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Osteoarthritis (OA) affects over 2.1 million Australians and is the most common form of arthritis. Many patients are told to rest, take pain medication, and wait until their joints are "bad enough" for surgery. This advice is outdated. Exercise therapy supervised by a physiotherapist is the most evidence-based, effective, and safe treatment for OA — at any stage.
What Is Osteoarthritis?
Osteoarthritis is a whole-joint condition involving deterioration of articular cartilage, changes to the underlying bone, and inflammation of the joint lining. It causes pain, stiffness, swelling, and progressive loss of function. The most commonly affected joints are the knee, hip, and spine, though OA can affect any joint.
Contrary to popular belief, OA is not simply "wear and tear" from old age. It is a complex condition influenced by muscle strength, weight, movement patterns, prior injuries, and genetics. Many of these factors are modifiable — which is why physiotherapy is so effective.
Why Exercise Is the Number One Treatment
Every major international guideline — including the Australian Physiotherapy Association, NICE (UK), and OARSI (International) — recommends exercise therapy as the first-line treatment for knee and hip OA. Here is why:
- Strengthening the muscles around an arthritic joint reduces the load transmitted through the damaged cartilage
- Exercise reduces pain through central pain modulation mechanisms
- Exercise improves joint lubrication and nutrient delivery to cartilage
- Exercise reduces weight (a key driver of OA severity) and improves cardiovascular health
- Strong muscles are the best brace for an arthritic joint
Multiple randomised controlled trials show that supervised exercise therapy produces greater pain reduction and functional improvement than anti-inflammatory medication, cortisone injections, or viscosupplementation (gel injections) — with no side effects.
What Does OA Physiotherapy Involve?
- Detailed assessment — measuring muscle strength, joint mobility, pain patterns, and functional limitations to create a targeted program
- Progressive strengthening — targeting the quadriceps, hamstrings, hip abductors, and calves for knee OA; and hip abductors, flexors, and extensors for hip OA
- Aerobic exercise prescription — walking, cycling, and swimming programs tailored to your fitness level and joint tolerance
- Manual therapy — joint mobilisation and soft tissue treatment to reduce stiffness and improve movement
- Hydrotherapy — aquatic exercise is ideal for patients who find land-based exercise too painful; the buoyancy reduces joint load significantly
- Weight management advice — every 1 kg of weight lost reduces knee joint load by approximately 4 kg
- Activity modification — practical guidance on how to remain active and enjoy life while managing your OA
Prehabilitation — Before Joint Replacement
If you are planning a knee or hip replacement, physiotherapy before surgery (prehabilitation) significantly improves your post-operative outcomes — reducing hospital stay, speeding recovery, and improving final function. Starting physio now, before you need surgery, is always worthwhile.
Frequently Asked Questions
My X-ray shows severe arthritis. Is there any point trying physio?
Absolutely. The correlation between X-ray findings and pain is actually quite poor — many people with severe arthritis on imaging have minimal pain, and vice versa. Exercise therapy produces significant pain reduction even in patients with advanced OA on imaging. The muscle strength and function you build is what matters most.
Won't exercise damage my arthritic joints?
No. This is one of the most persistent myths about arthritis. Research consistently shows that appropriate exercise does not damage arthritic joints — it reduces pain and improves function. Inactivity is far more harmful than exercise.
What type of exercise is best for knee osteoarthritis?
Supervised land-based exercise — particularly quadriceps and hip strengthening — has the strongest evidence. Aquatic (hydrotherapy) exercise is an excellent alternative for people who find land-based exercise too painful initially. Walking, cycling, and swimming are all appropriate ongoing activities.
I've been told I need a knee replacement. Should I try physio first?
Yes — and this is strongly recommended by orthopaedic guidelines. Pre-operative physiotherapy (prehabilitation) improves post-surgical outcomes. More importantly, a structured physiotherapy program often reduces symptoms enough that surgery can be delayed for years, or avoided altogether for many patients.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora