Physiotherapy management of knee osteoarthritis: recent advances and evidence-based practice

Abstract

Knee osteoarthritis is a prevalent whole-joint condition associated with pain, reduced mobility and limitations in daily participation. Contemporary physiotherapy aims not merely to reduce symptoms during a clinic visit, but to develop capacity, confidence and durable self-management. This narrative review summarises evidence-based assessment and rehabilitation, including therapeutic strengthening, aerobic exercise, neuromuscular and functional training, aquatic exercise, education, activity pacing, weight-management support and selected assistive devices. It discusses the importance of screening for atypical symptoms, measuring outcomes that matter to patients, adapting treatment for comorbidity and addressing barriers to adherence. Recent developments in digital physiotherapy and low-load blood-flow-restriction training are examined with attention to limitations in the current evidence. Current guidelines consistently place tailored exercise and education at the centre of non-surgical management, although recommendations for adjunctive interventions vary. Digital delivery can extend access but should preserve individualisation, safety and follow-up. Bloodflow-restriction training may be an option for selected patients who cannot tolerate conventional loading, but evidence certainty and safety requirements mean it should not be treated as routine firstline care. A practical staged pathway is proposed, moving from assessment and shared goals to progressive loading, functional practice, outcome review and long-term maintenance. The review concludes that the most important advances are likely to be reliable, equitable delivery of established treatments, supported by transparent communication, patient-centred outcomes and appropriate integration of newer methods.