Low-tech wins big for knee osteoarthritis

When it comes to managing knee osteoarthritis (KOA) without medication, simpler may actually be better. A large network meta-analysis published in PLOS One — drawing on 139 clinical trials and nearly 10,000 patients — compared 12 non-drug therapies and found that knee braces, hydrotherapy, and regular exercise consistently ranked among the top performers for reducing pain, stiffness, and mobility limitations.

Knee braces stood out across multiple outcome measures, while water-based therapy was especially effective for pain relief. Exercise delivered steady, reliable benefits for both pain and physical function. Meanwhile, ultrasound — often considered a more advanced option — repeatedly landed near the bottom of the rankings.

Key Takeaways:

• Knee braces ranked highest overall, improving pain, stiffness, and physical function
• Hydrotherapy was particularly effective for pain reduction
• High-intensity laser and shock wave therapy showed promise in select areas
• Ultrasound consistently underperformed compared to other treatments
• Combining therapies may yield even greater benefits — an area flagged for future research

Why it matters: With anti-inflammatory drugs carrying real cardiovascular and GI risks, these findings give clinicians a strong, evidence-backed case for prioritizing accessible, low-cost physical therapies — and could push clinical guidelines in a meaningful new direction.