Man holding a knee as if in pain.

Knee osteoarthritis—a progressive loss of cartilage at the ends of knee joints—can cause pain, stiffness, and swelling. And about half the estimated 15 million Americans with knee OA have a severe form of the progressive condition.

In their search for relief, many people may be turning to the wrong treatments, according to a 2017 study published in The Journal of Arthroplasty.

More on Pain Relief

“We suspect both patients and providers are trying to exhaust conservative measures in an attempt to avoid surgery,” says study leader Nicholas Bedard, M.D., orthopedic surgery resident at the University of Iowa Hospitals and Clinics in Iowa City.

His team looked at the records of more than 86,000 people who’d had knee replacements and found that in the year before the surgery, they’d spent nearly $44 million—an average of $506 eachon questionable therapies such as opioid pain medications. 

But if opioid drugs are a poor choice—they’re potentially addictive, and a March 2018 study published in JAMA found them of no use for moderate to severe knee OA pain—what are the most effective ways to handle your discomfort? Here, the experts weigh in.

How to Ease the Pain Now

When your knee starts aching, experts suggest the following steps: 

Apply ice or heat. Both can reduce pain; ice can also cut swelling, and heat can ease stiffness. For icing, place a towel or cloth on your skin, then top with a small bag of ice at least once a day for 20 minutes, recommends physical therapist Erica Fritz, P.T., D.P.T., manager of the Orthopedic Physical Therapy Center at the Hospital for Special Surgery in New York City.

If your knee feels stiff but isn’t swollen, apply a heating pad to the area for 20 minutes twice a day. Place a protective layer, such as a towel, between the heat source and your skin.

Get some low-impact activity. You may not feel much like being active when your knees hurt, but the evidence suggests that it can help. A 2015 review by the independent Cochrane Collaboration found that the short-term pain relief conferred by exercise is comparable to that achieved with use of a nonsteroidal anti-inflammatory drug (or NSAID, such as ibuprofen or naproxen).

Walking and cycling are good choices. But if land-based exercise is too painful, try an aquatic workout. The buoyancy of water is gentle on joints and may make it easier to work out. Aquatic exercise also provides a small but measurable decrease in pain and disability in people with knee and/or hip OA, according to another Cochrane review, published in 2016.

Consider tai chi, too: A study published in 2016 in the Annals of Internal Medicine found that people with knee OA who practiced this mind-body form of exercise twice a week for 12 weeks reaped pain-relief benefits similar to those of people who did physical therapy twice a week for six weeks. Try some gentle stretches as well, which may ease stiffness and increase the range of motion in your knee joint. 

Ask about physical therapy. If pain and swelling make it very challenging to be active or you’re unsure which exercises are best for you, see a physical therapist.

He or she can assess you and customize a program of aerobic, strengthening, and stretching exercises, and, possibly, ice and heat, or transcutaneous electrical nerve stimulation (the application of a controlled electrical current). Check with your insurer to see whether you’ll need a referral and how many sessions will be covered.

Talk to your doc about a topical. For pain that’s tolerable but not fully relieved by heat or ice and gentle activity, consider a topical prescription NSAID before you reach for an over-the-counter oral pain reliever. Why? Oral NSAIDs can cause side effects such as gastrointestinal upset and bleeding, and several are associated with an increased risk of cardiovascular events, so it’s worth seeing whether you can get sufficient relief without them.

If you do use an OTC pain reliever, try oral naproxen (Aleve and generic). That’s the oral NSAID that the American Academy of Orthopaedic Surgeons recommends in its OA guidelines. And in a study comparing nonsurgical treatments for knee OA, published last May in the Journal of the American Academy of Orthopaedic Surgeons, researchers found that naproxen is better at reducing pain and improving function than acetaminophen (Tylenol and generic) or other oral NSAIDs. If you’re still very uncomfortable after using naproxen for a week, consult your doctor.

To Keep Pain at Bay

Once your acute pain eases, these steps can help you maintain your quality of life.

Keep up with exercise. Make regular physical activity, including low-impact aerobics and stretching, part of your life on an ongoing basis. (A little exercise can go a long way.) And be sure to include strengthening exercises, which can help stabilize your knee and possibly prevent discomfort, Bedard says.

Lose weight. If you are overweight or obese, try to lose at least 5 to 10 percent of your body weight. Many studies have found that this can help prevent pain—and some research suggests that each pound of weight lost reduces stress on the knee fourfold with each step taken.

You’ll find some useful weight-loss strategies here. Or consider the Mediterranean diet, which is rich in fruits, veggies, whole grains, nuts, and legumes; substitutes healthy fats, such as olive oil, for butter and margarine; limits red meat; and encourages people to eat poultry and fish at least twice a week. A study published in 2017 in the Journal of Nutrition, Health & Aging reported that people who followed the Mediterranean diet for 16 weeks lost weight and had lower levels of an inflammatory protein associated with OA. 

When Knee Pain Is Chronic

If your knee pain continues for three months or longer, stick with an exercise program; apply ice or heat as needed; use NSAIDs judiciously; continue to lose weight, if needed; and consider the following:

Walking aids. Using a cane or walker as needed (and some people may benefit from this sooner than the three-month mark) can reduce the load on the affected knee, easing discomfort. A study published in 2012 in the Annals of the Rheumatic Diseases found that people with knee OA who used a cane daily for two months had less pain and better function.

Cognitive-behavioral therapy. Some evidence finds that CBT, a short-term therapy that can provide strategies for coping with pain, may help reduce discomfort and help you function better. A study published in 2015 in Arthritis & Rheumatology reported that people with knee OA plus insomnia who received CBT not only slept better but also reported less pain. 

Think Twice About These Treatments

Our experts say that some people may find relief with the following therapies but that this may be because of a placebo effect:  

Injections. While injections of corticosteroids may ease inflammation and pain, relief is short-lived, and the therapy can cause side effects, such as bone thinning, tendon weakening, and nerve damage. The May 2018 Journal of the American Academy of Orthopaedic Surgeons study mentioned above reported that injections of hyaluronic acid, which is also sometimes used for knee OA, don’t have a significant positive effect on pain and function. 

Bracing. A 2015 Cochrane review on bracing found that wearing a brace, such as a valgus knee brace, neutral brace, or neoprene sleeve, may have little or no effect on pain reduction, knee function, or quality of life. And because a knee brace must exert enough force on the knee to change your gait, “it’s pretty uncomfortable,” says David S. Jevsevar, M.D., chair of the department of orthopedics at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. 

Glucosamine and chondroitin supplements. There’s little evidence that these help knee OA, according to the AAOS guidelines. In addition, supplements aren’t regulated by the Food and Drug Administration in the same way that medications are, and you can’t be sure that what’s on the label is what’s in the bottle. 

Acupuncture. While generally safe as long as a credentialed practitioner performs it, experts say that acupuncture—where thin needles are inserted into the body at specific points—does not ease symptoms of knee OA. 

When to Consider Knee Replacement

If your knee pain is chronic and worsening, recommended therapies provide insufficient relief, you find that you’re unable to perform everyday activities without pain, and you have trouble walking without using an assistive device such as a cane, you might be a candidate for a knee replacement. Get the lowdown on this surgery.