Managing Knee Arthritis: A Physiotherapist's Practical Guide

Osteoarthritis (OA) of the knee affects more than 4.7 million people in the UK, making it one of the most common conditions treated by physiotherapists. Despite being widely associated with ageing, knee OA is neither inevitable nor irreversible in its impact on daily life — and physiotherapy is the most evidence-based treatment available.

Dispelling the "wear and tear" myth

Osteoarthritis has long been described as "wear and tear" — a label that implies a progressive and inevitable decline. The reality is more nuanced. While structural changes in the joint are real, pain and disability are strongly influenced by factors that physiotherapy can directly address: muscle weakness, movement patterns, activity levels, weight management, and pain sensitisation.

Why exercise is the best medicine

Exercise is the most effective long-term treatment for knee OA. This might seem counterintuitive — surely moving a painful joint makes it worse? In fact, the opposite is true: cartilage receives its nutrition from the compression and release of movement. Inactivity leads to further weakening, weight gain, and pain sensitisation. The challenge is finding the right type and dosage of exercise for each individual.

Effective exercises for knee OA

• Quadriceps strengthening (straight leg raises, leg press)
• Hamstring and calf strengthening
• Hip strengthening (particularly hip abductors and glutes)
• Low-impact aerobic exercise (swimming, cycling, walking)
• Balance and proprioception exercises

When is knee replacement surgery considered?

Surgery is considered when conservative management — including physiotherapy, appropriate analgesia, and lifestyle modification — has not adequately controlled symptoms and quality of life is significantly affected. Physiotherapy is also essential before and after knee replacement surgery to optimise outcomes.