Osteoarthritis of the knee and hip: exercise and physiotherapy

Joint pain that builds slowly and eases with rest is something many adults notice, often in the knees, hips or hands. A common cause is osteoarthritis. This article explains what it is, who is more likely to get it, how doctors recognise it and why exercise and physiotherapy sit at the centre of everyday care. It draws on the NHS, MedlinePlus, the World Health Organization (WHO) and the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

1. Introduction

The NHS describes osteoarthritis as a long-term condition in which joints become painful and stiff. It is the most common type of arthritis in the UK ^[1]. Healthy joints are covered by smooth cartilage, a slippery tissue at the ends of the bones. In osteoarthritis the cartilage breaks down and becomes rough, and extra bone growths called bone spurs may form ^[2].

WHO reports that about 528 million people worldwide had osteoarthritis in 2019, that the knee is the most commonly affected joint, followed by the hip and hand, and that it is not an unavoidable part of ageing ^[3].

2. Signs and symptoms

The NHS and MedlinePlus list these common features ^{[1, 2]}:

• Joint pain, often worse with movement and easing with rest
• Stiffness, especially for up to 30 minutes after getting up
• Swelling, tenderness or reduced movement
• A grating or crackling sound, or a feeling that the joint is loose

Symptoms vary widely. They may be mild and come and go, or they may be constant and get in the way of daily life ^[1]. NIAMS adds that osteoarthritis can bring tiredness, poor sleep and low mood ^[4]. WHO notes that reduced movement can weaken the muscles around a joint ^[3].

3. Causes and risk factors

The exact cause is unknown. The NHS explains that joints normally cope with low-level wear and repair themselves, and that in osteoarthritis the protective cartilage at the ends of the bones breaks down ^[1]. NIAMS adds that it is not simply caused by ordinary wear and tear ^[4]. Factors linked to a higher risk include ^{[1, 2, 3]}:

• Getting older
• A past joint injury or operation
• Being overweight, which adds strain to the knees and hips
• Family history
• Being female
• Other joint diseases such as gout or rheumatoid arthritis
• Heavy, repeated loading of a joint at work or in sport

WHO also lists diabetes among the conditions linked to osteoarthritis ^[3].

4. Diagnosis and tests

The NHS says a doctor asks about your symptoms and examines your joints. Osteoarthritis may be suspected in people aged 45 or over when pain gets worse with use and morning stiffness is absent or lasts less than 30 minutes ^[1]. MedlinePlus and NIAMS state that no single test confirms it. X-rays or other scans and blood tests may be used to rule out other conditions, although the NHS says they are usually not needed ^{[1, 2, 4]}.

5. Treatment and management

Exercise comes first

MedlinePlus lists exercise to build strength, flexibility and balance as part of initial care ^[2]. NIAMS says regular exercise can reduce pain and stiffness and improve muscle strength, and advises building a safe programme with a doctor or physical therapist and increasing activity gradually ^[4]. WHO agrees that exercise strengthens the muscles around the joint and improves movement ^[3].

For general health the NHS suggests at least 150 minutes of moderate activity each week, such as brisk walking or cycling, plus muscle-strengthening exercise on two or more days a week. It also reminds readers that too much repeated loading of a joint can raise risk, so balance matters ^[1].

Physiotherapy

NIAMS lists physical therapists among the professionals who may be part of the care team ^[4]. The NHS says people with more severe symptoms may need a structured exercise programme with a physiotherapist ^[1]. WHO describes care as often involving several health workers and a rehabilitation plan made for the individual ^[3].

Weight, footwear and aids

The NHS notes that losing excess weight can reduce joint strain, and also suggests suitable footwear and devices that reduce strain during everyday tasks ^[1]. MedlinePlus mentions braces or shoe inserts, called orthotics ^[2]. WHO says assistive devices such as braces can help people stay independent ^[3].

Medicines and surgery

MedlinePlus says over-the-counter pain relievers and creams can help, but a provider should be consulted, and that injections or prescription medicines may be offered if needed ^[2]. WHO notes that most guidelines do not support opioid painkillers or glucosamine for osteoarthritis ^[3]. Surgery, including joint replacement, is considered for a small number of people when other treatments have not helped or damage is severe ^{[1, 3]}. Your doctor decides what suits you.

6. When to see a doctor

The NHS advises seeing a doctor if you have joint symptoms that do not go away, so the diagnosis can be confirmed and treatment planned ^[1]. Long morning stiffness can point to a different condition, so mention it ^[1]. Early diagnosis and sticking to a plan help to slow progression and keep function ^[3].

A joint that suddenly becomes very swollen, hot and painful, or a joint that cannot take weight after an injury, needs prompt medical review. In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Osteoarthritis is a long-term joint condition. The NHS says it does not necessarily get worse, and MedlinePlus says many options exist to manage symptoms. Regular exercise, support from a physiotherapist, a healthy weight and suitable footwear are the foundations of care. Medicines, injections and surgery have a place when these steps are not enough, as decided by your doctor.