Knee braces and water-based exercises are among the most effective techniques for alleviating pain and stiffness associated with knee osteoarthritis. High-quality evidence is necessary before these methods can be universally recommended in clinical practice, as indicated by reviews of 12 non-pharmacological therapies.

This condition arises from the deterioration of cartilage, which cushions the edges of bones, leading to inflammation, discomfort, and stiffness. Pain relief medications and anti-inflammatory drugs can ease these symptoms, but side effects may occur, so healthcare providers often recommend physical therapy, such as shoe inserts to reduce knee pressure, tape for joint support, or laser therapy aimed at encouraging cartilage repair.

However, it remains uncertain how these treatments compare to one another. “Many reviews of treatments focus solely on the efficacy of individual therapies,” states Sarah Kingsbury, who was not part of the recent research conducted at the University of Leeds in the UK.

To address this gap, Yuan Luo from China’s First People’s Hospital and colleagues evaluated data from 139 randomized controlled trials examining 12 approved or experimental physiotherapy approaches for knee osteoarthritis. These trials included over 9,600 adults suffering from this condition.

Some studies compared two or three physical therapies, while others investigated one therapy against either a placebo or no treatment at all. Participants typically underwent treatment for several weeks before completing a symptom assessment.

Based on their findings, researchers concluded that knee braces effectively diminish pain and stiffness, emerging as the top method for enhancing mobility, followed by water-based exercise. “When you’re walking in a pool, you engage your muscles without stressing the joints in the same way walking in a park would,” says Kingsbury.

The ranking of efficacy for the other tested treatments is as follows: high-energy laser therapy, which delivers high-energy sound waves into the knee; low-energy laser therapy, which applies electrical stimulation to knee nerves; taping the knee; electromagnetic stimulation; ultrasound treatment; and wearing insoles.

Due to various factors, the findings are insufficiently robust to change clinical practices, Kingsbury notes. Many studies involved fewer than 50 participants, resulting in a limited sample size that can undermine confidence in the results. Additionally, treatment durations varied widely, from one week to less than a few months, which may skew perceptions of effectiveness.

Another limitation is that these studies did not juxtapose physical therapy with drug treatments or evaluate the efficacy of combining pharmaceutical and non-pharmaceutical interventions, Kingsbury points out.

Despite these limitations, the reviews offer valuable insights regarding the most effective approaches, she suggests. “Establishing this ranking is useful and crucial. It allows us to possibly exclude the least effective 6 to 10 therapies, enabling us to focus on strengthening the evidence surrounding a few selected treatments.”