When researchers pooled the evidence on non-drug treatments for knee osteoarthritis, the top of the list was almost unfashionably simple.
A network meta-analysis published in PLOS One in June 2025 ranked knee braces first, water-based therapy second and exercise third for easing pain, stiffness and everyday movement problems. Ultrasound and other high-tech options finished at the bottom.
The analysis pulled together 139 randomized clinical trials and 9,644 patients, comparing 12 different non-drug approaches head to head.
A network meta-analysis works by combining direct and indirect comparisons across many studies, so it can rank treatments that were never tested in the same trial.
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Knee osteoarthritis is the wearing down of cartilage in the knee joint, and it is one of the most common causes of pain and lost mobility in older adults.
The CDC estimates that more than 32.5 million US adults live with osteoarthritis, and the knee is one of the joints hit hardest.
Why the low-tech options came out on top
Knee braces topped the rankings for pain, function and stiffness on the WOMAC scale, a standard scoring tool used across the field.
A brace unloads part of the weight the knee normally carries, and steadies the joint during walking and standing.
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Hydrotherapy, meaning exercise in warm water, was especially effective for reducing pain. The study authors linked its effect to heat and buoyancy, which take stress off the joint while still letting the muscles work.
Regular exercise on land ranked third overall and delivered consistent gains for both pain and physical function.
That echoes previous findings that aerobic activity is one of the strongest levers for chronic knee pain. Ultrasound, by contrast, sat at the bottom of the pain and function rankings.
"Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis," the researchers said in a statement released with the study.
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Why non-drug options matter for older patients
The interest in non-drug options is not just about cost. Non-steroidal anti-inflammatory drugs, better known as NSAIDs, are a common first choice for arthritis pain.
The study authors point out that long-term use is linked to gastrointestinal and cardiovascular side effects, and a higher risk of death in older patients. That makes therapies without a pill bottle attached especially attractive for the age group most affected.
The researchers looked at 12 approaches in all, including low-level and high-intensity laser therapy, transcutaneous electrical nerve stimulation, interferential current, short-wave diathermy, wedged insoles, kinesio taping and extracorporeal shock wave therapy.
Some, like high-intensity laser and shock wave therapy, showed useful effects in specific measures. None outperformed the three at the top.
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What this means before your next appointment
The findings do not mean patients should skip their doctor. Knee osteoarthritis has many causes and treatment plans differ, and severe cases may still call for surgery or medication.
Anyone with worsening knee pain, swelling or locking should be evaluated by a clinician.
The authors also flagged limits. Trial sizes varied, treatment lengths differed, and some rankings sit close together, so the exact order is not the point.
What is clear is that the simplest tools in the box, a brace, a pool and a structured exercise plan, kept beating the machines across the analysis.
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The CDC already lists physical activity, weight management and physical therapy among its core recommendations for osteoarthritis, and notes that "joint-friendly physical activity can actually improve arthritis pain, function, and quality of life."
Off-the-shelf knee braces are available at most pharmacies, and many community pools run warm-water arthritis programs through the Arthritis Foundation's certified network.
This article is made and published by Mie Hermansen, who may have used AI in the preparation.