For knee osteoarthritis, braces, water therapy and exercise were the most effective non-drug treatments in a large analysis.
Knee osteoarthritis is a widespread and often disabling condition that affects millions of older adults. It causes ongoing pain and stiffness in the knee joint, making everyday movement more difficult. Many patients rely on anti-inflammatory medicines, but these can carry risks including gastrointestinal and cardiovascular side effects.
To compare alternatives, researchers analysed data from 139 clinical trials involving nearly 10,000 participants. The study compared 12 different therapies, including laser therapy, electrical stimulation, knee braces, insoles, kinesiology tape, water-based therapy, exercise and ultrasound. The findings come from a meta-analysis published in the open-access journal PLOS One.
By combining results from all of these studies using a network meta-analysis, the researchers were able to rank each treatment based on its effectiveness.
Knee braces ranked highest overall, showing strong results in reducing pain, improving joint function and easing stiffness. Hydrotherapy, which involves exercises or treatments performed in warm water, was especially helpful for pain relief. Regular exercise also delivered consistent benefits, improving both pain levels and physical function.
Some advanced treatments, such as high-intensity laser therapy and shock wave therapy, provided moderate improvements. In contrast, ultrasound consistently ranked as the least effective option.
The researchers noted that variations in study design, smaller sample sizes in some trials and differences in how long treatments were used could affect how precise the rankings are. Even so, the overall findings suggest that physical therapy approaches offer meaningful benefits without the risks linked to anti-inflammatory medicines.
Future research should explore how combining different therapies might improve outcomes further and whether these approaches are cost-effective in real-world care.
The authors said: “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 prioritise 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.”