Six steps to ease knee pain and possibly delay surgery, experts say

Jon Reeves, a 54-year-old runner from Oxfordshire, was diagnosed with osteoarthritis in 2020 after mornings when climbing stairs felt painful and laborious. The degenerative joint disease now affects about ten million Britons, with more than half of cases targeting the knee and about 100,000 people each year ending up on the NHS waiting list for joint replacement surgery. After initial anti-inflammatory drugs and prescribed exercises offered little relief, doctors warned he might need a double knee replacement. By embracing a combination of acupuncture, weight training and a Mediterranean-style diet, Reeves says he reduced his pain enough to postpone surgery. “I am now managing amazingly – largely pain-free and back to hiking, swimming, cycling and long walks with my dalmatian Oscar,” he said.

Experts say thousands more could delay or avoid surgery with similar lifestyle changes. The debate reflects growing interest in non-surgical options for osteoarthritis care. Last week, a Daily Mail column by Dr Ellie Cannon highlighted that many patients may not realize there are steps they can take to avoid knee replacement, prompting a flood of reader remembrances of remedies ranging from supplements to topical creams. One reader, 81-year-old Bill Ellis of Suffolk, said a combination of supplements and consistent squats helped reduce pain, while Eddie Boyle of Bedfordshire credited capsaicin cream with easing his symptoms. While individual experiences vary, clinicians say a holistic approach can help many people cope with pain and maintain function longer before considering surgery.

The six strategies promoted by clinicians and researchers are: following a Mediterranean-style diet; considering weight-loss injections; building strength before cardio; using acupuncture; trying evidence-based supplements; and employing specialist knee braces when appropriate. Each strategy is supported by varying levels of evidence, but together they form a framework for non-surgical management that may delay the need for joint replacement for some patients.

1. Follow the Mediterranean diet. The eating pattern, common in Greece, Italy and Spain, emphasizes fresh fruit and vegetables, fish and chicken, whole grains and olive oil while limiting red meat and sweets. A 2016 study of more than 4,000 people with osteoarthritis in their knees found those who adhered most closely to the Mediterranean diet were less likely to report crippling joint pain, while also showing better overall physical health and lower depression scores. Experts say the diet’s anti-inflammatory properties can help soothe swollen joints and aid weight control—two key factors in arthritis management. Dr Wendy Holden, medical adviser for Arthritis Action, notes that a diet rich in produce, fish and whole grains, and low in ultra-processed foods, can cut inflammation. Nutrition guidance also emphasizes protein intake to preserve muscle mass, which tends to decline with age; researchers suggest around 40 grams daily from sources such as fish, nuts and legumes, leveraging leucine-rich foods to stimulate muscle protein synthesis. Prof Philip Conaghan, an arthritis specialist at the University of Leeds, underscores that weight loss itself is a major benefit because it reduces load on the joints and lowers systemic inflammation, which can worsen symptoms.

2. Consider weight-loss injections. There is growing interest in whether weight-loss medications can ease osteoarthritis symptoms beyond fat reduction. A case cited by Reeves’ group is Sian Rios, a 54-year-old care home manager from Swindon, who used a prescription for Mounjaro and experienced dramatic mobility gains. Four months into treatment she shed about six stone, reducing pain and flare-ups to the point where a planned hip replacement was postponed. A 2025 Taiwanese study of nearly 1,000 knee-osteoarthritis patients found weight-loss injections reduced the risk of needing joint replacement. While preliminary, such findings suggest these regimens may slow disease progression in some patients. At present, arthritis is not included in prescribing guidelines for weight-loss drugs, but experts anticipate evolving guidance as evidence accumulates.

3. Build strength first. A central tenet of OA care is that muscle strength supports joint stability and reduces pain more effectively than (or before) turning to endurance training. Professor Philip Conaghan often tells patients: “First, get strong, then get fit.” After establishing strength, patients can typically progress to activities such as cycling, swimming or pool-based walking. A 2023 review in the Annals of Physical and Rehabilitation Medicine concluded there was overwhelming evidence that strength training significantly reduces pain and improves function, performance and quality of life for those with knee and hip osteoarthritis. Isaac Selby-Burton, a trainer specializing in arthritis coaching, emphasizes starting with resistance bands and focusing on the quadriceps, which are crucial for knee support and movement. Early signs of weakening—such as difficulty opening jars or rising from a chair—may indicate the need for targeted strength work before advancing to more rigorous cardio.

4. Use acupuncture. Many patients rely on acupuncture to manage OA pain, enabling them to perform strengthening workouts with less discomfort. The therapy involves inserting fine needles at specific points to potentially trigger natural pain-relief mechanisms and improve circulation. A 2025 review of 18 studies with about 14,000 participants found acupuncture could reduce pain and improve function in osteoarthritis, though results are variable and not all guidelines endorse it as a primary treatment. Dr Lucy Donaldson of Versus Arthritis notes that while guidelines may not formally recommend acupuncture for OA, many patients pursue it for chronic pain and report relief. The prevalence of chronic pain and inflammation in other conditions also drives continued use of complementary therapies.

5. Use supplements that work. Among popular options are turmeric (curcumin), glucosamine sulfate and chondroitin, but evidence supporting their effectiveness is limited. Dr Wendy Holden notes that two supplements with the most robust, albeit modest, evidence are cod liver oil and rosehip powder; however, even in those cases results are not uniform and products vary in potency. While omega-3 oils in cod liver oil have theoretical anti-inflammatory benefits, clinical trials in OA have not consistently shown clear improvement. Rosehip may modestly reduce pain and stiffness in some small studies, but more research is needed to confirm these findings across broader populations.

6. Consider specialist knee braces. Unloading or offloading knee braces can alter joint alignment and reduce pressure during activity. A 2017 study followed 63 patients awaiting total knee replacement who wore such braces; after eight years, 40 percent of those who used the brace consistently for two years reported they no longer needed surgery. The brace design typically features a lightweight plastic-shell or fabric wrap with a hinge that redirects forces to reduce load on the affected compartment. The same model—Unloader One, from Ossur—has gained public attention after being worn by public figures such as Ant McPartlin in his OA journey. While braces are not a cure, they can help some patients stay active and delay surgical intervention.

The approach outlined here does not promise a cure for osteoarthritis, and experts stress that care must be individualized. While the evidence base continues to grow for some therapies and weaker for others, patients and clinicians alike are encouraged to weigh benefits, risks and costs and to use a combination of diet, physical activity, and vetted medical treatments to manage symptoms and improve quality of life over time.