Knee osteoarthritis is a common long-term condition where the joint's cartilage, bone and surrounding tissues change, causing pain and stiffness, mainly with activity. It is not simply 'wear and tear', and it does not always get worse. NICE guidance recommends exercise, weight management where relevant, and good information as the core of care.
Also known as knee arthritis, wear and tear of the knee, knee OA
Symptoms
- Aching knee pain that is worse with walking, stairs or standing for long periods
- Short-lived stiffness after rest or first thing in the morning (usually under 30 minutes)
- Reduced bending or straightening of the knee
- Creaking or grinding sensations
- Occasional swelling, or a feeling of the knee being weak or unstable
- Symptoms that vary, with good days and flare-ups
Causes and risk factors
- Increasing age (most common over 45)
- Previous knee injury or surgery, such as a ligament or meniscus tear
- Carrying extra body weight, which increases load on the knee
- Weak thigh muscles and low physical activity
- Family history and being female
- Joint shape or alignment differences
What the evidence says helps
- Tailored therapeutic exercise, including muscle strengthening and general aerobic activity, is a core treatment recommended for everyone with osteoarthritis in NICE guidance.1
- A 2024 Cochrane review found exercise probably improves pain and physical function compared with no treatment or usual care, though the size of benefit varies and the evidence is of low to moderate certainty.2
- For people living with overweight, NICE advises that any weight loss is likely to help pain and function, and losing around 10% of body weight is likely to help more than 5%.1
- Manual therapy (hands-on treatment) may be considered for knee osteoarthritis, but only alongside exercise; there is not enough evidence to support it on its own.1
- Topical anti-inflammatory gels are recommended as a first-choice painkiller for knee osteoarthritis. Paracetamol is not routinely recommended, and steroid injections may give short-term relief of a few weeks.1
- Keyhole (arthroscopic) washout or 'tidy-up' surgery is not recommended for knee osteoarthritis, as it does not give lasting benefit.14
Things you can try at home
- Keep moving: walking, cycling and swimming are all good ways to stay active
- Do simple strengthening exercises for your thighs and hips two or three times a week
- Expect some discomfort when you start exercising; mild, short-lived pain is not a sign of harm
- Pace activities through the day and build up gradually rather than doing too much at once
- Wear comfortable, supportive shoes for walking
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Your knee is suddenly hot, red and swollen and you feel feverish or unwell: get same-day medical help (NHS 111, or A&E if very unwell), as a joint infection needs urgent treatment.
- After a fall, collision or twisting injury you cannot put weight on the leg, the knee looks deformed, or it swells up within a few hours: go to A&E or an urgent treatment centre.
- Your knee locks and you cannot straighten it, or it suddenly gives way repeatedly: see a GP or urgent care promptly.
- Your calf becomes painful, swollen, warm or red, especially after surgery, a long journey or a period of immobility: call NHS 111 or see a GP urgently. Call 999 if you also have chest pain or breathlessness.
- You have unexplained weight loss, night sweats or severe pain at night that does not ease: see your GP promptly.
How Apollo can help
We start with a thorough assessment and a clear explanation of what is going on in your knee, so you understand your options. Our team builds a personalised strengthening and activity plan, which may include hands-on care alongside exercise, and supervised clinical exercise sessions to help you progress with confidence. We can also measure your leg strength with VALD testing, and we will refer you back to your GP if you need further investigation or a surgical opinion.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is walking good for knee osteoarthritis?
Yes, for most people. Regular walking and other aerobic activity are part of the exercise NICE recommends for osteoarthritis. Start at a comfortable distance and build up gradually; some mild aching that settles within a day is normal.
Do I need an X-ray or MRI to diagnose knee arthritis?
Usually not. NICE advises that osteoarthritis can be diagnosed from your symptoms and an examination if you are 45 or over, have activity-related joint pain and little or no morning stiffness. Scans are mainly used if something unusual is suspected.
Will my knee osteoarthritis keep getting worse?
Not necessarily. Symptoms often go up and down, and many people stay stable or improve with exercise, weight management and good self-care. Surgery such as a knee replacement is an option for some people when other treatments have not helped enough.
References
- National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management (NG226). NICE. View source
- Lawford BJ, Hall M, Hinman RS, et al. (2024). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. View source
- National Institute for Health and Care Excellence (2020). Osteoarthritis: diagnosis and management – final scope (NG226). NICE. View source
- Siemieniuk RAC, Harris IA, Agoritsas T, et al. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 357:j1982. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
