Knee Osteoarthritis: who to see and what helps

Knee Osteoarthritis · Kitchener, Waterloo & Cambridge

Knee osteoarthritis is the gradual breakdown of the knee joint that makes stairs, hills and getting moving after a rest painful and stiff. Exercise is the treatment guidelines recommend most strongly, with braces, taping and anti-inflammatory gel as possible additions. Book first with a CARESPACE physiotherapist or chiropractor: either will assess the knee and begin treatment at that visit.

What knee osteoarthritis is

The knee is where Osteoarthritis is felt most: among people with osteoarthritis who have joint pain, it is the site reported most often. Unless the cause is an injury or another condition in one knee, both knees are usually affected over time.

Symptoms of knee osteoarthritis

• Pain when you walk, particularly up or down hills and stairs
• Stiffness after sitting or first thing in the morning that eases within about 30 minutes
• Difficulty getting up from a chair
• A knee that sometimes gives way beneath you (see the warning signs below for when that needs attention)
• Difficulty straightening the leg fully
• A soft grating sound or feeling as the knee moves
• Some swelling, in some people

What causes knee osteoarthritis

The risk factors are those of osteoarthritis in general. Ones to note at the knee: a previous injury to the joint (an old hockey or soccer injury, for many people here), excess body weight, which adds stress to weight-bearing joints, heavy physical work, and weakness in the muscles around the joint.

How knee osteoarthritis is diagnosed

A practitioner goes by the pattern of your symptoms and what the knee does when it is examined. Ontario’s quality standard says imaging is not required for people aged 40 or older with typical symptoms. A knee that locks is not typical: it is a reason to look for something else, such as a torn meniscus (see Meniscus Tears) or a loose fragment in the joint.

When it is not osteoarthritis

A joint infection comes on quickly, usually over a few days; osteoarthritis does not. The NHS, the UK’s health service, gives these signs of one: severe pain in a joint, usually just one, that started suddenly; swelling around a joint; a change in the colour of the skin around a joint; difficulty moving a joint; or joint pain along with feeling generally unwell and a high temperature, or feeling hot, cold or shivery. Ontario’s quality standard adds chills and sweats, and names a hot, swollen joint as a feature that needs investigating. If you develop any of these, go to an urgent care clinic or an emergency department the same day. A joint infection is serious and should be treated as soon as possible, usually in hospital, so it is not something to bring to an appointment with us.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Get medical care the same day, from a physician or nurse practitioner, an urgent care clinic or an emergency department, if the knee is very painful or quickly getting worse, you cannot move it or put any weight on it, it is badly swollen or has changed shape, or it locks or clicks painfully. Apart from quick worsening, which the UK guideline lists as a feature that does not fit osteoarthritis, that is the NHS’s list for knee pain, in Ontario terms. Giving way is on it too, although the NHS also lists occasional giving way as a symptom of knee osteoarthritis. Treat it as a same-day sign when it is new, more frequent, or has never been assessed.

If you have injured the knee, go by the warning signs on Knee Pain, not this page: some of them mean calling 911 or going to an emergency department.

Morning stiffness that lasts longer than about 30 minutes is a reason to see a physician or nurse practitioner. Like locking, a hot, swollen joint and a recent injury, it does not fit osteoarthritis, and it may call for blood work, imaging or another diagnosis such as rheumatoid arthritis or gout.

What the evidence says about treating knee osteoarthritis

• Four guidelines, not always in agreement. Ontario Health (2024), the UK’s NICE (2022), the American College of Rheumatology (2026 update, so far a summary) and the American Academy of Orthopaedic Surgeons (2021). The rheumatologists’ “strongly” means their panel was confident the benefits outweigh the downsides for almost everyone; “conditionally” is weaker: most informed people would choose the treatment, some would not. The surgeons grade by the amount of good research: strong, moderate or limited.
• Exercise, of any kind you will do. All four recommend it, each at the firmest level it uses. Supervised, unsupervised and water-based exercise are all recommended over no exercise, and balance, agility and coordination training could be added (moderate).
• Weight loss, for people with overweight or obesity. Strongly recommended by the rheumatologists, and recommended, if sustained, by the surgeons (moderate). A minimum of 5% of body weight is suggested for some symptom relief, ideally 10% or more.
• Hands-on treatment only with exercise. NICE’s wording is to only consider manual therapy, alongside exercise; the surgeons say it may be used in addition to an exercise programme (limited). In 2019 the rheumatologists conditionally recommended against adding it to exercise, and it is absent from their 2026 summary.
• Braces, taping and canes: sometimes. Knee braces and therapeutic taping are conditionally recommended by the rheumatologists, and the surgeons say a brace or a cane could be used (moderate). NICE is more cautious: do not routinely offer them unless the joint is unstable or abnormally loaded, exercise is ineffective or unsuitable without the device, and the device is likely to improve movement and function.
• Wedged insoles: no. Lateral wedge insoles are not recommended by the surgeons (strong); the rheumatologists conditionally recommend against lateral and medial ones.
• Acupuncture and dry needling: the guidelines disagree. NICE says do not offer either. Acupuncture has a conditional recommendation from the rheumatologists; the surgeons say it may improve pain and function (limited) and that the usefulness of dry needling is unclear.
• TENS, laser and shockwave: also disputed. Do not offer TENS or laser, says NICE; the rheumatologists conditionally recommend against TENS; the surgeons say all three may be used (limited).

What a doctor may offer

These are medical treatments, outside what CARESPACE provides. The knee is the one joint for which NICE says to offer an anti-inflammatory gel as a first medicine, and both American guidelines back the gel strongly. Corticosteroid injections are strongly recommended by the rheumatologists; the relief is short-term, 2 to 10 weeks by NICE’s estimate. Hyaluronic acid injections are not recommended for routine use (surgeons) and not to be offered (NICE). Keyhole surgery to wash out or tidy an arthritic knee has no role, according to Ontario’s standard. Referral for a knee replacement is considered when symptoms are substantially affecting quality of life and non-surgical treatment is ineffective or unsuitable; Knee Replacement Rehab covers what follows.

How each CARESPACE service treats knee osteoarthritis

Physiotherapy

A physiotherapist can test thigh and hip strength, how far the knee bends and straightens, and how you manage stairs and rising from a chair, then set a strengthening programme and progress it. Balance work, hands-on treatment alongside the exercises, taping, and advice on a brace or cane are options where they fit; CARESPACE supplies braces, splints, straps and tape. Some CARESPACE physiotherapists offer dry needling, which for knee osteoarthritis has one guideline against it and none clearly for it (see the evidence list).

See our physiotherapy team →

Chiropractic

A chiropractor can examine the knee together with the hip, ankle and foot, and treat with joint mobilization, soft-tissue work and exercise. Hands-on treatment for the knee is supported only in addition to an exercise programme, so expect strengthening to do between visits.

See our chiropractic team →

Kinesiology

A kinesiologist can supervise the exercise itself: progressive leg strengthening, balance and agility drills, and aerobic work that suits the knee, such as cycling or exercise in a pool. Supervised sessions are an option NICE says to consider.

See our kinesiology team →

Personal Training

A personal trainer can keep leg strengthening and aerobic exercise going, and progressing, after a course of treatment ends. The benefits of an exercise plan increase with long-term adherence.

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Massage Therapy

A Registered Massage Therapist can treat the thigh and calf muscles that work across a sore knee. Two guidelines allow for it: a conditional recommendation on low-certainty evidence (the rheumatologists) and “may be used in addition to usual care” (the surgeons, limited). Arthritis Society Canada says there is not enough research evidence to say massage should be recommended.

See our massage therapy team →

Nutrition & Dietitian

Where weight is adding stress to the knee, a Registered Dietitian can work on weight management with you, at a pace you choose, and you leave the first visit with a plan. Supplements have little support. NICE says do not offer glucosamine; the rheumatologists strongly recommend against glucosamine and chondroitin, and conditionally against fish oil and vitamin D; Ontario’s standard does not recommend glucosamine or chondroitin for slowing the disease. Only the surgeons say glucosamine, chondroitin, vitamin D, turmeric and ginger extract may be helpful, calling the evidence inconsistent and limited. Check with a pharmacist, physician or nurse practitioner before starting one.

See our nutrition team →

Acupuncture

Pain relief is the aim when an acupuncture practitioner treats an arthritic knee. The research, most of it on the knee, is read in opposite ways: a lack of benefit and some evidence of harm (NICE, which says not to offer it), a conditional recommendation (the rheumatologists), and “may improve pain and function” (the surgeons). If you try it, add it to exercise; do not swap one for the other.

See our acupuncture team →

Where most people start

Start with a physiotherapist or a chiropractor. Bring or wear shorts so the knee can be examined properly.

How your team works together

Strengthening is the centre of the plan. A physiotherapist or chiropractor can set the exercises and judge whether hands-on treatment, taping or a brace belongs alongside; a kinesiologist or personal trainer can carry the programme forward. Your physician or nurse practitioner handles gels, tablets, injections and any surgical opinion.

Browse by service: physiotherapists, chiropractors, kinesiologists, personal trainers, registered massage therapists, registered dietitians and acupuncture practitioners.

What to expect at your first visit

1. The story of the knee. One knee or both, old injuries, how stairs and hills feel, whether it gives way or locks.
2. An examination. Bending and straightening, swelling, thigh and hip strength, and how you walk, squat and rise from a chair.
3. What it means. Whether it fits osteoarthritis, and whether anything needs a physician.
4. Treatment that day, with two or three strengthening exercises to begin at home.

What you can do at home

• Stay active: walking, cycling and exercise in the water all count.
• If running or another high-impact activity makes the knee worse, modify or swap it, and ask your physician what the knee can tolerate.
• Tai chi and yoga each carry a conditional recommendation for the knee.
• An ice pack wrapped in a towel can ease a sore, swollen knee. Heat suits stiffness, but keep it off a knee that is already inflamed.

Icy winter sidewalks cut down on walking around here. An indoor track, a pool or a stationary bike keeps the routine going until spring.

Outlook

Knee osteoarthritis usually progresses slowly, over months or years. None of the guidelines gives a number of weeks for exercise to work; the benefit grows the longer you keep to the plan. Surgery is for osteoarthritis that has become severe when other treatment is not working.

Knee osteoarthritis treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Kinesiology in Kitchener, Personal Training in Kitchener, Massage Therapy in Kitchener, Nutrition in Kitchener and Acupuncture in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Kinesiology in Waterloo, Personal Training in Waterloo, Massage Therapy in Waterloo, Nutrition in Waterloo and Acupuncture in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge, Nutrition in Cambridge and Acupuncture in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Does a grinding or clicking knee mean damage?

A soft grating sound is one of the listed symptoms of knee osteoarthritis, and painless clicking is normal. Clicking that hurts is one of the same-day signs above.

Is it arthritis or a torn meniscus?

Locking points away from osteoarthritis and toward something like a meniscal injury. It is one of the same-day signs above.

Should I stop running or using the stairs?

Stairs and walking, no: staying active is part of the treatment. For running and other high-impact sport, Arthritis Society Canada says the evidence on possible harm is conflicting, and advises working out what your body tolerates, consulting your doctor, and modifying or swapping an activity if it worsens your symptoms.

Will I need a knee replacement?

Not unless non-surgical treatment has stopped being enough; the test for referral is under “What a doctor may offer”. Age, smoking, other health conditions and body weight are not reasons to rule someone out of a referral, according to NICE.

Where can I get treatment for knee osteoarthritis in Cambridge?

Begin with Physiotherapy in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Ontario Health. Osteoarthritis: Care for Adults With Osteoarthritis of the Knee, Hip, Hand, or Shoulder. Quality standard, 2024.
• National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. Full text on the NCBI Bookshelf.
• American College of Rheumatology. 2026 Update of the American College of Rheumatology Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand. Guideline summary, approved September 8, 2026; the full paper has not yet been published.
• Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology, 2020. Used for how the recommendation strengths are defined and for its position on manual therapy.
• American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline. 2021.
• Arthritis Society Canada. Osteoarthritis. Reviewed February 2021.
• NHS. Osteoarthritis: symptoms. Reviewed March 2023; its next review was due in March 2026.
• NHS. Septic arthritis. Reviewed September 2026.
• NHS. Knee pain. Reviewed December 2023.

Related conditions

Osteoarthritis
Knee Pain
Meniscus Tears
Knee Replacement Rehab
Hip Osteoarthritis

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Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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