What self‑care measures and physical‑therapy recommendations are appropriate for managing chronic knee pain?

Managing Chronic Knee Pain: Home Treatment and Physical Therapy Follow-Up

You should begin a structured exercise program with at least 12 supervised physical therapy sessions, combined with weight loss if overweight (minimum 5% body weight reduction), and use acetaminophen as your first-line pain medication if needed. 1, 2

Immediate Home-Based Actions

Exercise Program (Most Important)

• Start knee-specific strengthening exercises focusing on quadriceps muscles 2 days per week at moderate-to-vigorous intensity (60-80% of maximum effort) for 8-12 repetitions. 1, 2 This produces effect sizes of 1.05 for pain reduction—equivalent to NSAIDs but without side effects. 2, 3

• Add aerobic exercise (walking, cycling, swimming) for 30-60 minutes daily at moderate intensity. 1, 4 Both aerobic and resistance training are equally effective over 18 months. 2

• Include flexibility and range-of-motion exercises as part of your routine. 1

• Exercise should progress in intensity and duration over time—this progression is critical for sustained benefit. 1 Some discomfort during exercise is acceptable, but sharp pain or pain lasting more than 24 hours indicates excessive load. 3

• Continue exercising even if you have mild pain—exercise therapy works even in the presence of pain and improves long-term outcomes. 3, 5

Weight Management (If Overweight)

• If your BMI is greater than 25, lose at least 5% of your body weight through dietary modification combined with exercise. 1, 2 Weight loss programs with explicit goals, problem-solving strategies, and regular follow-up visits achieve mean reductions of 4.0 kg and significantly improve pain and function. 1, 4

Self-Management Education

• Enroll in a structured self-management program (such as those offered by the Arthritis Foundation) that includes education about your condition, activity modifications, and coping strategies. 1 These programs reduce pain with effect sizes of 0.28-0.35 and decrease healthcare costs by up to 80% within one year. 1, 4

• Modify activities by choosing lower-impact alternatives (walking instead of running, swimming instead of high-impact sports). 1

Pain Management at Home

• Start with acetaminophen (paracetamol) up to 3,000-4,000 mg per day as your first oral pain medication. 1, 2, 4 This is the safest long-term oral analgesic option. 1

• Apply ice after activities to manage acute pain flares. 3

• Consider topical NSAIDs (such as diclofenac gel) before oral NSAIDs—they provide localized pain relief with minimal systemic absorption and superior safety. 2, 3, 4

Supportive Measures

• Use knee sleeves or elastic bandages during activities for modest pain relief. 3

• Wear shock-absorbing footwear or consider insoles if biomechanical factors contribute to your pain. 3, 4

• If you have significant difficulty walking, use a walking cane or walker to reduce joint loading. 4

Physical Therapy Follow-Up Plan

Initial Supervised Phase

• Attend at least 12 directly supervised physical therapy sessions, then transition to a home-based maintenance program. 4 Supervised programs produce superior outcomes compared to unsupervised approaches, particularly for patients with other medical conditions. 2

• Your physical therapist should design an individualized exercise plan that progresses over 8-12 weeks with 3-5 sessions weekly. 4 This dosage produces effect sizes of 0.29-0.58 for pain reduction and functional improvement. 4

• The program should include closed kinetic chain exercises initially (leg press, squats, step-ups) to reduce knee stress, progressing to open kinetic chain exercises after 4 weeks. 3

• Add neuromuscular training (balance, agility, coordination exercises) to improve performance-based function and walking speed. 2

Long-Term Adherence Strategy

• Better adherence to home exercises and staying physically active are significantly associated with better outcomes for pain, function, and overall effect—this association remains consistent over time. 6 Exercise adherence declines over time, so maintaining your routine is critical. 6

• Schedule regular follow-up visits (every 2-4 weeks initially) to reassess your response, adjust your program, and reinforce adherence. 1, 3

• Consider regular telephone contact with your healthcare provider or physical therapist to promote self-care—this reduces pain experienced by patients. 1

When to Escalate Treatment

Additional Interventions

• If acetaminophen and topical NSAIDs are insufficient, consider oral NSAIDs at the lowest effective dose for the shortest duration. 2, 4 Monitor blood pressure if you have hypertension. 2

• For moderate-to-severe pain flares, especially with joint swelling, intra-articular corticosteroid injections provide short-term improvement. 2, 4

• For refractory pain unresponsive to conservative measures, genicular nerve blocks or radiofrequency ablation may be options. 2

Surgical Consideration

• Joint replacement should only be considered if you have radiographic evidence of knee osteoarthritis with refractory pain and disability despite comprehensive conservative management including exercise, weight loss, education, and appropriate medications. 2, 4

Critical Pitfalls to Avoid

• Do not delay starting physical therapy—early supervised exercise intervention is crucial for optimal outcomes. 3 Waiting for pain to resolve before exercising leads to deconditioning and prolonged recovery. 3

• Do not rely solely on medications while neglecting exercise—exercise has superior long-term outcomes compared to pharmacological management alone. 3, 7

• Do not prescribe yourself complete rest—this causes muscle weakness and worsens outcomes. 3 Relative rest with continued modified activity is appropriate. 3

• Do not progress exercises too aggressively—gradual progression prevents symptom exacerbation. 3

Expected Timeline and Outcomes

• Digital care programs incorporating exercise, education, and behavioral support show 61% reduction in pain for those completing 12-week programs compared to 21% in control groups. 5

• Exercise therapy produces sustained improvements for at least 2-6 months after treatment, with some studies reporting long-term improvements of 6-18 months. 1

• Weight loss combined with exercise in obese patients shows significant improvements in both pain and function. 1