Knee osteoarthritis is one of the most common causes of chronic pain (with lower back problems being another hot contender for the title), and anti-inflammatory drugs are most people’s go-to, and is often what doctors will suggest first too.

For those who want “non-drug drugs”, i.e. natural remedies that do a similar job, there are options, for example: Five Supplements That Actually Work vs Arthritis

However, there are other options, and we’ve discussed some of them previously, for example: Avoiding/Managing Osteoarthritis

Today we’ll be looking at some of those treatments and more, ranked against each other. Of course, most of them aren’t “either/or” options; you can usually do multiple things if you want, but it’s worth knowing which ones are more worth investing time and energy into.

No need for drugs?

A recent meta-analysis of 139 clinical trials with 9,644 patients compared 12 different non-drug therapies, namely:

• low level laser therapy (LLLT)
• high intensity laser therapy (HILT)
• transcutaneous electrical nerve stimulation (TENS)
• interferential current (IFC)
• short wave diathermy
• ultrasound
• lateral wedged insole
• knee brace
• exercise
• hydrotherapy
• kinesio taping (KT)
• extracorporeal shock wave therapy (ESWT)

…and ranked them according to following methods, and subcategories thereof:

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC):

• pain
• stiffness
• function
• total

Visual Analog Scale (VAS):

• rest
• activity

Because different therapies were better or worse in different categories, it’s difficult to produce a pure-and-simple 1-to-12 ranking without being misleading, but the top 3 are quite clear:

1. Braces ranked highest overall for reducing pain, improving function, and easing stiffness
2. Hydrotherapy was especially effective for pain relief
3. Exercise consistently improved pain and mobility

All three consistently outperformed drugs, making them excellent choices, especially since they avoid gastrointestinal and cardiovascular risks (which are common problems with popular arthritis drugs) while being low-cost and accessible.

On the other end of the scale, it’s worth noting that ultrasound consistently performed worst, followed by short-wave diathermy. So maybe skip those.

You can read the paper in full, here: Clinical efficacy of different therapeutic options for knee osteoarthritis: A network meta-analysis based on randomized clinical trials

Before you get shopping for knee braces…

Of those top 3 that we mentioned, there are some further observations we can make.

About hydrotherapy, that can mean a lot of different things (hot water therapy, cold water therapy, exercising in a swimming pool, etc). You can read about that here: How Useful Is Hydrotherapy?

It’s likely that the latter one (exercising in a pool) works well since it is in some ways a combination of exercise and bracing the knee—since the water provides support, while the exercise can still take the knee through a range of motion, which is important.

See for example: The Most Underrated Mobility Exercise (Not Stretching) ← this is written with hips in mind, but it’s about making sure to get a full range of motion, and it applies just the same for knees

Now, about knee braces and exercise…

A likely reason that braces perform better than exercise overall is that it is zero-effort, which likely makes adherence higher, especially if using “intention to treat” scores, as many studies in the meta-analysis did.

What that means: instead of carefully checking how good adherence was (i.e. how much people consistently followed through with treatments, did things correctly, etc), the qualifying factor can simply be that the treatment decision was made, that this patient has been referred for such-and-such, has been given access to that treatment, and has agreed to embark on it.

Which, when applied to this situation, means: a patient who has been given knee braces is more likely to wear them, than a patient who has been given daily exercises to do is likely to do them. Consequently, the patient the patient with the knee braces enjoys greater relief, even if the exercises might have actually worked better, had they been undertaken more seriously.

What exercises, you wonder? Here’s a good example: Knee Pain Won’t Get Better Unless You Fix This First

Want a knee brace in any case? We don’t sell them, but here for your convenience is an example product on Amazon 😎

Want to learn more?

For a much deeper understanding of treating knee pain, here’s a great book that we reviewed a little while back:

Treat Your Own Knee – by Robin McKenzie ← he’s a physiotherapist and not a doctor, but with 40 years of practice to his name and 33 letters after his name (CNZM OBE FCSP (Hon) FNZSP (Hon) Dip MDT Dip MT), he seems to know his stuff. His work is very well-respected, and almost any English-speaking physiotherapist will have read his books.

Take care!