Knee Osteoarthritis: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- Jun 30
- 6 min read
All information in this blog is supported by NICE guidance and peer-reviewed research. Reference numbers appear throughout, with the full list at the bottom of the page.
What Is Knee Osteoarthritis?
Knee osteoarthritis is a progressive condition affecting the whole joint, the most common type of osteoarthritis in the UK, and the most prevalent joint disease overall. ¹ Key symptoms include knee pain, stiffness, and a gradual loss of physical function. ¹ Osteoarthritis affects an estimated 10% of men and 18% of women over 60, with around 8.75 million people in the UK over 45 seeking treatment for it. ² ³
NICE Guideline NG226, Osteoarthritis in over 16s: diagnosis and management, provides the framework for diagnosing and managing this condition across the UK, and applies directly to the knee as one of the most commonly affected joints. ³
How Is It Diagnosed?
NICE states that imaging is not routinely required for diagnosis. A person aged 45 or older can be diagnosed with knee osteoarthritis without investigation if they have activity-related knee pain and either no morning joint-related stiffness, or stiffness lasting no longer than 30 minutes. ⁴ This validated approach allows for timely diagnosis based on history alone in most cases.
Risk Factors
A 2023 systematic review and meta-analysis of over 60,000 participants identified several statistically significant risk factors for knee osteoarthritis in middle-aged and older adults: ⁵
Previous knee trauma, increasing risk by around 37%
Higher body mass index (BMI)
Age, the most consistently identified risk factor across osteoarthritis research
Female sex
Genetics
More recent research has highlighted body composition specifically, finding that high fat mass combined with low lean (muscle) mass is a critical factor influencing both the severity of knee osteoarthritis and physical function, beyond weight alone. ⁶ The presence of other chronic health conditions has also been shown to meaningfully influence how osteoarthritis progresses and how it should best be managed. ⁶
What to Look Out For
Please seek prompt medical assessment if you experience:
Sudden, severe knee pain following a fall or trauma
Inability to bear weight on the affected leg
Fever, redness, or warmth around the knee
Significant, unexplained weight loss alongside knee pain
Rapidly worsening symptoms not following the usual gradual pattern
How We Can Help
NICE recommends exercise as the core form of therapeutic management for knee osteoarthritis. ¹ Manual therapy is recommended specifically as an adjunct alongside exercise, NICE's guideline development group found there was insufficient evidence to recommend manual therapy used alone, but decided there was enough evidence of benefit when combined with therapeutic exercise to recommend considering it for people with hip and knee osteoarthritis. ⁷
Osteopathic manual techniques and manual therapy: used as an adjunct to your exercise programme, in line with NICE guidance, manual therapy can include manipulation, mobilisation, or soft tissue techniques, and is genuinely most effective when combined with active, structured exercise rather than used on its own. ⁷
Deep tissue and sports massage: supporting overall muscle function and comfort around the knee, complementing your exercise-based treatment.
Walking aids: NICE supports considering walking aids, such as sticks, for people with lower limb osteoarthritis, where appropriate, to help with mobility and balance. ⁷
Weight management advice: where relevant, NICE acknowledges that weight loss is generally associated with improved symptoms and quality of life for people with knee osteoarthritis specifically, and any amount of weight reduction is considered beneficial. ⁷ ² We can discuss this sensitively as part of a supportive, broader treatment plan.
Acupuncture for Knee Osteoarthritis: A More Nuanced Picture
It's worth being genuinely transparent here, because the evidence landscape has shifted since NICE's last review. NICE NG226, published in 2022, advises against offering acupuncture or dry needling for managing osteoarthritis, citing a lack of clear benefit and some evidence of potential harm at the time of that review. ⁷
However, research published since then tells a more positive story. Both the American College of Rheumatology and the American Academy of Orthopedic Surgeons have explicitly recommended acupuncture as a treatment option for knee osteoarthritis. ⁸ Multiple recent systematic reviews and meta-analyses, including a 2025 review finding clinically significant, durable improvements in pain and function persisting into the medium to long term, and a dedicated 2024 review specifically investigating the durability of acupuncture's benefits for knee osteoarthritis, given how many other treatments for this condition fail to provide lasting relief, have reported genuinely positive findings. ⁸ ⁹ Further recent reviews looking specifically at electroacupuncture and acupuncture combined with active exercise training have similarly found meaningful improvements in pain and function. ¹⁰ ¹¹
Given this gap between NICE's 2022 position and the more recent, growing evidence base, we discuss this openly with patients. We're happy to include medical acupuncture as part of a broader, exercise-led treatment plan for knee osteoarthritis if you would like to try it, recognising that current research increasingly supports its use, even though it sits outside NICE's most recent formal guidance on the matter.
Exercise: The Core of Treatment
Exercise is the central, evidence-based pillar of knee osteoarthritis management, and current research has explored which types and doses work best.
Different forms of exercise place varying degrees of impact force through the knee joint, and NICE OA guidelines recommend exercise as the core form of therapeutic management regardless of which specific modality is chosen. ¹ Research exploring optimal exercise modalities and dosing for knee osteoarthritis continues to refine how exercise should be structured and progressed for best effect. ¹
Strengthening exercise: targeting the muscles surrounding the knee, particularly the quadriceps, to better support the joint.
Low-impact aerobic exercise: activities such as swimming or cycling that maintain cardiovascular fitness and joint mobility without excessive impact loading.
Range of motion and flexibility work: supporting joint mobility and reducing stiffness.
Functional and balance training: supporting safe, confident movement in daily activities.
Your practitioner will guide a structured, individualised exercise programme appropriate to your stage and severity of knee osteoarthritis.
What to Expect at Your First Appointment
We will take a thorough history and assess your symptoms against NICE's validated diagnostic criteria where appropriate, without the routine need for imaging. We will explain clearly what we find and build an evidence-based treatment plan centred on exercise, with manual therapy used as a genuine adjunct, in line with current NICE guidance, and we will discuss acupuncture as a transparent, optional addition based on the wider current evidence.
Frequently Asked Questions
Do I need a scan? Not usually. NICE supports clinical diagnosis without imaging for most people aged 45 and over with the typical activity-related pain and limited morning stiffness pattern.
Will I need surgery? Joint replacement is considered when nonsurgical management has been ineffective or is unsuitable, and symptoms are substantially affecting quality of life, this decision is based on clinical assessment rather than any single test or score. ⁷
Will you offer me acupuncture for this? We're happy to, if you'd like to try it. NICE's 2022 guidance advises against it, but a meaningful body of more recent research, including reviews from 2024 and 2025, has found genuine, durable benefit, and other major guideline bodies internationally recommend it. We'll be honest with you about this discrepancy and let you make an informed choice.
Will losing weight really help? For people who are overweight, yes, genuinely. NICE acknowledges weight loss is associated with improved symptoms and quality of life, particularly for knee osteoarthritis, and even modest weight reduction is considered beneficial.
Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Optimal exercise modalities and doses for therapeutic management of osteoarthritis of the knee. Frontiers in Aging. 2025. Available at: https://www.frontiersin.org/journals/aging/articles/10.3389/fragi.2025.1458983/full
NICE on the diagnosis and management of osteoarthritis. Prescriber. 2023. Available at: https://wchh.onlinelibrary.wiley.com/doi/10.1002/psb.2040
What Can Clinicians Learn from the New NICE Guideline on Osteoarthritis? Medscape. Available at: https://reference.medscape.com/cc1/p10/what-can-gps-learn-new-nice-guideline-osteoarthritis-2023a1000204
National Institute of Health and Care Excellence Clinical Criteria for the Diagnosis of Knee Osteoarthritis: A Prospective Diagnostic Accuracy Study in Individuals With Type 2 Diabetes. Arthritis Care & Research. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12038217/
Dong Y, Yan Y, Zhou J, Zhou Q, Wei H. Evidence on risk factors for knee osteoarthritis in middle-older aged: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2023. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10464102/
Osteoarthritis year in review 2025: Epidemiology and therapy. Osteoarthritis and Cartilage. 2025. Available at: https://www.sciencedirect.com/science/article/pii/S1063458425011276
Osteoarthritis: Key takeaways from the new NICE guidelines. Practice Business. Available at: https://practicebusiness.co.uk/osteoarthritis-key-takeaways-from-the-new-nice-guidelines
Research trends and hotspots of acupuncture for knee osteoarthritis from 2004 to 2024: a bibliometric analysis. Frontiers in Medicine. 2025. Available at: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1604209/full
Chen H, Shi H, Gao S, et al. Durable Effects of Acupuncture for Knee Osteoarthritis: A Systematic Review and Meta-analysis. Current Pain and Headache Reports. 2024;28(7):709-722. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271378/
Electroacupuncture superiority in knee osteoarthritis: a meta-analysis of four acupuncture techniques. Frontiers in Medicine. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12226530/
Chen J, Guo H, Pan J, et al. Efficacy of acupuncture combined with active exercise training in improving pain and function of knee osteoarthritis individuals: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2023. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693122/
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