Knee osteoarthritis is the one people ask about most, and it is the most common reason someone ends up in our clinic with a sore knee. Around 1.8 million Australians report having osteoarthritis, and knees and hips are the joints most affected.
Physiotherapy is one of the better-supported treatments for it. Here is what that actually involves, because “come and see a physio” is not a useful answer on its own.
Assessment first
Before anything gets prescribed, we need to know what we are dealing with.
That means working out how much of the knee is genuinely arthritic and how much is something else, since knee pain often has several contributors at once. It means looking at how much movement the joint has, how strong the muscles around it are, and what it stops you doing.
It also means looking at how you move. Whether you limp, how you manage stairs, how your hip and foot are behaving, because a knee that has to compensate for a stiff hip or a flat foot will keep complaining no matter what we do to it.
This part is not skippable. The right program for one arthritic knee is the wrong one for the next.
A plan that fits you
From there we build something specific to your knee and your week.
Two people with identical scans can need completely different programs. One might be mostly stiff and need mobility work. The other might be strong but flaring badly and need load taken off for a fortnight. Guessing between those is how people end up worse.
Exercise, which is the main event
This is where most of the benefit comes from, and it is worth being specific about what kind.
Strengthening. Strong thigh muscles take load directly off the knee joint. This is the single most useful thing you can do and the one with the most evidence behind it. It usually means quads, glutes and calves, progressed gradually.
Range of movement. Keeping the knee moving through what range it has stops it stiffening further. A stiffer knee gets loaded at awkward angles, which makes everything worse.
Low-impact aerobic work. Walking, cycling, swimming. Good for the joint fluid, good for weight, good for how you feel. Cycling is often the most tolerable because you get the movement without the impact.
Balance work. Less obvious, but knees get injured when people catch themselves awkwardly. Better balance means fewer bad moments.
The dose matters more than the type. Enough to make a difference, not so much that you spend the next two days paying for it. Calibrating that is a large part of what a physio does.
Hands-on treatment
Manual therapy — joint mobilisation and soft tissue work — can reduce pain and improve movement, which then makes the exercise easier to do.
It is worth being straight about its role: it helps you get to the exercise, and it helps through a flare. It is not the treatment on its own, and anyone promising that a sore knee will be fixed by massage alone is selling you something.
Teaching you to manage it yourself
The point of seeing a physio is not to need one forever.
So we cover how to protect the joint day to day, what movement habits are worth changing, and how to handle a flare when it comes. Because it will come. Knowing that a bad week is a spike rather than a decline, and knowing how to settle it and get moving again, is what stops the cycle of flare, rest, stiffness, flare.
Braces and supports, when they help
Some knees do better with a brace, a sleeve, or occasionally something more structured. Sometimes a walking aid is the right answer, at least temporarily.
The test is whether it lets you keep moving more than it restricts you. If a brace means you can walk again, that is a good brace. If it sits in a drawer, it was not.
Monitoring, so it keeps improving
We keep adjusting as you go, adding load or range as the knee tolerates it, and backing off when it needs it. Progress is rarely a straight line and does not need to be.
Where to start
If your knee is the problem, our knee injury page sets out how we assess and treat knees specifically. For the wider picture, is osteoarthritis just part of getting older? explains what is going on in the joint, and osteoarthritis and Pilates covers why controlled exercise works better than rest.
To keep moving while your knee settles, our 30 Minute Hip and Lower Back Reset class is low impact and easy to modify.
