Non-Drug Treatments for Knee Osteoarthritis: Exercise, Braces, and Hydrotherapy Outperform Medications

What Did the New Knee Osteoarthritis Analysis Find?

A comprehensive analysis involving nearly 10,000 patients with knee osteoarthritis has demonstrated that simple, accessible therapies can significantly reduce pain and improve function without the side effects associated with long-term medication use. The study compared a range of non-pharmacological interventions — including structured exercise programs, knee braces, hydrotherapy, and combinations of these approaches — against standard drug treatments commonly prescribed for the condition.

The results showed that several non-drug approaches produced clinically meaningful improvements in pain scores and physical function. Exercise-based interventions, in particular, consistently ranked among the most effective strategies. Hydrotherapy — exercise performed in warm water — offered additional benefits for patients who found land-based exercise difficult due to pain or limited mobility. Knee braces that redistribute mechanical load across the joint also showed meaningful symptom relief, especially for patients with malalignment.

Why Are Non-Drug Approaches Recommended as First-Line Treatment for Osteoarthritis?

Leading international bodies including the Osteoarthritis Research Society International (OARSI) and the European Alliance of Associations for Rheumatology (EULAR) have long recommended non-pharmacological approaches as the foundation of osteoarthritis management. Unlike anti-inflammatory drugs or analgesics, which primarily mask symptoms, exercise and physical therapy address contributing factors such as muscle weakness, joint instability, and excess body weight. These guidelines emphasize that medications should be considered as adjuncts to — not replacements for — lifestyle-based interventions.

The rationale is also one of safety. Nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used for osteoarthritis pain, carry well-documented risks of gastrointestinal bleeding, cardiovascular events, and kidney damage with long-term use, particularly in older adults who make up the majority of osteoarthritis patients. Opioid analgesics present even greater concerns, including dependence and increased fall risk. In contrast, exercise, hydrotherapy, and bracing have favorable safety profiles, with the primary risks being minor muscle soreness or skin irritation — issues that are easily managed.

How Can Patients Start Non-Drug Treatment for Knee Osteoarthritis?

For patients newly diagnosed with knee osteoarthritis or those looking to reduce medication reliance, clinical guidelines suggest starting with a structured exercise program tailored to individual fitness levels and symptom severity. Low-impact activities such as walking, stationary cycling, swimming, and tai chi have strong evidence supporting their use. A physiotherapist or exercise specialist can design a progressive program that strengthens the quadriceps and hamstrings — muscles critical for knee joint stability — while avoiding excessive joint loading.

Hydrotherapy, also known as aquatic therapy, is especially beneficial for patients with more severe symptoms or those who are overweight, as the buoyancy of water reduces joint stress while still allowing muscle-strengthening exercise. Unloader knee braces, which are specifically designed to shift weight away from the damaged compartment of the knee, may be prescribed for patients with predominantly medial or lateral osteoarthritis. Importantly, these interventions are not mutually exclusive — combining exercise with bracing or hydrotherapy often produces better outcomes than any single approach alone. Patients should discuss options with their healthcare provider to develop a multimodal plan suited to their needs.