A knee brace is emerging as one of the most effective methods to manage pain, improve function, and reduce stiffness associated with osteoarthritis. This common degenerative condition occurs when the cartilage that cushions the joints gradually deteriorates over time. A recent study conducted by researchers in China assessed the relative effectiveness of various treatments, including laser therapy, ultrasound, wedged insoles, and kinesiology tape, as documented in 139 randomized controlled trials. The findings, which included data from 9,644 participants, concluded that the simple knee brace was the most effective treatment for alleviating arthritis symptoms.
Despite the proven benefits, “the challenge,” according to Prakash Jayabalan, director of musculoskeletal research at the Shirley Ryan AbilityLab in Chicago, “is getting patients to actually wear knee braces.” Other clinicians, not involved in the study, agree that while knee braces can provide immediate relief by supporting the load on the joint, some patients find them uncomfortable to wear.
In the same meta-analysis, hydrotherapy and exercises such as weightlifting and yoga ranked second and third in effectiveness, respectively. Hydrotherapy, also known as water exercises or aquatherapy, is designed to improve symptoms and enhance the overall quality of life for those suffering from knee osteoarthritis. According to experts, staying active and maintaining a healthy weight are among the best strategies to alleviate symptoms. Morgan Jones, a sports medicine orthopedic surgeon at Mass General Brigham, emphasized that both regular exercise and weight management can improve symptoms and slow the progression of arthritis.
Knee osteoarthritis occurs when the cartilage in the knee breaks down, resulting in a painful “bone on bone” motion. As Jayabalan explains, cartilage does not have the ability to repair itself like other tissues in the body, and many individuals may not realize they have lost cartilage until significant damage has occurred. Common risk factors for developing knee arthritis include previous knee injuries, such as an ACL tear, and unhealthy weight gain. Steve Messier, director of the J.B. Snow Biomechanics Laboratory at Wake Forest University, noted that each additional pound of body weight translates to four pounds of stress on the knees during walking.
Once diagnosed with knee arthritis, individuals are encouraged to adopt broad lifestyle changes, including regular exercise, to effectively manage their pain. Messier stated, “It doesn’t really matter what type of exercise you do, as long as you stay active. All forms of exercise will help reduce pain.” This sentiment is echoed in the 2019 guidelines published by the Osteoarthritis Research Society International, which recommend physical activity as a primary intervention for knee arthritis.
Approximately 33 million adults in the U.S. suffer from osteoarthritis, as reported by the Centers for Disease Control and Prevention. Many individuals resort to non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for relief. However, Jayabalan cautions against long-term use, as these medications can damage the gut lining. He recommends limiting NSAID use to no more than ten days for individuals experiencing debilitating pain that affects their daily functioning.
Traditionally, knee replacements have been viewed as the gold standard for treating severely damaged joints. However, recovery from such surgeries can take up to a year for some patients. Emerging treatments target the nerves to alleviate pain and block blood flow to reduce inflammation. Jones pointed out that two individuals with the same degree of structural damage to their knee may experience vastly different pain levels, making the decision to proceed with knee replacement highly individualized.
The recent study highlighted that knee braces scored highest in terms of pain relief, stiffness reduction, and functional improvement, showcasing the “highest probability of being the best technique” for managing symptoms. Jones noted that knee braces can be particularly beneficial for individuals with arthritis localized to specific compartments of the knee, as they can shift the load to less affected areas. However, for those with widespread arthritis, an unloader brace may not offer as much relief.
The researchers compared twelve different interventions, including low-level laser therapy, high-intensity laser therapy, transcutaneous electrical nerve stimulation, interferential current, short wave diathermy, ultrasound, lateral wedged insoles, knee braces, exercise, hydrotherapy, kinesio taping, and extracorporeal shock wave therapy. Hydrotherapy emerged as the second most effective treatment option, as the buoyancy of water alleviates pressure on the knee joints and helps enhance range of motion. Conversely, ultrasound therapy was found to be less effective overall, and wedged insoles did not outperform neutral devices in terms of pain reduction.
It is important to note that many studies included in the meta-analysis were short-term, ranging from six to twelve weeks. According to Messier, this indicates that while these treatments may provide temporary relief, they do not necessarily lead to long-term pain management. Jayabalan pointed out that none of the studies investigated whether these treatments resulted in mechanistic improvements in the knee, such as cartilage regrowth. Instead, the studies primarily documented clinical observations of potential benefits. Furthermore, many randomized controlled trials were conducted on small participant groups, leading to variability in results.
