Physical Therapy For Osteoarthritis Of The Knee | How Does It Work?

Written By on June 13, 2022 — Medically Reviewed By Kris Ceniza (PT)

Going to physical therapy for osteoarthritis of the knee is a key part of every OA treatment. Not only because it reduces knee pain but for many other reasons as well (more on this later). (1)

In reality, we -physios- work with you as a team, with the single goal of helping you live with this condition. We give you tools and strategies to get back to the life we know you can have.

I’ll discuss them all here. In the end, you’ll know exactly what to expect from your physical therapy process. The topics I’ll be covering are listed below. Tap on any of them to easily navigate through the article:

10 strategies physios use to manage knee OA

Once the knee osteoarthritis diagnosis is made, your doctor will recommend starting physical therapy as soon as possible.

See, this is a huge part of the conservative management of symptomatic knee osteoarthritis because it (1):

  • Reduces pain, stiffness, and swelling.
  • Keeps your legs strong, so you can do your daily activities easier.
  • Helps you slow down the progression of the disease.
  • Teaches you how to live with the condition.
  • Can delay and even avoid your need for surgery.

We’ll work with you to achieve these goals through several methods. These depend on each physical therapist, though, as we all have different areas of expertise. You may want to find a professional specializing in orthopedics.

With that said, most of us use the following strategies to treat knee arthritis:

1) Manual therapy

This is probably the first thing that comes to mind when you think about PT. Now, there are two hands-on treatments commonly used in PT (1, 2):

Massage

Here, the therapist kneads, rubs, and/or presses the muscles around your knee. This in turn can reduce joint stiffness, ease pain, and increase mobility.

It’s a great adjunctive therapy to prepare your knee for other, more active treatments.

Knee joint manipulation

In this treatment, your PT tries to move the joint itself. This is usually to stretch the soft tissues at different points of the range of motion. It also helps with mobility and pain.

Note: Both techniques are much more effective when paired with exercise. As a standalone treatment, they provide short-term relief only. (3)

2) Thermotherapy

This is the application of heat or cold to get their therapeutic benefits. Both can help with pain, but they do so in different ways.

In a nutshell, heat reduces symptoms by promoting blood flow to the area. Whereas cold has a numbing effect on the nerves and can reduce inflammatory chemicals present in the joint itself. (4)

Now, when it comes to knee osteoarthritis, your therapist will likely suggest heat.

But your personal preferences are extremely important. They play a huge role in whether a treatment works or not. (4)

So, if you’d prefer cold or even contrast therapy instead of hot compresses, don’t hesitate to mention it to your physio.

Learn more: What’s better for knee arthritis – hot or cold?

3) Electrotherapy

Here, your therapist places electrodes around your knee joint, which transmit an electrical signal that can reduce pain. The current can alter the nerve activity, quickly relieving symptoms. (2)

The effects are short-termed, though. That’s why we tend to use it at the beginning of the session, before doing exercises. (1)

There are several forms of electrotherapy, the most popular being TENS – transcutaneous electrical nerve stimulation. This is a portable device you can also buy for home treatment, as it’s a great strategy for easing flare-ups.

Related: 11 home treatments for your knee osteoarthritis.

4) Exercise therapy

This is one of the best treatments for knee osteoarthritis. It can improve pain and function, plus prevent further degeneration. This is regardless of (2):

150 minutes per week of moderate aerobic exercise can be enough. Doing moderate to vigorous strengthening exercises twice a week also provides these results. (4)

If you prefer to walk to keep your knee joints healthy, the equivalent would be between 5750 and 7500 steps per day.

But, before diving into the different types of exercise, a little disclaimer.

It’s completely normal to have a temporary increase in knee pain or muscle soreness after exercise. (1)

The condition is not getting worse. It’s your tissues adapting to the new stimuli – keep going because it will get better. Do discuss with your physical therapist what’s normal post-exercise pain and what isn’t, though.

With that said, there are several types of exercise modalities physios use to help your knee osteoarthritis:

Supervised exercise program

Here, your therapist or another professional gives you a set of exercises and supervises you while you do it. This can be extremely helpful for people with severe pain, or with stability problems.

This can be done individually or in a group setting. Common examples include (2):

  • Yoga.
  • Tai chi.
  • Pilates.
  • Osteoarthritis-specific movement classes.
  • Aquatic exercise.

At-home exercise program

As the name suggests, this is the homework your therapist gives you. This is the core of your treatment and it’s imperative you do it. It will boost and maintain what you already did in the clinic.

Your physical therapist will give you a set of movements to strengthen your leg muscles. As well as stretching exercises to promote mobility and joint health.

Now, one issue no one talks about is whether you enjoy your home exercise program or not.

Don’t get me wrong – you have to do some type of physical activity. There’s no way around it.

But if you don’t like, say, the set of straight leg raise in your routine, it’s completely fine to ask your therapist to change it. There are thousands of exercises and variations available to target the same muscle groups.

Note: To truly understand all the levels at which exercise helps this condition, take a look at our guide on the pathophysiology of knee osteoarthritis.

5) Activity modification strategies

Some patients need to change the way they do some activities to not make their symptomatic knee OA worse.

This can be as simple as learning new ways to lift objects from the floor to avoid kneeling. Or switching to a standing desk to include more movement in your daily life.

Whatever the case, your physical therapist will give you specific recommendations according to your needs.

Related: 5 tips for working with knee osteoarthritis.

6) Recommend specific knee garments

Wearing a knee brace can help you keep pain and stiffness at bay during the day. Which makes it much easier to live your life despite the osteoarthritis.

Your physio will likely recommend one if your symptoms require it. There are several designs available, but the ones that can help knee degeneration the most are:

Knee sleeves

These minimalist garments work by providing compression to the knee joint. This in turn brings blood flow to the area, which can decrease pain and enhance mobility.

For my knee osteoarthritis patients, I always recommend having at least one high-quality knee sleeve at home.

It can be a life-saver when your symptoms flare-up. Or for those days when you want to do tons of stuff without overexerting your joint.

Learn more: The best sleeves for knee arthritis pain.

Hinged braces

Knee osteoarthritis can cause meniscus and/or ligament problems, which inevitably affect the stability of your joint. In this case, a hinged brace may be the best choice.

These garments provide external support to your knee, making it easier for you to walk, climb stairs, or even squat without having a wobbly joint.

Check this out: Guide with the best hinged braces out there.

Unloader braces

Unloader braces are designed in a way that reduces the load on one side of the knee. As such, they’re best for people with unicompartmental arthritis.

They are a bit more expensive than the other options, though. But if you have cartilage degeneration in one side of the joint, it will do wonders for your symptoms.

Further reading: Ranking of the best unloader knee braces.

7) Prepare you for flare-ups

One of the most frustrating things about this degenerative joint disease is that it will flare up at some point. More so for patients with bilateral knee osteoarthritis.

Don’t worry – your therapist will work with you to design a plan for when that happens. You’ll know exactly what to do and how to manage it. This will help you overcome it faster.

He/she will also be there for you during the flare-up. The sessions may not be as exercise-focused as others, though. They will likely focus on passive treatments (like the first ones in this list) to ease your symptoms naturally.

This may help: 7 tips to live better with knee OA.

What if a physical therapy program is not enough?

Physical therapy is one of many strategies to manage knee osteoarthritis. It should be done in combination with other treatments as well, such as:

Weight loss

Having a BMI >25 is a risk factor for the development and worsening of knee osteoarthritis. That’s why doctors recommend patients lose weight early on their treatment journey.

It doesn’t have to be drastic, though. A weight reduction of 5% to 10% can greatly help with pain and improve quality of life. (1, 4)

But, it’s best to achieve it through a combination of diet and exercise. This is way more effective for weight loss than doing either treatment alone. (4)

Dietary supplements

There’s a wide variety of supplements available. The most commonly used for knee osteoarthritis include:

  • Glucosamine chondroitin – may help maintain articular cartilage.
  • Turmeric – has anti-inflammatory properties, comparable to NSAIDs.
  • Hyaluronic acid – taken orally, can boost the effects of hyaluronic injections.
  • Vitamins – the lack of certain vitamins can promote knee pain.
  • CBD – can help with pain and sleep.

Now, deciding which supplement to take can be a challenge. So, think first about what benefit you want to get first. This will make it easier for you to decide.

But, a word of caution – dietary supplements are extremely safe, but they can cause adverse reactions in certain people. Consult with your doctor first if you have a previous medical condition or if you’re taking other medications.

Know more: The best supplements for helping knee OA symptoms.

Medications

These are one, if not the fastest way to get rid of knee joint pain. However, the side effects can be huge for some patients.

Now, your doctor will recommend specific drugs depending on your age, symptoms, overall health, and other factors. The most commonly used for knee osteoarthritis are acetaminophen and NSAIDs, like ibuprofen.

If they’re not enough, your physician may recommend injections. The exact compound will depend on your symptoms, but the typical options are:

  • Corticosteroids.
  • Hyaluronic acid.
  • PRP.

More info: 11 medications for knee osteoarthritis.

What about surgery?

This should be the last resort for managing knee osteoarthritis symptoms.

It becomes a viable option if all previous conservative options are unsuccessful, after trying them for at least 6 months. (4)

See, for selected patients, knee joint replacement will be extremely effective. But it is key to exhaust all other treatments before – otherwise, the surgery may worsen symptoms instead of improving them.

Now, if you take the surgical route, you’ll also have to do physical therapy afterward. This is to make sure you recover properly and regain the full function of your knee.

This will help: Know when surgery is necessary for knee OA.

FAQs

Does physical therapy help osteoarthritis of the knee?

Absolutely. It will be key to your recovery, regardless of the stage of your knee osteoarthritis.

What type of exercise is good for osteoarthritis of the knee?

Walking, yoga, tai chi, Pilates, and strength training are amazing for this condition. However, the type of exercise is not as important as your ability to do it in the long term. So, it’s best to choose a physical activity you enjoy. (1)

What should you not do with osteoarthritis of the knee?

Avoid activities that worsen the knee pain, as well as periods of sedentarism. Prioritize proper sleep and nutrition, as well as some type of daily physical activity.

Conclusion: Physical therapy for knee osteoarthritis

You can see why physical therapy is a staple in any hip or knee osteoarthritis treatment. It’s a highly individualized treatment that helps you reduce pain, improve function, and get your life back.

But for it to work, you have to go in with a teamwork mentality. The therapy will be as effective as the effort you put in – passive strategies only help so much.

Finally, remember that we’re here to help you. Don’t be afraid to ask us questions, or tell us what you’d like to change in your treatment. We’ll go through this together!

Resources

  1. American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). Retrieved on May 2022 from: https://www.aaos.org/oak3cpg
  2. “Guideline for the management of knee and hip osteoarthritis.” The Royal Australian College of General Practitioners. Retrieved on May 2022 from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf
  3. Reza, Mohammad Kashif, et al. “Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis.” Journal of pain research vol. 14 127-138. 26 Jan. 2021, DOI: 10.2147/JPR.S285297
  4. Dantas, Lucas Ogura, et al. “Knee osteoarthritis: key treatments and implications for physical therapy.” Brazilian journal of physical therapy vol. 25,2 (2021): 135-146. DOI: 10.1016/j.bjpt.2020.08.004

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Author
Mich Torres (PT)
Mitch is a physical therapist, personal trainer, and nutrition coach. Fascinated with the knee joint, Mitch poured that passion into writing about knee pain and how to overcome it with movement. His goal is to teach you how to apply this knowledge into your daily life, so you can keep knee pain away for good.

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