A sweeping analysis of nearly 10,000 patients reveals that knee braces, hydrotherapy, and exercise stand out as the most effective non-drug therapies for knee osteoarthritis. Unlike common pain medications that carry risks, these low-cost and accessible options reduce pain, improve mobility, and could shift treatment guidelines toward safer, drug-free approaches.
Knee braces, water therapy and exercise are the most promising non-drug therapies for treating knee osteoarthritis, according to a new meta-analysis published June 18, 2025, in the open-access journal PLOS One by Yuan Luo of the First People’s Hospital of Neijiang, China.
Knee osteoarthritis (KOA) is a common and often debilitating condition that affects millions of older adults, causing pain and stiffening of the knee joint. Treatment usually includes anti-inflammatory drugs, which are linked to gastrointestinal and cardiovascular adverse events.
In the new study, researchers examined the current evidence on non-drug therapies for treating KOA. They looked at data from 139 clinical trials involving nearly 10,000 people to compare 12 different non-drug treatments.
These included laser therapy, electrical stimulation, braces, insoles, kinesiology tape, water-based treatment, exercise, and ultrasound. By combining results from all these studies into a robust network meta-analysis, the team could rank the therapies based on how well they worked.
The authors caution that differences in study design, small sample sizes, and variability in treatment duration between the 139 included studies may limit the precision of the rankings.
However, they conclude that physical therapy has promising effects on KOA, offering potential treatments without the risks of anti-inflammatory drugs.
Future studies should examine the clinical efficacy of combined treatments, as well as their cost-effectiveness.
The authors add: “Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis.
They reduce pain and improve mobility without the gastrointestinal or cardiovascular risks linked to common pain medications. Patients and clinicians should prioritise these evidence-based options.”
“Our analysis of nearly 10,000 patients reveals that simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound. This could reshape clinical guidelines to focus on safer, lower-cost interventions.”
Knee braces came out on top across most categories, including reducing pain, improving function, and relieving stiffness. Hydrotherapy — exercises or treatments performed in warm water — was particularly effective at easing pain, and general exercise was also consistently effective, improving both pain and physical function.
High-intensity laser therapy and shock wave therapy showed some benefits, while ultrasound consistently scored the lowest in effectiveness.
