Knee braces, water therapy, and exercise are the most effective non-drug treatments for knee osteoarthritis, according to a major new study published in the open-access journal PLOS One. The meta-analysis suggests that these simple, accessible therapies outperform more high-tech interventions, offering safer alternatives to medication-based treatment.
Knee osteoarthritis (KOA) is a degenerative joint condition affecting millions of older adults, often causing pain, stiffness, and limited mobility. While anti-inflammatory drugs are commonly prescribed, they carry risks of gastrointestinal and cardiovascular side effects. In response, researchers conducted a large-scale analysis to determine which non-drug therapies offer the greatest benefit.
The team reviewed 139 clinical trials involving nearly 10,000 participants. The studies examined 12 types of non-pharmacological treatments, including knee braces, insoles, kinesiology tape, hydrotherapy, exercise, laser therapy, electrical stimulation, shock wave therapy, and ultrasound. By using a network meta-analysis, which combines and compares data across multiple studies, the researchers ranked the treatments based on their effectiveness in reducing pain, improving physical function, and relieving stiffness.
Knee braces ranked highest in nearly all categories, followed closely by hydrotherapy — therapeutic exercises performed in warm water — and general physical exercise. “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,” the authors noted.
Other interventions, such as high-intensity laser therapy and shock wave therapy, showed moderate benefit, while ultrasound was consistently the least effective. The researchers acknowledged limitations in their analysis due to variability in study design, treatment duration, and sample sizes. They call for future research to assess the cost-effectiveness of combined therapies.
Reference: Xiao Chen, Yuanhe Fan, Hongliang Tu, Yuan Luo. Clinical efficacy of different therapeutic options for knee osteoarthritis: A network meta-analysis based on randomized clinical trials. PLOS One, 2025; 20 (6): e0324864 DOI: 10.1371/journal.pone.0324864
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