarthritis (OA) is a chronic, degenerative joint disease that progresses gradually and affects all parts of the joint—including the cartilage, bones, synovial membrane, tendons, and surrounding muscles. It typically begins with cartilage thinning and breakdown, the development of bone spurs (osteophytes), inflammation of the joint lining, and muscle weakness around the knee.

Common symptoms include:

• Pain (usually worsens with movement, improves with rest, but may occur at night in later stages)

• Stiffness (especially in the morning or after long periods of inactivity; often lasts less than 30 minutes)

• Muscle weakness (particularly in the thigh and lower leg)

• Limited mobility, difficulty walking, standing up, sitting down, or climbing stairs

• Swelling, cracking or popping sounds (crepitus), and feelings of instability

• Knee deformity in advanced stages

These symptoms can significantly limit daily activities, reduce physical activity, and even lead to social isolation and depression.

2. Why is early treatment important, and what are the key recommended approaches?

OA is a progressive disease—if left untreated, it leads to increasing pain and loss of mobility. Early intervention helps slow progression, relieve symptoms, and preserve independence for as long as possible.

First-line treatment includes:

• Patient education: Understanding the condition, debunking myths, and becoming an active participant in care.

• Physical activity and exercise: The foundation of modern OA treatment. Programs combining aerobic exercise (e.g., walking, swimming) with strength and balance training are highly effective.

• Weight management: Even a modest weight loss (5–10% of body weight) can significantly reduce pain and improve joint function.

• Support and individualized care: Treatment should be tailored to each person’s needs, capabilities, and goals.

3. What treatments are proven to work—and which ones are questionable or ineffective?

Proven effective:

• Patient education and regular, tailored exercise

• Weight management

• Assistive devices when needed (braces, canes, orthotics)

• Topical NSAIDs (nonsteroidal anti-inflammatory creams or gels)

Questionable, inconsistent, or not recommended:

• Dietary supplements (glucosamine, chondroitin): Not recommended—no solid evidence of benefit

• Passive physical therapies (laser, ultrasound, electrical stimulation): Limited or conflicting evidence

• Opioids: Not recommended except in rare, short-term cases due to serious side effects

• Surgery: A last resort after all conservative options have failed

• Heat and cold therapy: May provide temporary relief for some but lacks strong evidence—use only with guidance

4. What is the role of the physical therapist, and what are the most helpful tips for patients?

A physical therapist is a key partner in managing knee OA, providing support and expertise in:

• Creating individualized exercise plans (targeting strength, flexibility, balance, and endurance)

• Teaching proper movement patterns and joint-protection strategies

• Monitoring progress and adjusting activity levels over time

Practical advice:

• Aim for at least 150 minutes of moderate physical activity per week

• Don’t fear mild discomfort during movement—it doesn’t mean you're harming the joint

• Increase intensity gradually, track your progress with small tests, and set realistic goals

• Stay in touch with your care team—share changes and concerns openly

5. How can I navigate the overwhelming number of treatment options and avoid ineffective ones?

• Think critically: Many therapies are advertised as “miracle cures”—trust science-based, expert-recommended treatments

• Avoid starting supplements or passive treatments (like ultrasound, laser, or kinesio taping) without clear guidance and full understanding of the risks and benefits

• Opioids and surgery should be last-resort options—only considered after thorough consultation and when all else has failed

• Be proactive: Ask questions, request understandable information, and take an active role in treatment decisions

• Take care of your mental health—support from others and a positive mindset are essential parts of healing

Source: Knee osteoarthritis: key treatments and implications for physical therapy https://doi.org/10.1016/j.bjpt.2020.08.004