Osteoarthritis (OA), the most common form of knee arthritis, is a degenerative disease marked by the gradual breakdown of cartilage. This process leads to pain, stiffness, and reduced mobility, often resulting in bones rubbing against each other and causing chronic inflammation. Fortunately, many effective non-surgical strategies exist to manage symptoms and improve function. Conservative management is the initial and preferred pathway for treating knee OA, aiming to reduce pain and enhance quality of life without invasive procedures.
Foundational Lifestyle Modifications
Managing the mechanical load on the knee joint is a cornerstone of non-surgical arthritis management. Excess body weight significantly increases the force transmitted across the knee during daily activities, accelerating wear and tear on compromised cartilage.
Weight management is a highly impactful strategy for slowing disease progression. Clinical guidelines recommend a realistic weight loss goal of 5% to 10% of total body weight. Achieving this target provides a substantial reduction in joint stress and has been consistently shown to improve pain and function.
Regular, low-impact exercise is equally important for maintaining joint health and stability. Activities that minimize joint stress, such as swimming, cycling, and walking, are preferred over high-impact exercises. Water-based exercise is particularly beneficial as it reduces the weight-bearing load on the lower extremities. The goal is to keep the joint mobile and the surrounding tissues conditioned.
Strengthening the muscles around the knee provides a dynamic support system that helps stabilize the joint during movement. Stronger muscles absorb shock and better control the knee’s alignment, reducing abnormal forces that contribute to pain. Combining muscle strengthening with flexibility exercises helps maintain the knee’s range of motion, which often diminishes due to pain and stiffness.
Pharmaceutical and Topical Pain Relief
Medications offer a way to manage the pain and inflammation associated with knee arthritis. Over-the-counter options are generally the first pharmacological approach, with acetaminophen serving as the initial analgesic choice. This medication works centrally to block pain signals. Acetaminophen is generally well-tolerated but does not address the underlying inflammation in the joint.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen, treat both pain and inflammation. They are often more effective than acetaminophen for moderate-to-severe pain. However, oral NSAIDs carry systemic risks, including gastrointestinal irritation, kidney issues, and increased cardiovascular risk, especially with long-term use. Consequently, they must be used at the lowest effective dose for the shortest duration possible, often requiring physician oversight.
Topical pain relief offers a localized alternative with fewer systemic side effects. Topical NSAIDs, applied as gels or creams, penetrate the skin to deliver the anti-inflammatory drug directly to the joint area. Since drug absorption into the bloodstream is significantly lower than with oral versions, the risk of systemic complications is reduced. This makes topical NSAIDs a preferred option for knee arthritis.
Another topical agent is capsaicin cream, derived from chili peppers. It works by depleting Substance P, a neuropeptide responsible for transmitting pain signals, effectively desensitizing the area. Capsaicin application may initially cause a temporary burning sensation. It requires consistent use, often for two to four weeks, before the full therapeutic pain-relieving effect is experienced.
Biomechanical Support and Physical Therapy
External supports and directed movement therapies are designed to improve the mechanical function and alignment of the arthritic knee. Physical therapy (PT) is an individualized treatment program aimed at reducing pain and improving mobility. A therapist assesses gait, strength, and range of motion, then implements a program focused on strengthening supporting muscles.
PT exercises focus on building strength for better joint stability and shock absorption. Therapy also incorporates manual techniques and stretching routines to increase the knee’s range of motion and flexibility, counteracting stiffness. Through focused therapy, individuals learn new ways to move that reduce stress on the joint, improving their ability to perform daily activities.
Biomechanical support often includes specialized bracing to alter the forces acting on the joint. Unloader braces are rigid devices designed for individuals whose arthritis is worse on one side of the knee (unicompartmental osteoarthritis). These braces shift the weight-bearing load away from the damaged compartment to the healthier side of the knee. This offloading effect can significantly reduce pain and may help delay the need for surgery.
Simple compressive knee sleeves, made of neoprene or elastic, provide warmth and a sense of stability. These sleeves compress the joint, helping to control swelling and offering minor support, but they do not change the mechanical alignment like an unloader brace. Thermal treatments are also routinely used, with heat applied to reduce stiffness and ice used to decrease acute pain and inflammation following activity.
Intra-Articular Injection Therapies
When non-pharmacological methods and oral medications fail to provide sufficient relief, injections directly into the joint space are often considered. Corticosteroid injections (cortisone shots) are a powerful anti-inflammatory treatment. The medication rapidly suppresses localized inflammation within the joint capsule, typically leading to quick, though temporary, pain relief lasting several weeks to a few months.
Due to the potential for corticosteroid injections to damage surrounding cartilage and soft tissues, their frequency is strictly limited. Physicians generally recommend no more than three to four injections in the same knee within a one-year period to mitigate the risk of adverse effects.
Viscosupplementation involves introducing a gel-like substance called hyaluronic acid (HA) into the joint. In a healthy joint, HA is a natural component of the synovial fluid, serving as a lubricant and shock absorber, but its quality diminishes in an arthritic knee. The injected HA attempts to restore the fluid’s properties, improving joint cushioning.
Unlike corticosteroids, viscosupplementation generally has a slower onset of action, sometimes taking several weeks to feel the full benefit. However, the relief can be longer-lasting, potentially extending for six months or more. The mechanism provides both mechanical lubrication and mild anti-inflammatory effects.
Another emerging option is Platelet-Rich Plasma (PRP) therapy, which involves drawing a person’s own blood, concentrating the platelets, and injecting the resulting plasma into the knee. Platelets contain growth factors that are thought to promote healing and reduce inflammation. Recent consensus suggests PRP is an appropriate and effective option for patients with mild-to-moderate knee arthritis, often offering more sustained relief than other injectable treatments.