Managing Osteoarthritis with Physiotherapy: Staying Active and Pain-Free
- Helen Ryder
- Oct 12
- 4 min read
What the Latest NICE Guidelines Say and How Physiotherapy Can Help
Osteoarthritis (OA) is one of the most common joint conditions, affecting millions of adults in the UK and this is reflected in clinic, with the vast amount of our MSK caseload being OA. It can cause pain, stiffness, and swelling in joints such as the knees, hips, and hands. But there’s good news — OA is manageable, and modern understanding of the condition has changed significantly.
According to the latest NICE guidelines (NG226, 2022), osteoarthritis is not just “wear and tear.” It’s a whole-joint condition involving low-grade inflammation that affects the cartilage, bone, joint lining (synovium), ligaments, and surrounding muscles. That means there’s a lot that can be done to influence symptoms and improve quality of life — and physiotherapy plays a central role in that process.
🧠 Understanding Osteoarthritis: Beyond “Wear and Tear”
NICE highlights that OA is a complex, active process, not an inevitable consequence of ageing. Inflammation within the joint contributes to stiffness, swelling, and pain — but it’s not the same as the inflammation seen in conditions like rheumatoid arthritis.
This newer understanding means the focus of treatment has shifted from “protecting cartilage” to supporting overall joint health through movement, muscle strength, and healthy lifestyle changes.
💪 Physiotherapy and NICE: Core, Evidence-Based Care
The NICE guideline places non-pharmacological management — especially exercise and education — at the heart of osteoarthritis care. These approaches are effective, safe, and sustainable.
Here’s how physiotherapy fits perfectly within NICE’s evidence-based recommendations:
1. Exercise as the Foundation of Treatment
NICE states that therapeutic exercise should be offered to everyone with osteoarthritis, regardless of age, severity, or pain level.
This includes:
Local muscle strengthening to support and stabilise joints
Aerobic exercise (such as walking, cycling, swimming, or seated activity) to improve fitness and reduce inflammation
It’s normal for exercise to feel uncomfortable at first, but consistent activity helps to reduce pain, improve mobility, and dampen inflammation over time. Physiotherapists can design a personalised programme that feels safe and achievable.
2. Education and Self-Management
NICE emphasises that people with OA should receive clear information about their condition and its management. Physiotherapists can help you understand:
What osteoarthritis really is — an inflammatory, not purely degenerative condition
How exercise, pacing, and joint care reduce pain and improve function
That pain or stiffness does not necessarily mean harm — movement is safe and beneficial
How to manage flare-ups and maintain confidence in daily activities
Education builds empowerment — you’re not powerless against OA.
3. Weight Management and Metabolic Health
For people with overweight or obesity, NICE strongly recommends support for weight loss as part of OA management. Even small reductions in body weight can:
Decrease joint loading
Lower systemic inflammation
Improve overall energy and mobility
Physiotherapists can guide you on joint-friendly activity to help manage weight safely and effectively.
4. Manual Therapy (as an Adjunct)
NICE allows for manual therapy — such as joint mobilisation or soft tissue techniques — when used alongside exercise, particularly for knee or hip OA. It can help reduce stiffness, ease pain, and make it easier to stay active, but should not be used as a standalone treatment.
5. Pharmacological and Adjunct Treatments
While physiotherapy and exercise are the foundation, NICE recognises that medications and other interventions may be used to support activity.
Topical NSAIDs (anti-inflammatory gels or creams) are recommended as first-line pain relief for affected joints
Oral NSAIDs or corticosteroid injections can be considered if symptoms persist — but always alongside exercise and self-management
NICE advises avoiding opioids and long-term reliance on painkillers where possible
The goal is to manage inflammation enough to enable movement and activity, not to replace them.
🧍 Why Movement Matters
Movement is medicine. NICE guidance is clear: keeping active is the most effective treatment for osteoarthritis. Regular exercise:
Reduces stiffness and pain
Improves circulation and lubrication in the joints
Builds muscle strength and stability
Lowers inflammatory activity within the body
Supports mental wellbeing and confidence
Your physiotherapist will help you find the right type and level of activity for your lifestyle — from gentle strengthening to enjoyable forms of aerobic movement.
💬 The NICE Takeaway
According to NICE (NG226, 2022):
“Exercise, weight management, and information are the core treatments for osteoarthritis, irrespective of age, comorbidities, pain severity, or disability.”
This means osteoarthritis is manageable at every stage, and physiotherapy is central to that process.
By combining evidence-based exercise, education, and lifestyle support, we can help you:✅ Reduce pain and stiffness✅ Improve movement and confidence✅ Manage inflammation naturally✅ Maintain independence and quality of life
🌿 Let’s Get You Moving
If you’re living with osteoarthritis and want to take control of your symptoms, our physiotherapy team can help. We follow NICE-based, evidence-informed approaches to support your mobility, confidence, and long-term joint health.
👉 Book an appointment today or contact us to find out how physiotherapy can help you move with confidence again.
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