Knee Osteoarthritis: Why Looking Beyond the Knee Could Be the Key to Lasting Relief
Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.
Knee Osteoarthritis: Why Looking Beyond the Knee Could Be the Key to Lasting Relief
Is your knee pain stopping you from enjoying everyday life?
Whether it's walking the dog around Sunbury, keeping up with the grandchildren in Melton, climbing the stairs at home, or simply getting out of the car after travelling along the Calder or Western Highway, knee pain can slowly take the enjoyment out of everyday activities.
Many Australians living with knee osteoarthritis believe that their worn cartilage is the only cause of their pain. While arthritis certainly plays a role, exciting new research suggests there is much more to the story.
The latest evidence shows that improving the strength and movement of your hips, pelvis, core and even your feet may be just as important as treating the knee itself.
The good news? Many people can improve their pain, function and quality of life without surgery by following a well-designed rehabilitation programme.
What is knee osteoarthritis?
Knee osteoarthritis (OA) is a condition where the cartilage that cushions your knee gradually wears down over time.
As this happens, you may experience:
Pain during walking
Morning stiffness
Swelling
Reduced movement
Difficulty climbing stairs
Pain getting up from a chair
Reduced confidence with balance
Worldwide, knee osteoarthritis affects around 3.8% of the population, making it one of the leading causes of pain and disability as we age.
What does the latest research tell us?
A comprehensive systematic review analysed 18 randomised controlled trials involving adults with mild to moderate knee osteoarthritis (Kellgren-Lawrence Grades 1–3).
The review examined which conservative treatments produced the best improvements in:
Pain
Strength
Walking ability
Balance
Mobility
Quality of life
Daily function
Rather than focusing only on the knee, researchers looked at the entire kinetic chain—the way the spine, pelvis, hips, knees, ankles and feet all work together.
Your knee doesn't work in isolation
One of the biggest messages from this research is that knee pain is often influenced by what is happening above and below the joint.
Weakness in the:
Core muscles
Gluteal muscles
Hip stabilisers
Pelvic muscles
can change how forces travel through your knee every time you walk.
When these muscles aren't doing their job, the knee often ends up carrying more load than it was designed to handle.
Researchers explain that poor hip strength can contribute to a pelvic drop, causing the thigh to rotate inward and increasing stress through the inside of the knee—the area where osteoarthritis most commonly develops.
Strong hips mean happier knees
Several studies found that strengthening the muscles around the hips and pelvis produced significant improvements in pain and function.
One study compared:
Hip strengthening exercises
Core stability exercises
After 6 weeks, both approaches produced similar improvements in:
Pain
Muscle strength
Daily activities
Quality of life
This tells us there isn't just one "magic exercise"—building strength throughout the body is what really matters.
Core stability may be even more important than we realised
Another study compared three different rehabilitation programmes over 6 weeks:
Trunk stabilisation exercises
Mulligan Mobilisation with Movement (MWM)
Isometric strengthening alone
The researchers found that trunk stabilisation exercises produced the greatest improvements in:
Pain reduction
Functional ability
Walking endurance
Stair-climbing performance
This reinforces the idea that improving spinal and pelvic stability helps reduce unnecessary stress on the knee during everyday movement.
Manual therapy helps people exercise more comfortably
Exercise remains the cornerstone of managing knee osteoarthritis.
However, several studies found that adding manual therapy helped people progress more quickly.
Research showed:
Manual therapy combined with neuromuscular training produced greater improvements in pain, balance, knee movement and quality of life than exercise alone over 12 months.
Mobilisation with Movement (MWM) combined with strengthening exercises produced faster pain relief than strengthening alone after 6 weeks.
Improvements from combining manual therapy with exercise were maintained for at least six months in one clinical trial.
Walking backwards? Surprisingly, yes!
One of the more interesting findings involved retro walking (walking backwards).
Compared with:
Normal walking
Standard physiotherapy
A 6-week supervised backwards walking programme resulted in:
Greater pain reduction
Better quadriceps strength
Improved physical performance
Reduced disability
Walking backwards changes the way forces travel through the knee and may reduce pressure on painful joint surfaces while strengthening important muscles. It should only be introduced under the guidance of a healthcare professional.
More exercise isn't always better
Many people assume lifting heavier weights will produce better results.
Interestingly, one large study involving 377 participants compared:
High-intensity strength training
Low-intensity strength training
Healthy lifestyle education
After 18 months, researchers found that high-intensity training was no more effective than lower-intensity exercise for reducing pain or decreasing stress through the knee joint.
The message?
Consistency is often more important than intensity.
Exercises commonly used in successful rehabilitation programmes
Across the 18 studies, the most effective rehabilitation programmes commonly included combinations of:
Core stability exercises
Designed to improve control of the trunk and pelvis.
Examples include:
Abdominal bracing
Dead bugs
Bird dogs
Modified planks
Pelvic control exercises
Hip strengthening
To improve pelvic stability and reduce unnecessary stress on the knee.
Common exercises include:
Side-lying leg raises
Clamshells
Standing hip abduction
Monster walks with resistance bands
Glute bridges
Knee strengthening
To improve joint support.
Frequently prescribed exercises include:
Quadriceps isometric contractions
Straight leg raises
Sit-to-stands
Mini squats
Step-ups
Hamstring strengthening
Balance and neuromuscular training
Often included to improve confidence and reduce falls.
These may involve:
Single-leg balance
Controlled stepping drills
Functional movement training
Gait retraining
Walking programmes
Depending on the individual, these included:
Forward walking
Backward walking
Stationary cycling
Lower-body positive pressure treadmill training
Progressive aerobic exercise
Most successful programmes lasted between 4 and 12 weeks, with supervised sessions several times each week, alongside regular home exercises.
Why a whole-body approach often delivers the best results Knee osteoarthritis isn't simply a "knee problem". The latest research consistently shows that combining exercise, manual therapy, movement retraining, weight management where appropriate, education and lifestyle advice provides the greatest improvements in pain, mobility and quality of life. Treating the entire movement system—not just the painful joint—helps optimise long-term outcomes.
Can exercise delay knee replacement?
One of the most encouraging findings from the review is that well-designed conservative care may help delay the need for surgery.
The researchers suggest that structured rehabilitation programmes may postpone knee replacement by approximately two to five years in suitable people with mild to moderate knee osteoarthritis, while helping maintain independence and function. They also note that this estimate is based on emerging evidence and individual outcomes depend on factors such as arthritis severity, body weight, overall health and adherence to the programme.
How chiropractic care can help
At Health Wise Chiropractic, we recognise that successful management of knee osteoarthritis often requires looking beyond the knee itself.
Following a thorough assessment, your care may include:
Joint mobilisation or manual therapy where clinically appropriate
Assessment of spinal, hip and pelvic movement
Individualised strengthening exercises
Balance and movement retraining
Advice on walking mechanics
Lifestyle and activity modifications
Guidance on remaining active safely
Our aim is to help improve the way your entire body moves so your knees can cope with everyday activities more comfortably.
Supporting healthier knees in Sunbury and Melton
Whether you're enjoying a walk around your local neighbourhood, working in the garden, playing with the grandchildren or simply wanting to stay active for years to come, knee pain doesn't have to dictate what you can and can't do.
At Health Wise Chiropractic, our experienced teams in Sunbury and Melton understand how frustrating knee osteoarthritis can be. We take a whole-body approach, combining hands-on care, personalised rehabilitation and practical lifestyle advice to help you move with greater confidence.
If knee pain is limiting your daily activities, we'd love to help you explore evidence-informed, non-surgical options that can support your mobility, independence and quality of life.
How Chiropractic Care May Help
At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.
Treatment may include:
We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.
About the Author
Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.
He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.
His treatment focus includes:
Chiropractic adjustments
Sports chiropractic
Massage therapy
Shockwave therapy
Laser therapy
Non-surgical spinal decompression
Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.
Reference
Somade OA, Shinde S, Thorat VM, Joshi AV, Thomas MS. Physical Therapy-Based Realignment Strategies for Knee Osteoarthritis: A Systematic Review. Cureus. 2026 Jun 2;18(6):e110125. doi: 10.7759/cureus.110125. PMID: 42395233; PMCID: PMC13326894.
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