Knee osteoarthritis (KOA) is a widespread joint condition that affects millions of older adults. It can cause persistent pain, stiffness, and difficulty moving the knee, sometimes making everyday activities much harder.

Many patients are treated with anti-inflammatory medications, but these drugs can carry gastrointestinal and cardiovascular risks. That has increased interest in treatments that can relieve symptoms without relying on medication.

Researchers Compare 12 Knee Osteoarthritis Treatments

To determine which non-drug therapies appear to work best, the researchers analyzed evidence from 139 clinical trials involving nearly 10,000 people.

The studies evaluated 12 different approaches, including laser therapy, electrical stimulation, knee braces, insoles, kinesiology tape, water-based therapy, exercise, and ultrasound.

Rather than examining each treatment separately, the team used a network meta-analysis. This method allows researchers to compare multiple therapies across many different trials and estimate how each one performs relative to the others.

Knee Braces Perform Particularly Well

Knee braces ranked highly across several important measures. They were associated with reductions in pain and stiffness as well as improvements in physical function.

Hydrotherapy, which involves exercises or treatments performed in warm water, was especially effective for reducing pain. Regular exercise also produced consistent benefits, helping improve both pain and physical function.

Some more technologically advanced treatments also showed promise. High-intensity laser therapy and shock wave therapy produced benefits in certain areas.

Ultrasound, however, repeatedly ranked near the bottom of the treatment comparisons.

Simple Treatments May Have an Advantage

The findings suggest that relatively simple and accessible therapies may be among the strongest options for managing knee osteoarthritis without medication.

The researchers caution that the rankings are not definitive. The 139 studies differed in how they were designed; some involved relatively small groups of participants, and treatment durations varied considerably. Those differences can make it harder to precisely determine which therapy is truly best.

Even with those limitations, the authors concluded that physical therapies appear promising for KOA and could provide useful alternatives to anti-inflammatory medications.

Future research will need to investigate whether combining treatments produces even better results. Researchers also want to determine which approaches provide the greatest benefits relative to their cost.

The authors add: "Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis. They reduce pain and improve mobility without the gastrointestinal or cardiovascular risks linked to common pain medications. Patients and clinicians should prioritize these evidence-based options."

"Our analysis of nearly 10,000 patients reveals that simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound. This could reshape clinical guidelines to focus on safer, lower-cost interventions."