Knee osteoarthritis: your treatment options

What really helps knee osteoarthritis: exercise and weight management first, then physiotherapy, walking aids, braces, anti-inflammatory gels, injections, and knee replacement when it's needed.

7 min read · last reviewed October 1, 2026

If you have knee osteoarthritis, you may have heard many different ideas about what to do. Rest it or use it? Supplements? Gel shots? Surgery? This guide sorts through the options using the latest major guidelines from the UK (NICE), the U.S. (American College of Rheumatology) and the international osteoarthritis research society (OARSI).

Think of treatment as a staircase. Everyone starts on the first step, and most people find they don't need to climb all the way up.

Step 1: The core treatments for everyone

Exercise

All major guidelines agree: exercise is the most important treatment for knee osteoarthritis, whatever your age and however bad your X-ray looks. A Cochrane review of many trials found that exercise eases pain and improves how well people can use their knee, with benefits similar to pain medicines but without the side effects.

Helpful types include:

• Strengthening the thigh, hip and calf muscles, 2 to 3 times a week
• Aerobic exercise such as walking, cycling or swimming
• Water exercise, which can feel easier on sore joints
• Tai chi, which helps strength, balance and confidence

Your knee may ache a bit more when you start. That is normal and not a sign of damage. Most people find it settles within a few weeks. See our guide Pain during exercise for how much is okay.

Supervised programmes can help you get started and stick with it. GLA:D, an education and exercise programme for hip and knee osteoarthritis, is offered by trained physiotherapists in Canada and many other countries.

Learning about your condition

Understanding osteoarthritis helps you make good choices and feel more confident. Education is a core part of care in every major guideline.

Weight management, if needed

If you are living with overweight, losing some weight takes pressure off your knees and can ease pain and improve function. UK guidelines say any amount of weight loss is likely to help, and losing 10 percent of your body weight is likely to be better than 5 percent. Your care team can help you set a goal and find support. There is no blame here. Weight is affected by many things, and help is available.

Something you can do today: Pick one strengthening exercise, such as sit-to-stand from a chair, and do a few each day this week.

Step 2: Extra help when you need it

• Physiotherapy. A physiotherapist can tailor your exercises, check your form and help you progress. Hands-on treatment can be added, but works best alongside exercise, not instead of it.
• Walking aids. A cane or walking stick, held in the hand opposite your sore knee, can take load off the joint and help you feel steadier.
• Braces, insoles and taping. These may help some people, especially if the knee feels unstable or is bending to one side. They aren't needed by everyone. Ask a physiotherapist whether one would help you.
• Good shoes. Comfortable, cushioned shoes with good support are a simple help.
• Heat or cold. Many people find a warm pack eases stiffness, and a cold pack helps after activity or when the knee is swollen.

Step 3: Medicines

Medicines are best used alongside exercise, to make it easier to stay active, at the lowest helpful dose for the shortest time.

• Anti-inflammatory creams or gels (topical NSAIDs). These are recommended as the first medicine for knee osteoarthritis. Less of the medicine gets into your bloodstream than with pills, so they have fewer side effects.
• Anti-inflammatory pills (oral NSAIDs). Your doctor may suggest these if gels aren't enough. They are not safe for everyone, especially people with stomach, kidney or heart problems, or who take blood thinners. Ask your doctor or pharmacist.
• Acetaminophen (paracetamol). Recent guidelines say it gives little benefit for osteoarthritis, so it isn't usually a first choice on its own.
• Opioids. Strong opioid medicines aren't recommended. The risks outweigh the benefits.
• Glucosamine and chondroitin. These supplements are popular, but major guidelines advise against them because there is no strong evidence that they help.

Step 4: Injections

• Steroid injections into the knee can ease pain and swelling for a short time, usually a few weeks. They can be useful to get you through a flare or help you start exercising. Most doctors limit how often you have them.
• Hyaluronic acid ("gel") injections are not recommended by UK guidelines, and the U.S. guideline advises against them for most people, because the benefit is small or unclear.
• Platelet-rich plasma (PRP) and stem cell injections aren't recommended by major guidelines. The evidence isn't strong enough, and they can be expensive. If you are thinking about one, ask what the proof is and what it costs.

Step 5: Surgery

• Knee replacement. This can be a life-changing option when pain, stiffness or loss of function badly affects your quality of life and other treatments haven't helped enough. Most people get good pain relief and can walk more comfortably afterward. Recovery takes several months, and exercise before and after surgery helps. There is no "right" age or weight; it is a decision for you and your surgeon.
• Partial knee replacement may be an option if only one part of the knee is affected.
• Keyhole "clean-out" surgery (arthroscopy) for osteoarthritis isn't recommended. Studies show it doesn't help more than exercise and other non-surgical care.

Making your plan

There is no single path. Most people combine exercise, learning, weight support if needed, and a topical gel, and many never need more. Your care team can help you choose what fits your goals and your life.

Something you can do this week: Ask your doctor or a physiotherapist about a knee exercise programme near you, or a home programme you can follow.

Questions to ask your care team

• What exercises should I start with, and how do I progress?
• Is there a programme like GLA:D near me?
• Which pain medicine or gel is safe for me?
• Would a brace, insole or walking aid help me?
• Would an injection help me right now? What are the risks?
• At what point should we talk about knee replacement?

This article is general information, not medical advice. Talk with your health care team about your own situation. In an emergency, call 9-1-1 or your local emergency number.

In an emergency, call 9-1-1 or your local emergency number.

General information, not medical advice. It does not replace your own care team. If you think you or someone else is having a medical emergency, call 9-1-1 or your local emergency number. If you are in crisis or thinking about suicide, call or text 9-8-8 (Canada and the US).

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