Knee Osteoarthritis: Exercises, Creams and Injections, Explained Honestly

Knee osteoarthritis is one of the most searched knee problems in Qatar, and one of the most misunderstood. Many people are told their knee is “worn out” and that the only options are to rest it, rub something on it, or wait for an injection or surgery. The evidence says something more hopeful: for most people, the right exercise is the foundation of treatment.

This is general information, not a diagnosis or a substitute for your doctor's advice.

Osteoarthritis is not simply wear and tear

Osteoarthritis involves the whole joint: cartilage, bone, the joint lining and the muscles around it. Pain does not track neatly with X-ray changes: some people with marked changes on imaging have little pain, and the reverse is also true. The UK NICE guideline on osteoarthritis (NG226, 2022) advises that it can be diagnosed clinically, without imaging, in people aged 45 or over who have activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes.

Exercise is first-line care

NICE, the Osteoarthritis Research Society International (OARSI, 2019) and the American College of Rheumatology (2019) all place exercise at the core of management. A Cochrane systematic review (Fransen and colleagues, 2015) found that land-based therapeutic exercise reduces knee pain and improves physical function in people with knee osteoarthritis.

Exercise works by strengthening the muscles that support the knee and absorb load, improving balance and confidence, and helping the joint tolerate more activity over time. It is not about pushing through severe pain. Some discomfort during exercise is acceptable as long as it settles within a day and does not build week on week.

What you can do at home

• Sit to stand: rise from a chair without using your hands, slowly and with control, then sit back down. Use a higher seat if a normal chair is too hard.
• Straight leg raises: lying on your back, tighten the thigh and lift the straight leg to the height of the other, bent knee, then lower it slowly.
• Step-ups onto a low step, holding a rail for balance, raising the height as it gets easier.
• Walking, cycling or swimming on most days. In the Doha summer, malls, indoor tracks, a gym or a pool make this realistic.
• Pacing: spread demanding activities across the week rather than doing them all on one day, and build back up gradually after a flare.

These are general examples. The right exercises, amounts and progression depend on your knee, so check with a physiotherapist if any of them clearly increases your pain.

Weight, if it applies to you

For people living with excess weight, guidelines recommend weight loss as part of management, because every step loads the knee by a multiple of body weight. Even a modest change can help. This is a conversation to have with your doctor, and exercise supports it.

Creams and gels: which one helps?

After “which exercises?”, the most common question is “which cream?”. Topical anti-inflammatory gels (topical NSAIDs) are recommended by NICE and OARSI as a first medication option for knee osteoarthritis, because they act locally with less effect on the rest of the body than tablets. Ask your pharmacist or doctor whether one is suitable for you, especially if you take other medicines or have stomach, kidney or heart problems. Warming rubs, herbal oils and similar products may feel soothing, but they do not change the joint. Use them alongside exercise, not instead of it.

Injections: what the guidelines say

• Corticosteroid (steroid) injections: NICE says they can be considered when other treatments are not working or are unsuitable, or to support exercise, and that the relief is short term, typically weeks rather than months.
• Hyaluronic acid (“gel” or “lubricant”) injections: NICE recommends against offering them for osteoarthritis, and the American College of Rheumatology guideline advises against them for knee osteoarthritis. Some people report benefit, but the evidence is not convincing.
• Platelet-rich plasma (PRP) and stem cell injections: widely marketed, but the American College of Rheumatology guideline recommends against them, citing inconsistent evidence and a lack of standardised preparations. If you are considering one, discuss the evidence and the cost carefully with a doctor.
• Glucosamine and chondroitin supplements: NICE advises against offering them for osteoarthritis.

Injections and surgery are medical decisions for your doctor or orthopaedic surgeon. Whatever you decide, a strong, well-conditioned leg helps, and physiotherapy supports every option, including preparing for and recovering from a knee replacement.

When to see a doctor first

• A hot, red, very swollen knee, especially with fever or feeling unwell.
• Suddenly being unable to put weight on the leg.
• A knee that locks and will not straighten.
• Knee pain after a fall or a significant twist.
• Calf pain and swelling with warmth or redness: seek urgent medical care.
• Severe, unrelenting pain at night, or unexplained weight loss.

How physiotherapy helps

At MVP we start with a full assessment of the knee, hip and foot, how you walk, and what you want to get back to: the stairs at home, a walk along the Corniche, a round of golf or your gym routine. We then build a progressive strength and movement programme, use hands-on techniques where they help you exercise more comfortably, and measure progress against goals we set together. We also tell you honestly when a medical opinion on injections or surgery is worth considering. Sessions are one to one, 45 minutes, 600 QAR.

Knee osteoarthritis: physio for stiff, painful knees at MVP→

Knee pain: physio assessment at MVP→

Sources

• NICE guideline NG226. Osteoarthritis in over 16s: diagnosis and management, 2022.
• Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 2019.
• Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research, 2020.
• Fransen M, et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 2015.