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NOVA HEALTHHome nursing and physiotherapy

Physiotherapy for knee osteoarthritis (knee degeneration) · home visits across Hong Kong

Physiotherapy for knee degeneration,
getting back the ability to walk

Knee degeneration does not mean putting up with pain for the long term, and it does not necessarily mean a knee replacement. However severe the X-ray looks, international guidelines consistently list exercise as the first-line treatment for everyone with knee osteoarthritis. Our registered physiotherapists visit the patient's home and design muscle-strengthening, aerobic and balance training. We also train everyday movements such as going downstairs, squatting to use the toilet and shopping for groceries.

  • Registered physiotherapists in Hong Kong
  • Home visits across Hong Kong
  • 1 hour $1,000 · 1.5 hours $1,300
  • Mainly exercise, easing pain and keeping mobility
WhatsApp for a free enquiry and quote

First, what you tell us

What people with knee pain often say

These are the six things people troubled by knee pain say most often. We understand the difficulties in life behind these words, and we know the real reasons for the pain.

Your situation · our response WE HEAR YOU

Knocked down by a doctor's "nothing can be done"?"The doctor said nothing can be done for my degenerative knee, only painkillers and losing weight, and waiting for a knee replacement.""Nothing can be done" means that the cartilage cannot grow back. It certainly does not mean you can only sit and put up with the pain. The three main international guidelines all list exercise as first-line treatment. Our professional team visits to assess your strength and gait precisely, and starts with the right targeted exercises, and does not simply wait for things to get worse.
Waiting for a public hospital with no end in sight, and nothing to do but wait?"I have waited nearly a year for orthopaedics at a public hospital. When the pain comes, apart from painkillers I don't know what else I can do."In a long wait, what worries people most is not the waiting, but watching the muscles slowly waste and walking become less steady. Progressive exercise can help you break this vicious circle. Stepping in early to ease pain and keep daily function is protecting the value of your legs.
Knee weak, nearly fell, afraid to go out?"My knee gave way for a moment on the stairs and I nearly fell down. Now I don't even dare to go out on the street."Can't get out of the door? This is exactly why we offer a home visit service. We train directly on the stairs you use every day, and teach you which leg goes down first to be steadiest, together with the correct use of handrails and a walking stick. First we help you overcome the fear, and then you can step out of the door again safely and with confidence.
Pain shrinking your world more and more?"It's more than just pain. I can't hike, go for dim sum or look after the grandchildren, and I'm even struggling at work."What torments people most about pain is that it forces them to give up daily life. We believe real rehabilitation has to solve the difficulties in your life. We start from the situations in life that you most want back, whether squatting, carrying a grandchild or standing for a long time, and design movement training for you around them. We aim at your most pressing needs and hand control of your life back to you.
Tried so many treatments and the knees are no better?"I've seen Chinese medicine and Western medicine, but progress has stalled, and sometimes I'm better for a few days and then back to square one."Passive equipment and drugs mostly give only temporary pain relief and do not solve the root problem of lost muscle strength, so the effect does not last. To see real improvement you need progressive training to strengthen the quadriceps and gluteal muscles, and this is also the step in first-line treatment that is most often skipped.
Elderly parent won't move however hard you persuade? Afraid of pain and refusing rehabilitation?"My mother walks more and more slowly and would rather hide at home. However much I urge her to go to a clinic for physiotherapy, she won't listen."Often an older adult is not really stubborn, but deep down is afraid of pain, afraid of falling and afraid of troubling the children. Our home visit service starts in the most familiar surroundings, training on the sofa and stairs the person uses every day. The therapist also teaches the family the right ways to help, so that you can help your family member through the difficulty of pain and regain mobility together.

Whatever the situation, the key to rehabilitation is starting with the right exercise. The patient does not have to wait passively, and does not necessarily need a knee replacement.

Looking at the question again

Common misunderstandings about knee degeneration

The pain caused by knee degeneration (degenerative knee arthritis) is less closely related to the amount of wear seen on X-ray than people imagine. What really decides whether someone can walk again is muscle strength, activity level and body weight. Rather than keep looking for ways to repair the cartilage, it is better to start suitable exercise early.

Common misunderstandings
  • Rest completely and wait for it to get better by itselfNot being active at all makes the muscles waste and the joint stiffer, and the pain lasts longer.
  • Eating well means no training is neededNutrition is only the base, and muscle strength still has to be built by exercise training.
  • Lose weight first and exercise laterThe IDEA trial showed that controlling diet and exercising together works better than doing either one alone.
What works
  • Strengthen the front thigh and gluteal musclesMuscles help the knee absorb shock, and the three main international guidelines all list muscle training as first-line treatment.
  • Progressive loading + aerobic exerciseTraining with a little pain is safe, and the physiotherapist helps to adjust the amount of exercise.
  • Weight lossFor every 1 lb lost, the knee takes 4 lb less pressure with each step when walking.

Pain relief is only the first step, and strength and mobility in the legs still have to be restored by training. A time when the pain is mild is just the right time to start exercising.

Client cases

Rehabilitation for knee degeneration: case sharing

A feature of home physiotherapy is one-to-one targeted training, so the rehabilitation method also fits the individual better.

Four clients · four scenes at home CASE STORIES

Mrs Chan · aged 68 · lives with her daughter"I don't dare take the stairs alone. I have to go down sideways one step at a time, and I haven't been out on the street for a whole month."The assessment found a weak quadriceps, an unsteady single-leg stance, and the knee collapsing inwards on the stairs. Training centred on sit-to-stand, single-leg weight bearing and the stairs with the weaker leg down first and the stronger leg last, with two home visits a week plus practice at home. After six weeks she could go down four flights holding the handrail with one hand, and now goes out for dim sum every other day.
Mr Lee · aged 78 · lives with his wife"I can't get up from the toilet and have to be pulled up by my wife. I don't dare drink water at night."The assessment found insufficient thigh strength: it took several tries to stand up from sitting, and sometimes his wife had to help. We prescribed daily progressive sit-to-stand training on a chair, and suggested a raised toilet seat and grab rails. After three weeks he could stand up alone holding the grab rail, no longer needed to call his wife at night, and slept better.
Mr Wong · aged 61 · lives with his family"After sitting for half an hour my knee is so stiff I have to get up slowly before it will straighten, and after standing all day at work it swells."The assessment found clear knee stiffness on getting up and after sitting for long, and body weight shifted to the unaffected side when standing. Training centred on joint movement before getting out of bed, strengthening the quadriceps and gluteal muscles, weight-bearing sit-to-stand on the sofa and weight shifting in standing, and the pauses in activity during work were adjusted. After six weeks the number of pain flare-ups and the swelling had fallen, he felt much more confident standing up and walking, and work and daily activities were back to normal.
Ms Leung · aged 70 · lives alone"I have to stop three times on the way to the market, and I can't carry the groceries back, so I order takeaway."The assessment found low walking endurance and knee pain that got worse when carrying. First she practised weight-bearing walking at home with water bottles and a backpack, with ultrasound to reduce swelling, and then we walked the market route with her on site and taught her to use a shopping trolley to share the weight and to plan resting places. She now goes to the market twice a week by herself and can shop and cook, and no longer relies on takeaway.
Note on the cases: These are the experiences of individual clients. Names and some details have been anonymised. Results differ from person to person and are no guarantee of treatment results. The actual training is based on the physiotherapist's home assessment.

Clinical evidence

The research on treating knee degeneration

The three studies below answer the three questions clients ask most: whether exercise at home works just as well, whether painkillers can be reduced, and what exercise does besides reducing pain.

Three studies · three answers EVIDENCE

Prescribed home exercise reduces pain just as wellExercise at home clearly eases pain and improves mobility and quality of life, with better results than only attending a health talk or not exercising.Systematic review and meta-analysis, 12 randomised controlled trials, 1,442 people with knee degeneration (Si et al., Journal of Orthopaedic Surgery and Research 2023)
Keeping up exercise reduces reliance on painkillersAfter a 12-week education + exercise programme, the proportion taking painkillers fell from 61.4% to 49.4%Real-world cohort, 4,100 people with knee or hip degeneration (Mahmoudian et al., Archives of Physical Medicine and Rehabilitation 2024)
More than pain relief: regaining self-care and social lifeExercise reduced pain by 6%, and also improved mobility by 5.6% and social ability by 7.9%, with improvement in depression as well.Cochrane mixed-methods review, 21 randomised controlled trials, 2,372 participants (Hurley et al., Cochrane Database of Systematic Reviews 2018)

Cartilage that has worn away is very hard to regrow. The aim of exercise is to be able to walk, to stand up and to hurt less, and not to change the result on the X-ray. The three main international guidelines (ACR 2019, OARSI 2019, NICE NG226) all consistently list exercise as the first-line treatment for all patients, whatever the degree of wear in the joint structure.

If you are not sure whether the knee can be trained at the moment, tell us about your situation and a physiotherapist will answer your questions directly.

WhatsApp for a free enquiry and quote

From the basics to the detail

Physiotherapy for knee degeneration: further reading

Want to know why the X-ray result does not match the level of pain, how much exercise to do, how to choose a knee brace and insoles, or how to make allowances on stairs and at the toilet? The related topics below cover these.

Related physiotherapy topics 04

Overview of physiotherapy servicesThe specialties of home physiotherapyRehabilitation after total knee replacementRehabilitation training after knee replacement surgeryPhysiotherapy for muscle painLong-term pain, pain sensitisation, and exercising with a little painRehabilitation exercise and exercise prescriptionExercise programmes for older adults and balance training to prevent falls

FAQ · cost and results

Physiotherapy for knee degeneration: frequently asked questions

NOVA HEALTH・FAQ01 – 06
Can knee degeneration be cured or reversed?

Worn cartilage is hard to grow back, but this does not mean you can only put up with the pain. Research has shown again and again that strengthening the thigh and hip muscles through exercise, together with weight loss, brings a clear improvement in pain and walking in the great majority of people. The aim is to be able to walk, stand up and hurt less, and not to look only at the X-ray. International guidelines (ACR 2019, OARSI 2019, NICE NG226) all list exercise as the first-line core treatment for everyone with knee degeneration, whatever the severity of the structural changes.

What is the most effective treatment for knee degeneration?

Exercise, especially progressive strengthening of the quadriceps (the front thigh muscle) and hip muscles, plus a moderate amount of aerobic exercise. Weight loss is added where needed (for every 1 lb of body weight lost, the load on the knee falls by about 4 lb with each step). The three main international guidelines, ACR 2019, OARSI 2019 and NICE NG226, all list exercise as the first-line core treatment for everyone with knee degeneration. Note that passive electrotherapy and massage cannot replace active exercise, because leg strength can only be restored by training. On a home visit we measure strength, gait and the home environment, and set the exercise dose for the individual.

While waiting for an orthopaedic appointment, what can be done?

The waiting period should not just be spent waiting. Waits for public hospitals often run into years, and knee pain leads to less walking, which makes the thigh muscles waste and balance worse. The greatest fear is that things get worse until a fall and fracture. Graded exercise during this time can relieve pain and protect function, and keeping the body in good condition makes whatever happens next go more smoothly.

With degenerative knees, can I still use stairs, hike and exercise?

Yes, and you should keep active. Not moving makes muscles waste, makes the joint stiffer and makes the pain last longer. The key is to use the right method and dose: going downstairs with the stronger leg first, using a handrail or a walking stick in the opposite hand where needed, and mild pain during exercise (about 5 out of 10 or below) is safe. In the real home, including walk-up tenement stairs and the toilet, we teach how to move safely.

A doctor has already mentioned a knee replacement. Is physiotherapy still needed?

Yes, and it helps in both stages. Before the operation, keeping muscle strength up helps (the better the function before surgery, the faster the recovery afterwards). After the operation, physiotherapy is certainly needed to retrain range of movement and strength, because a knee replacement deals with the joint structure, while strength and function still have to be built by training. If you have not yet decided on surgery, exercise therapy itself may bring enough improvement, and you do not have to go straight to the operation.

How much does the home service cost?

HK$1,000 for 1 hour and HK$1,300 for 1.5 hours, with no minimum spend and no package contract. A Hong Kong registered physiotherapist visits the home and does a full assessment at the first visit (strength, gait, pain, home risks) and then draws up a personalised exercise prescription. Enquire and book by WhatsApp for free.

If you have any questions about the knee, send us a message and we will answer them.

WhatsApp for a free enquiry and quote

1 hour $1,000 · 1.5 hours $1,300 · no minimum spend · Prices for all services

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Kolasinski, S. L., Neogi, T., Hochberg, M. C., et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology, 72(2), 220–233. PubMed
  2. Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589. PubMed
  3. National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management (NG226). nice.org.uk
  4. Messier, S. P., Gutekunst, D. J., Davis, C., & DeVita, P. (2005). Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism, 52(7), 2026–2032. PubMed
  5. Messier, S. P., Mihalko, S. L., Legault, C., et al. (2013). Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA, 310(12), 1263–1273. PubMed
  6. Si, J., Sun, L., Li, Z., et al. (2023). Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 18(1), 503. PubMed
  7. Mahmoudian, A., Lohmander, L. S., Dahlberg, L. E., & Kiadaliri, A. (2024). Digital self-management, analgesic use, and patient-reported outcomes in knee or hip osteoarthritis. Archives of Physical Medicine and Rehabilitation, 105(10), 1821–1828. PubMed
  8. Hurley, M., Dickson, K., Hallett, R., et al. (2018). Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database of Systematic Reviews, (4), CD010842. PubMed