Scientists confirm the best treatments for osteoarthritis are not medications

Knee arthritis pain is often treated with pills, injections, or devices. New research suggests simpler physical therapies can give stronger relief with fewer risks for many patients.

A new study of thousands of patients points to knee braces, warm water therapy, and structured exercise as top options for knee arthritis. These approaches work without adding new drugs and help people climb and walk with less pain.

Osteoarthritis and pills

Most people with osteoarthritis, a joint disease that slowly damages cartilage and limits movement, are told to manage pain with pills.

Today, about 528 million people live with osteoarthritis and roughly 365 million have knee involvement worldwide.

The work was led by Yuan Luo, a rehabilitation specialist at the First People’s Hospital of Neijiang in southwest China.

Luo’s research focuses on comparing non drug therapies for knee osteoarthritis to help patients avoid unnecessary medication side effects.

Many people with knee arthritis rely on nonsteroidal anti-inflammatory drugs (NSAIDs), medicines that reduce inflammation but can harm the stomach.

These drugs also raise concerns about kidney stress and heart problems when used for long periods, particularly in older adults.

A large review of NSAID use in people over 60 found higher rates of serious gastrointestinal bleeding and kidney injury among regular users. That work also tied long term NSAID exposure to more cardiovascular events.

What this study did differently

Instead of testing one treatment at a time, Luo’s team compared many therapies at once. They used a network meta-analysis, a method that combines results from many trials, so treatments can be ranked together.

To build the comparison, researchers pooled 139 trials that tested 12 non-drug options for knee osteoarthritis.

Those trials examined laser therapy, electrical stimulation, braces, insoles, taping, ultrasound, hydrotherapy, and several exercise programs.

Researchers examined standard rating scales that scored pain, stiffness, and day to day function. Those scores let them estimate which options worked best overall without letting any single small study dominate the picture.

“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,” said Luo.

How braces shift the load

A knee brace for arthritis is usually a rigid or semi rigid device that wraps around the joint. By changing how body weight passes through the knee, the brace can take pressure off the worn compartment and reduce irritation of sensitive tissues.

Clinical research on unloader braces, rigid supports that relieve pressure from one side of the knee, shows clear short term pain relief. Several trials also report better function and longer walking distance when people use these braces consistently.

An overview of 14 brace studies reported that many users experienced better overall quality of life while they wore the device. The authors also found early signs that bracing could delay knee replacement for some patients.

Braces have drawbacks, including bulk, skin irritation, and the hassle of wearing them for hours per day. Real world studies suggest many people stop using their brace or wear it only briefly, so comfort and fit can influence success.

Why water and exercise matter

Hydrotherapy involves guided exercise in warm water that supports body weight and lets joints move with less impact.

A systematic analysis of aquatic exercise programs found that water based sessions reduce pain and joint dysfunction for people with osteoarthritis.

Those benefits were especially clear for participants who struggled to tolerate land based workouts because of pain or poor balance. In Luo’s ranking, hydrotherapy rose to the top when a combined arthritis score was used, capturing gains in pain, stiffness, and daily function together.

That pattern fits reports from pool programs that work with older adults who have knee arthritis. In warm water, they can practice balance, strength, and walking drills without the sharp jolts they feel on dry ground.

Land based exercise also remains a central part of care for people with knee osteoarthritis. Walking, strengthening, simple balance drills, supervised sessions, and support for weight and self management are all strongly recommended in major clinical guidelines.

What this means for treatment

The new ranking supports a model where braces, exercise, and hydrotherapy sit at the center of long term care. In that approach, medications are used carefully as add ons, not the automatic first line.

Because these physical treatments shift load, strengthen muscles, and retrain movement patterns, they aim at causes of pain rather than only numbing signals. That focus on mechanics and strength can matter more than short courses of pills.

International bodies now encourage combinations of non drug and drug therapies tailored to each person with knee symptoms.

Tibiofemoral bracing and structured exercise sit among the most strongly endorsed options for painful knee osteoarthritis. Practical care plans often layer a brace for high demand activities with regular supervised exercise sessions.

Pool time when available and short courses of medication during symptom flares are added instead of escalating straight to injections or surgery.

More to learn about osteoarthritis

People living with knee arthritis can ask their clinician whether an unloading brace or a supervised exercise program is appropriate for their needs.

They can also ask about referral to aquatic therapy when their balance, weight, or other conditions make land exercise difficult.

Questions about brace fit, how many hours to wear it, and which exercises are safe help tailor treatment and may improve comfort and adherence.

Specific goals, such as hiking, kneeling, or climbing stairs for work, can guide which therapies deserve the most attention.

Researchers still need longer studies that follow brace users and exercise participants over several years. Those trials could reveal whether these approaches delay joint replacement and remain cost effective as people age.

Luo and colleagues also note that combinations of therapies, such as bracing plus hydrotherapy, could prove more powerful than any single option.

Robust trials of those treatment packages are still rare, so the best mix and timing remain open questions.

The study is published in PLOS One.

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