Beyond the Pill: Why Exercise, Hydrotherapy, and Braces Outperform Painkillers for Knee Osteoarthritis

For too long, the default response to the grinding pain of knee osteoarthritis has often been a quick reach for painkillers. But a groundbreaking study by the European League Against Rheumatism (EULAR) is fundamentally shifting this approach, spotlighting a more effective and sustainable path to relief: daily exercises, hydrotherapy, and supportive braces.

This isn't just a tweak; it's a paradigm shift.

The comprehensive new guidelines firmly position active interventions at the forefront of treatment, urging a significant re-evaluation of how we manage this pervasive condition that affects millions globally. Forget solely relying on pills; the future of knee osteoarthritis management is about movement, support, and empowerment.

The study’s findings are stark: while painkillers might offer fleeting respite, their long-term efficacy is limited, and the risk of side effects—especially from oral NSAIDs and even paracetamol when used extensively—is a genuine concern.

EULAR's experts now advocate for their use only in cases of severe, acute pain and strictly for short durations. The message is clear: painkillers are not a sustainable first-line solution.

So, what are the superior alternatives? The new guidelines champion a multi-faceted approach, beginning with fundamental lifestyle changes and targeted physical therapies:

• Daily Exercise: This is non-negotiable.

  Regular, gentle exercise such as walking, cycling, and targeted physiotherapy to strengthen the muscles around the knee joint is paramount. It improves joint flexibility, reduces stiffness, and builds supportive muscle mass, taking pressure off the worn cartilage.

• Hydrotherapy: Water-based exercises offer a buoyant environment that reduces gravitational stress on the knee.

  This allows for a greater range of motion and strengthening without the impact associated with land-based activities, making it ideal for those with significant pain or mobility limitations.

• Braces and Orthoses: Supportive knee braces can provide stability and offload pressure from affected areas of the joint.

  Similarly, shoe insoles can correct alignment issues, further distributing weight more evenly and reducing strain on the knees.

Beyond these primary interventions, EULAR emphasizes the critical role of education, self-management strategies, and, crucially, weight management. Losing even a small amount of weight can significantly reduce the load on the knee joints, slowing progression and alleviating pain.

These foundational elements empower individuals to take an active role in their own health journey.

The guidelines also acknowledge that treatment must be tailored to the individual, considering the severity of their osteoarthritis. Early-stage cases might focus more on exercise and education, while advanced cases might integrate a broader range of supportive devices and more intensive physiotherapy.

The goal remains consistent: to reduce pain, improve physical function, enhance overall quality of life, and ultimately, delay the need for joint replacement surgery.

As Dr. Elena Nikiphorou, a leading rheumatologist, aptly puts it, "These guidelines underscore the importance of a holistic and patient-centred approach.

It's not just about managing symptoms; it's about empowering patients with the tools to live better, more active lives."

By embracing this evidence-backed approach—prioritizing movement, support, and informed self-care over a reliance on medication—we can unlock truly effective and lasting relief from knee osteoarthritis, helping millions reclaim their mobility and well-being.