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For knee osteoarthritis, LLLT and ESWT are the most effective interventions for pain alleviation and functional recovery, while thermotherapy is the preferred modality for stiffness.
In a comprehensive new analysis led by Xiangzhou Lan et al., researchers have spotlighted the most advantageous physical therapies for mitigating pain, stiffness, and mobility issues in people living with knee osteoarthritis (KOA). The findings, drawn from a network meta-analysis of 32 randomized controlled trials (RCTs) involving 2078 volunteers, suggest that certain non-drug interventions substantially outperform others in easing the daily burden of this chronic condition.
Guided by PRISMA-P standards, this study delved into 9 major databases—spanning both Western and Chinese literature—to uncover RCTs exploring physical therapies for KOA. Treatments like low-level light therapy (LLLT), extracorporeal shock wave therapy (ESWT), thermotherapy, cryotherapy, and electrical stimulation therapy went head-to-head with resistance and range of motion exercises. Key outcomes encompassed pain (visual analog scale [VAS]), function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and mobility (6-minute walk test [6MWT]).
Among the therapies evaluated, LLLT emerged as the most promising for pain relief and functional improvement. Those treated with LLLT reported the greatest reductions in pain scores on both the VAS (mean difference [MD] = –3.32) and the WOMAC (MD = –3.74) pain index. The therapy also showed superior effects on overall joint function (Surface Under the Cumulative Ranking Curve [SUCRA] = 79.8), positioning it as a front-runner in the non-pharmacologic management of KOA.
Close behind was ESWT, which demonstrated robust effects in easing pain (VAS: MD = –1.31) and enhancing walking ability (6 MWT: SUCRA = 71.5). Meanwhile, thermotherapy proved to be the most beneficial approach for reducing stiffness (WOMAC stiffness: MD = –2.09; SUCRA = 98.1), offering significant relief for one of KOA’s most limiting symptoms. In contrast, ultrasonic therapy—the use of high-frequency sound waves—did not appear to offer meaningful improvements in any of the key outcome areas, raising questions about its continued use as a first-line intervention.
These findings suggest that clinicians should consider LLLT and ESWT as top choices for pain management and function restoration in KOA, while TT may be preferred when stiffness is a major complaint. However, individual patient characteristics and treatment tolerability should guide therapy decisions. The authors stress the importance of defining optimal dosing parameters and standardizing treatment protocols for these modalities. They also call for larger, high-quality RCTs to confirm these results and further explore heterogeneity in the current evidence base.
Aging Clinical and Experimental Research
Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis
Xiangzhou Lan et al.
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