If you have knee osteoarthritis, you may encounter a confusing number of treatment options.

Physiotherapy.

Painkillers.

Exercise.

Weight loss.

Shockwave.

Injections.

Supplements.

Radiofrequency procedures.

Knee replacement.

So what should you actually try first?

For most patients, the answer is not to immediately choose the most expensive or invasive treatment.

Singapore’s current clinical guideline recommends three mainstay strategies for knee osteoarthritis:

Education

Exercise

Weight Management

Additional treatments can then be added according to your symptoms, medical condition and response.

At The Pain Relief Clinic, we use a similar stepped approach:

ASSESS → REHABILITATE → STRENGTHEN → ADDRESS WEIGHT/LOAD → REASSESS → ESCALATE IF NECESSARY

The objective is to start with the simplest appropriate treatment and move to additional options when there is a clinical reason to do so.

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Step 1: Make Sure It Really Is Knee Osteoarthritis

Before deciding on treatment, first understand what is causing the knee pain.

Not every painful knee is arthritis.

Other causes can include:

• Meniscal problems
• Tendon problems
• Ligament injuries
• Patellofemoral pain
• Gout
• Inflammatory arthritis
• Previous injury
• Other musculoskeletal conditions

This is particularly important if:

• The pain appeared suddenly
• There was an injury
• The knee is very swollen
• The knee locks
• You cannot bear weight
• Symptoms are rapidly worsening
• You have fever or feel unwell
• The diagnosis is uncertain

A medical assessment can help determine whether osteoarthritis is likely and whether investigation is necessary.

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Step 2: Don’t Treat the X-Ray — Treat the Person

An X-ray can provide useful information about osteoarthritis.

But treatment should not be determined by the X-ray alone.

Two people can have similar-looking X-rays but very different symptoms.

One may still:

• Walk several kilometres
• Work normally
• Exercise
• Travel
• Climb stairs

while another struggles to walk to the bus stop.

Singapore’s current knee osteoarthritis guideline recommends considering:

• Pain
• Functional ability
• Quality of life
• Psychosocial factors
• Previous treatment response

when developing an individual treatment plan.

The important question is therefore not simply:

“How bad is my X-ray?”

It is:

“How much is my knee affecting my life?”

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Step 3: Start With Education

Understanding knee osteoarthritis is itself part of treatment.

Some patients become frightened when they hear phrases such as:

“Wear and tear.”

“Degeneration.”

or

“Bone-on-bone.”

They may respond by avoiding activity because they are worried about causing more damage.

But prolonged inactivity can contribute to:

• Muscle weakness
• Reduced fitness
• Reduced mobility
• Loss of confidence
• Weight gain
• Greater difficulty returning to activity

Understanding what activities are appropriate and how to manage symptoms can therefore be an important first step.

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Step 4: Exercise

Exercise is one of the mainstay treatments for knee osteoarthritis.

This does not necessarily mean:

“Go jogging.”

Exercise should be adapted to the individual.

It may include:

• Quadriceps strengthening
• Hip strengthening
• Lower-limb strengthening
• Mobility exercises
• Sit-to-stand exercises
• Step exercises
• Walking
• Cycling
• Swimming or water-based exercise
• Other appropriate aerobic exercise

The programme should take into account:

• Current fitness
• Pain
• Strength
• Mobility
• Other medical conditions
• Functional goals
• Exercise preferences

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“But Exercise Hurts My Knee”

This is one of the most common barriers.

Someone may be told:

“You need to exercise.”

But their response is:

“I would exercise if exercising didn’t hurt.”

This is where supervised rehabilitation can help.

Instead of simply telling someone to exercise, a physiotherapist can help determine:

• Which exercises are appropriate
• How hard to exercise
• How many repetitions to perform
• How frequently to exercise
• How to modify exercises
• How to progress
• How to manage temporary increases in symptoms

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Step 5: Consider Physiotherapy

Not everyone with knee osteoarthritis needs indefinite physiotherapy.

But physiotherapy can be particularly useful when someone:

• Does not know how to exercise
• Is weak
• Has significant functional limitations
• Has stopped exercising because of pain
• Needs help progressing exercises
• Is worried about damaging the knee
• Has difficulty walking or climbing stairs

At The Pain Relief Clinic, physiotherapy is provided by our:

Experienced, AHPC-Registered Physiotherapy Team

Our physiotherapists work alongside our doctors as part of the same knee arthritis pathway.

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Why Should Your Physiotherapist Be AHPC-Registered?

Physiotherapy is a regulated healthcare profession in Singapore.

The Allied Health Professions Council (AHPC) regulates physiotherapists and maintains the professional register.

Patients should check that their treating physiotherapist is appropriately AHPC-registered and authorised to practise.

At The Pain Relief Clinic, our physiotherapy team consists of experienced, AHPC-registered physiotherapists.

This also helps support a properly documented clinical pathway where MediSave or insurance documentation may be relevant.

AHPC registration itself, however, does not automatically make treatment MediSave- or insurance-claimable.

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Step 6: Strengthen the Knee — and More Than the Knee

Knee rehabilitation should not necessarily focus only on the knee joint.

Muscles around the:

• Thigh
• Hip
• Pelvis
• Lower limb

all contribute to movement.

A rehabilitation programme may therefore include strengthening of the:

Quadriceps

Gluteal muscles

Hip muscles

Other lower-limb muscles

The objective is functional improvement.

Can you:

Walk further?

Get out of a chair more easily?

Climb stairs more comfortably?

Exercise again?

Perform your work more comfortably?

Spend more time outside with family and friends?

These are meaningful measures of progress.

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Step 7: Address Weight Where Appropriate

Weight management is another mainstay strategy for knee osteoarthritis.

This is particularly relevant for people who are overweight.

But telling someone:

“Lose weight.”

without helping them address the reason they cannot exercise may not be particularly useful.

Knee pain can create a cycle:

Pain

↓

Less movement

↓

Reduced strength and fitness

↓

Weight gain or difficulty losing weight

↓

Greater load through the knee

↓

More difficulty exercising

A coordinated programme can address rehabilitation and weight management together.

At The Pain Relief Clinic, lifestyle and weight-management counselling can be incorporated where appropriate.

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Step 8: Medication Can Support the Programme

Medication may sometimes be useful for symptom relief.

Singapore’s current guideline recommends topical non-steroidal anti-inflammatory drugs as an option supporting the mainstay strategies.

Short courses of oral NSAIDs can also be considered when topical treatment is unsuitable or ineffective, taking individual medical risks into account.

Medication can sometimes make it easier for a patient to:

• Walk
• Sleep
• Exercise
• Participate in physiotherapy

But medication does not strengthen the knee.

It should therefore usually support rather than replace rehabilitation.

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Should I Just Take Painkillers and Wait?

Not necessarily.

If medication makes the knee feel better but nothing is done about:

• Strength
• Physical function
• Activity
• Weight where relevant

then an important part of the problem may remain unaddressed.

A more complete strategy may be:

Control symptoms sufficiently

so that you can:

Move → Exercise → Strengthen → Improve function.

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Step 9: Reassess Before Adding More Treatment

This step is often overlooked.

After beginning appropriate conservative treatment, ask:

Is it actually working?

Look at outcomes such as:

• Pain
• Walking distance
• Stair climbing
• Ability to stand from a chair
• Exercise tolerance
• Work function
• Sleep
• Confidence
• Quality of life

If these are improving, continuing conservative treatment may make sense.

If they are not improving, simply repeating the same treatment indefinitely may not.

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What If Physiotherapy Isn’t Enough?

The first response should usually be:

Reassess.

Questions may include:

• Is the diagnosis correct?
• Is another condition contributing?
• Was the exercise programme appropriate?
• Was it performed consistently?
• Was it sufficiently progressed?
• Is pain preventing meaningful rehabilitation?
• Is excess weight contributing?
• Is additional medical treatment appropriate?
• Does the patient need another level of care?

Only then should additional treatment be considered.

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Step 10: Consider Additional Rehabilitation Options Where Appropriate

Some patients may benefit from additional treatment alongside active rehabilitation.

At The Pain Relief Clinic, selected patients may be considered for adjunctive modalities such as:

Shockwave Therapy

where clinically appropriate for selected musculoskeletal problems.

TECAR-Based Therapy

as an adjunct to rehabilitation in selected situations.

These should not automatically replace exercise.

The fact that a clinic owns a treatment machine does not mean every knee arthritis patient needs it.

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Step 11: When Should You Consider a Steroid Injection?

Singapore’s current knee osteoarthritis guideline recommends considering an intra-articular corticosteroid injection for short-term symptom relief when symptoms persist despite appropriate medication and/or allied-health support.

This places steroid injection later in the pathway rather than making it the automatic first treatment.

For an appropriate patient, temporary pain reduction may help with:

• Walking
• Exercise
• Physiotherapy
• Daily function

But an injection does not strengthen the knee.

Rehabilitation may therefore remain important.

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Step 12: What About Hyaluronic Acid / Viscosupplementation?

Hyaluronic acid injections are sometimes offered for knee osteoarthritis.

They are also known as:

Viscosupplementation.

Evidence and recommendations for this treatment are less consistent than for core treatments such as exercise and weight management.

It should therefore not automatically be the first treatment simply because someone has been diagnosed with osteoarthritis.

Patients considering viscosupplementation should discuss:

• Potential benefits
• Limitations
• Risks
• Cost
• Alternatives
• Previous response to conservative treatment

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Step 13: What About Pulsed Radiofrequency?

Some people continue to experience significant chronic knee pain despite appropriate conservative treatment.

Singapore’s current guideline recommends discussing advanced pain-management referral when persistent symptoms significantly affect function and quality of life.

Selected patients at The Pain Relief Clinic may be assessed by visiting specialist doctors for interventional pain-management options such as pulsed radiofrequency, where clinically appropriate.

Again, this is an escalation option.

It is not the automatic starting treatment for knee osteoarthritis.

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Step 14: When Should You Consider Surgery?

Surgery should neither be:

Automatically rushed into

nor

Avoided at all costs.

For patients whose persistent knee osteoarthritis symptoms substantially affect function and quality of life despite appropriate conservative treatment, specialist surgical assessment may be appropriate.

Examples might include severe difficulty:

• Walking
• Climbing stairs
• Working
• Sleeping
• Performing everyday activities
• Maintaining independence

The decision should take into account:

• Symptoms
• Function
• Imaging
• Previous treatment
• Overall health
• Patient preferences

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What Should the Treatment Order Look Like?

A simplified pathway is:

1. ASSESS

Understand the diagnosis, symptoms and functional limitations.

↓

2. EDUCATE

Understand knee osteoarthritis and what you can do about it.

↓

3. EXERCISE

Begin appropriate strengthening and activity.

↓

4. PHYSIOTHERAPY

Use supervised rehabilitation where useful.

↓

5. MANAGE WEIGHT

Address excess weight where appropriate.

↓

6. SUPPORT WITH MEDICATION

When clinically indicated.

↓

7. REASSESS

Measure whether pain and function are improving.

↓

8. ADD TREATMENT IF NECESSARY

Consider appropriate adjunctive rehabilitation or injection options.

↓

9. ADVANCED PAIN MANAGEMENT

For selected persistent cases.

↓

10. SURGICAL ASSESSMENT

When persistent symptoms substantially impair function and quality of life.

This is not a rigid formula.

Individual patients may enter the pathway at different points.

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Why Not Start With the Most Powerful Treatment?

Because more invasive or expensive treatment is not automatically better treatment.

For example, someone may ask:

“Should I have an injection?”

But perhaps they have never tried an appropriate strengthening programme.

Another person may ask:

“Should I have surgery?”

But their symptoms may currently be manageable with conservative treatment.

Conversely, someone with severe persistent disability after appropriate conservative treatment should not necessarily continue repeating treatments that are no longer helping.

The appropriate question is:

“What is the simplest treatment likely to help me at this stage?”

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The Pain Relief Clinic Knee Arthritis Care Pathway

At The Pain Relief Clinic, we provide a stepped pathway rather than relying on a single treatment.

Medical Assessment

Doctor-led assessment and diagnosis.

↓

Appropriate Investigation

X-ray or other imaging where clinically indicated.

↓

AHPC-Registered Physiotherapy

Experienced physiotherapists providing active rehabilitation.

↓

Exercise & Strengthening

Individualised according to the patient.

↓

Lifestyle & Weight Management

Where appropriate.

↓

Medical Review

Assess progress.

↓

Additional Treatment

Where clinically appropriate.

↓

Specialist Escalation

When necessary.

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A Structured Starting Option: $650 Knee Arthritis Rehab Programme

For suitable patients who have not yet gone through a structured conservative programme, The Pain Relief Clinic offers:

$650 Knee Arthritis Rehab Programme

Including:

2 Doctor Consultations

For medical assessment, treatment planning and review.

2 Physiotherapy Sessions

With our experienced, AHPC-registered physiotherapy team.

Individualised Rehabilitation Programme

For strengthening and continued exercise.

Lifestyle Counselling

Where appropriate.

Weight-Management Counselling

Where appropriate.

Knee X-Ray

Where clinically indicated.

Medication

Where clinically indicated.

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Up to $500 MediSave Claimable in 2026*

For eligible patients:

Programme price: $650

MediSave: up to $500*

Cash payment: from $150*

*Subject to individual CDMP/MediSave eligibility, available annual withdrawal limits, sufficient MediSave balance, applicable co-payment requirements, clinical indication and eligibility of individual services.

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What About Insurance?

Depending on the patient’s individual policy and circumstances, some physiotherapy or musculoskeletal treatment may potentially fall under:

• Employee medical benefits
• Corporate flexi-benefits
• Personal accident insurance
• Travel insurance following eligible injury
• Motor or third-party accident claims
• Other rehabilitation benefits

Our doctors and AHPC-registered physiotherapists work within the same care pathway, which can facilitate appropriate clinical documentation relating to treatment received.

Insurance approval remains subject to the individual policy and insurer.

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Frequently Asked Questions

What is the first treatment for knee osteoarthritis?

Singapore’s current clinical guideline identifies patient education, exercise and weight management as mainstay management strategies.

Treatment should be individualised according to symptoms, function and other patient factors.

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Should I start with physiotherapy?

Physiotherapy can be particularly useful when you need help with exercise, strengthening, mobility or functional rehabilitation.

---

Should I exercise if my knee hurts?

Appropriate exercise remains important for knee osteoarthritis.

The programme may need to be modified according to symptoms rather than stopping all activity.

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Should I lose weight before starting physiotherapy?

Not necessarily.

For someone who is overweight, rehabilitation and weight management can be addressed together.

Improving movement may actually make weight management easier.

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Should I get an injection first?

Not necessarily.

Singapore’s current guideline places corticosteroid injection after mainstay strategies and considers it for short-term symptom relief when symptoms persist despite appropriate medication and/or allied-health support.

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Should I have an MRI first?

Not routinely for straightforward knee osteoarthritis.

MRI may be appropriate when the diagnosis is uncertain or additional information would change management.

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When should I consider knee replacement?

When persistent symptoms continue to substantially affect function and quality of life despite appropriate management, specialist surgical assessment may be appropriate.

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What if physiotherapy has already failed?

Reassessment is important.

The question should be why it did not help and whether the diagnosis, exercise programme or treatment strategy needs to change.

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Are The Pain Relief Clinic’s physiotherapists AHPC-registered?

Yes.

Our physiotherapy team consists of experienced, AHPC-registered physiotherapists working alongside our doctors.

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Don’t Ask Only “What Treatment Should I Buy?”

A better question is:

“What stage of treatment am I at?”

If you have just been diagnosed, you may need:

Education + exercise + rehabilitation.

If pain prevents rehabilitation, you may need:

Appropriate symptom management + rehabilitation.

If conservative treatment has genuinely failed, you may need:

Reassessment + additional treatment.

If severe symptoms continue to substantially affect your life, you may need:

Advanced pain-management or surgical assessment.

The treatment should follow the patient — not the other way around.

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Start With the Simplest Appropriate Treatment

At The Pain Relief Clinic, our approach to knee osteoarthritis is:

Start conservatively where appropriate.

Use experienced AHPC-registered physiotherapists for rehabilitation.

Address exercise, strength and weight where relevant.

Reassess rather than endlessly repeating treatment.

Add medical or specialist treatment when clinically necessary.

For suitable patients, ask about our:

$650 Knee Arthritis Rehab Programme

Doctor + AHPC-Registered Physiotherapy + Rehabilitation

Up to $500 MediSave claimable in 2026*

Cash payment from $150*

*Subject to individual eligibility and prevailing MediSave/CDMP requirements.

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About the Reviewer

Reviewed by Dr Terence Tan
Founder, The Pain Relief Clinic
Singapore

Dr Terence Tan provides doctor-led assessment and non-surgical management of musculoskeletal conditions and works alongside The Pain Relief Clinic’s experienced, AHPC-registered physiotherapy team within an integrated care pathway.

Last reviewed: 3 October 2026

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Medical, MediSave & Insurance Disclaimer

This article provides general information and does not replace individual medical assessment, diagnosis or treatment.

The appropriate treatment for knee osteoarthritis depends on symptoms, functional limitations, medical history, examination findings, previous treatment response and patient preferences.

MediSave eligibility depends on prevailing CDMP requirements, individual eligibility, clinical indication, annual withdrawal limits, co-payment requirements and applicable provider accreditation.

AHPC registration confirms professional registration but does not by itself establish MediSave or insurance eligibility.

Insurance reimbursement depends on individual policy terms, exclusions, limits, referral requirements and insurer assessment.