Knee braces beat other drug-free treatments for arthritis in trials covering nearly 10,000 people

A network meta-analysis of 139 clinical trials covering nearly 10,000 people with knee osteoarthritis has found that knee braces outperform every other drug-free option for easing pain, stiffness and mobility problems. Water-based therapy and regular exercise followed close behind. High-tech approaches such as ultrasound and electrical stimulation ranked near the bottom of the field.

The analysis pooled results from randomized trials testing twelve different non-drug approaches to knee osteoarthritis, a joint disease that breaks down tissue inside the knee over time and is more common in women, especially after age 50. Rather than comparing treatments two at a time, the researchers used a statistical technique called a network meta-analysis, which ranks every therapy against every other therapy at once, even when no single trial tested all of them head to head. The team scored each approach using the WOMAC index, a standard measure of joint pain, stiffness and physical function.

Ranking Twelve Non-Drug Treatments in One Framework

The study, led by Yuan Luo at the First People’s Hospital of Neijiang in China and published in PLOS One, drew on 139 randomized controlled trials involving 9,644 patients. Luo and co-authors Xiao Chen, Yuanhe Fan and Hongliang Tu ranked each treatment by its probability of producing the best outcome, a method called SUCRA that assigns every therapy a single comparative score rather than a simple win-loss tally.

Knee braces came out on top across nearly every outcome measured, according to a full-text copy of the analysis archived by the National Institutes of Health, which ranked the devices highest for pain scores, physical function and stiffness alike. Researchers assessed outcomes on the WOMAC index across its three components — pain, stiffness and physical function — plus a combined total score, and separately on a visual analog scale that captures pain at rest as opposed to pain during activity, letting the team see whether a treatment that eased pain also improved daily function.

Knee Braces, Water Therapy and Exercise Lead the Field

Chen, Fan, Tu and Luo concluded that “knee brace may be the most recommended therapeutic option” for knee osteoarthritis, with hydrotherapy and exercise as strong runners-up. A summary of the findings distributed by ScienceDaily put it more plainly: knee braces, hydrotherapy and exercise reduce pain and improve mobility without the gastrointestinal or cardiovascular risks tied to common pain medications. The pattern held across trials of different sizes and follow-up periods, part of why a network meta-analysis carries more weight than any single trial.

Hydrotherapy earned the top ranking for total WOMAC scores and for pain measured at rest, even though knee braces still led on pain during movement, stiffness and function individually. Exercise ranked second for both total WOMAC and WOMAC pain scores, reinforcing a message physical therapists have made for years: movement itself is treatment, not just something to resume once pain subsides. High-intensity laser therapy and shock-wave therapy showed promise in narrower categories, but neither matched braces, water therapy or exercise across the board.

Ultrasound and Other High-Tech Options Lag Behind

Ultrasound therapy, despite its routine use in physical therapy clinics, repeatedly landed near the bottom of the twelve-treatment ranking. Insoles and kinesiology tape performed similarly poorly. The finding cuts against a persistent assumption in rehabilitation medicine that newer, technology-driven treatments outperform low-tech alternatives such as a hinged knee brace or a course of pool-based exercise. The National Library of Medicine’s patient guidance on osteoarthritis already lists braces, orthotics and exercise among standard non-drug care, alongside weight loss for people carrying extra weight on the knee joint.

Avoiding the Risks of Long-Term Pain Medication

The appeal of a brace or a pool workout over a pill is partly about side effects. The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that osteoarthritis “is more common as people age” and disproportionately affects women after 50, a population that also carries higher baseline risk for the stomach bleeding and cardiovascular complications tied to long-term use of nonsteroidal anti-inflammatory drugs. Age is the single biggest risk factor for the disease, but NIAMS also lists excess weight, prior joint injuries, repetitive joint movement, improper joint formation and family history among the contributors, alongside the breakdown of joint tissue that defines the condition. None of those risk factors is treated by a brace or a pool workout, which is why the new ranking is being read as guidance on managing symptoms rather than a cure.

Because knee osteoarthritis is a chronic condition that can require years of pain management, the sequence of care matters. MedlinePlus, the National Library of Medicine’s patient information service, lists the conventional route as over-the-counter pain relievers and arthritis creams first, then prescription pain relievers or joint injections if those aren’t enough, with surgery reserved as a last resort. Each step up that ladder tends to carry more risk, more cost, or both, which is part of why a set of options that starts at the bottom of the risk scale and still outperforms the alternatives is notable to physicians managing a disease with no cure.

None of the twelve approaches in Luo’s analysis eliminates knee osteoarthritis or repairs damaged cartilage; the meta-analysis measured symptom relief, not disease reversal. But for a condition with limited drug options and few interventions patients can start on their own, the ranking gives physicians a comparative reference point that didn’t exist before, built from 139 trials rather than any single study’s word.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.