You have knee osteoarthritis.

You tried physiotherapy.

You did the exercises.

But your knee still hurts.

So what happens next?

Should you:

Continue physiotherapy?

Get an injection?

Try shockwave?

Have an MRI?

See a specialist?

Consider knee replacement?

The answer should not automatically be any one of these.

If appropriate physiotherapy has not produced sufficient improvement, the next step should usually be:

REASSESS.

At The Pain Relief Clinic, our approach is not:

“Physiotherapy didn’t work, so buy more physiotherapy.”

Instead, we ask:

Why hasn’t the knee improved?

The answer helps determine what should happen next.

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First: Did Physiotherapy Really Fail?

This may sound like an unusual question.

But saying:

“I’ve tried physiotherapy.”

can mean many different things.

One patient may have completed a progressive strengthening programme over several weeks.

Another may have attended two sessions consisting mainly of massage and passive treatment.

Another may have received exercises but rarely performed them.

Another may have exercised consistently but pain prevented meaningful progression.

These are very different situations.

Before declaring physiotherapy unsuccessful, it is useful to understand exactly what was tried.

---

What Should Knee Arthritis Physiotherapy Include?

For knee osteoarthritis, rehabilitation should generally involve an active component.

Depending on the individual, this may include:

• Quadriceps strengthening
• Hip and gluteal strengthening
• Lower-limb strengthening
• Mobility work
• Functional exercise
• Sit-to-stand practice
• Step exercises
• Walking progression
• Aerobic activity
• Home exercises
• Progressive increases in difficulty

Passive treatments may sometimes be useful as adjuncts.

But knee arthritis rehabilitation should not necessarily consist only of:

Massage + machines + repeat.

---

Was the Exercise Programme Progressed?

This is another common issue.

Exercise that was challenging during week one may become easy after several weeks.

If the programme never changes, the stimulus may eventually become insufficient.

Progression can involve changing:

• Resistance
• Repetitions
• Sets
• Range of movement
• Exercise difficulty
• Walking duration
• Aerobic intensity
• Functional challenge

A rehabilitation programme should therefore evolve as the patient improves.

---

Did Pain Prevent Effective Rehabilitation?

Sometimes physiotherapy is appropriate, but pain prevents the patient from participating properly.

For example:

The patient is asked to strengthen.

But every exercise hurts significantly.

So the patient performs less.

Strength does not improve sufficiently.

Walking remains difficult.

This does not necessarily mean:

“Exercise doesn’t work.”

It may mean that pain needs to be managed sufficiently for rehabilitation to progress.

That can require medical reassessment.

---

Is Knee Osteoarthritis Really the Main Problem?

Persistent knee pain should not automatically be attributed to osteoarthritis simply because an X-ray shows arthritis.

Other problems can contribute to knee symptoms.

These may include:

• Meniscal problems
• Tendon disorders
• Patellofemoral pain
• Ligament injuries
• Gout
• Inflammatory arthritis
• Previous trauma
• Referred pain
• Other musculoskeletal conditions

If symptoms are not responding as expected, reconsidering the diagnosis can be important.

---

Do I Need Another X-Ray?

Not necessarily.

If recent imaging already answers the relevant clinical question, repeating it may add little.

But imaging may be appropriate when:

• The diagnosis remains uncertain
• Symptoms have changed significantly
• There has been a new injury
• The doctor needs additional information to guide treatment

Imaging should answer a question.

It should not simply be performed because treatment has not worked.

---

Do I Need an MRI?

Again:

Not automatically.

MRI is not routinely required simply because someone has knee osteoarthritis.

It may be useful when:

• Symptoms do not fit straightforward osteoarthritis
• Another condition is suspected
• The diagnosis remains uncertain
• Additional information would change management

The question should be:

“Will this MRI change what we do?”

rather than:

“Can I get an MRI?”

---

Should I Just Continue Physiotherapy?

Sometimes, yes.

If the patient is clearly improving but has not yet reached their goals, continued rehabilitation may be reasonable.

For example:

Before treatment:

Walking tolerance: 10 minutes

After treatment:

Walking tolerance: 25 minutes

The knee still hurts, but function is clearly improving.

That is different from:

Eight weeks of treatment with no meaningful change.

The decision should be based on progress.

---

Measure Function, Not Just Pain

Pain scores alone do not tell the entire story.

Ask:

Can I walk further?

Are stairs easier?

Can I get out of a chair more comfortably?

Am I exercising more?

Can I work more comfortably?

Am I sleeping better?

Can I go out with family and friends again?

Do I feel more confident using my knee?

These changes can represent meaningful improvement even if some pain remains.

---

What If There Has Been No Meaningful Improvement?

Then repeating exactly the same programme indefinitely may not be useful.

The next step should be to identify possible barriers.

These may include:

• Incorrect diagnosis
• Inadequate exercise progression
• Insufficient adherence
• Pain preventing exercise
• Significant weakness
• Excess body weight
• Other medical conditions
• Another knee problem
• More advanced functional limitation

Treatment can then be adjusted accordingly.

---

Could Weight Be Limiting My Progress?

For patients who are overweight, weight management may be an important part of knee osteoarthritis treatment.

This does not mean:

“Your knee hurts because you’re overweight.”

Knee pain is usually more complicated than that.

But excess body weight is one potentially modifiable factor.

The challenge is that knee pain may itself make weight management harder.

This creates a cycle:

Pain

↓

Less activity

↓

Reduced fitness

↓

Difficulty managing weight

↓

Greater difficulty moving

For appropriate patients, rehabilitation and weight management can therefore be addressed together.

---

Could Medication Help?

Sometimes.

Medication may help reduce symptoms sufficiently to allow:

• Walking
• Exercise
• Physiotherapy
• Better sleep
• Improved daily function

Singapore’s current knee osteoarthritis guidance includes topical anti-inflammatory medication as an option supporting the mainstay strategies, with short courses of oral anti-inflammatory medication considered for suitable patients when appropriate.

Medication should be individualised according to medical history and risk.

---

What About Shockwave Therapy?

Shockwave therapy is used for selected musculoskeletal conditions.

At The Pain Relief Clinic, shockwave may be considered as an adjunct in appropriate situations when basic rehabilitation alone has not been sufficient.

However:

Not every patient with knee osteoarthritis needs shockwave.

It should be used because there is a clinical reason—not simply because physiotherapy has not produced the desired result.

Active rehabilitation may still remain part of the treatment plan.

---

What About TECAR Therapy?

TECAR-based therapy may also be used as an adjunct to rehabilitation in selected patients.

At The Pain Relief Clinic, this may be incorporated into treatment where clinically appropriate.

Again, it should not replace:

• Exercise
• Strengthening
• Functional rehabilitation
• Appropriate medical assessment

The treatment machine should support the rehabilitation plan rather than become the rehabilitation plan.

---

Should I Consider a Steroid Injection?

Possibly.

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 means steroid injection can have a role when first-line strategies have not been sufficient.

For an appropriate patient, reducing pain temporarily may make it easier to:

• Walk
• Exercise
• Participate in physiotherapy
• Perform everyday activities

But an injection does not strengthen the knee.

Rehabilitation may therefore remain important.

---

Does a Steroid Injection Cure Knee Arthritis?

No.

The purpose is generally symptom relief.

The duration and degree of benefit can vary between patients.

Potential benefits and risks should be discussed with the treating doctor.

---

What About Hyaluronic Acid or Viscosupplementation?

Hyaluronic acid injections are also known as:

Viscosupplementation.

They are offered by some clinics for knee osteoarthritis.

However, evidence and recommendations are less consistent than for core treatments such as exercise and weight management.

In Singapore, hyaluronic acid injections are not currently subsidised for knee osteoarthritis on the same basis as intra-articular corticosteroid injections, reflecting differences in the evidence considered for subsidy decisions.

That does not necessarily mean no patient can ever consider viscosupplementation.

It means it should not automatically be presented as a proven next step for everyone.

Patients should discuss:

• Potential benefit
• Limitations
• Risks
• Cost
• Alternatives
• Previous treatment response

before proceeding.

---

What About “Regenerative” Knee Injections?

Patients may encounter treatments marketed as:

• Regenerative injections
• Platelet-based treatments
• Biologic treatments
• Other injectable therapies

Claims can vary substantially.

Patients should ask:

What exactly is being injected?

What evidence supports it?

What outcome should I realistically expect?

What are the risks?

What does it cost?

What do current clinical guidelines say?

The more expensive a treatment is, the more important these questions become.

---

What About Pulsed Radiofrequency?

Some patients have persistent chronic knee pain despite appropriate conservative treatment.

For selected patients, advanced pain-management assessment may be appropriate.

At The Pain Relief Clinic, visiting specialist doctors can assess suitable patients for options including:

Pulsed radiofrequency

where clinically appropriate.

This is an escalation option rather than routine first-line treatment.

The purpose of advanced pain-management treatment may be to reduce pain and improve function in selected patients whose symptoms remain significant despite simpler measures.

---

Does Pain Treatment Replace Rehabilitation?

Usually, that should not be the assumption.

Imagine that a procedure reduces pain.

That can be valuable.

But if the patient remains:

• Weak
• Inactive
• Poorly conditioned
• Afraid to move

then an important part of the functional problem remains.

An effective strategy may therefore combine:

PAIN MANAGEMENT

with

REHABILITATION.

The aim is not simply:

“Make the knee hurt less.”

It is:

“Help the person function better.”

---

When Should I See an Orthopaedic Specialist?

Orthopaedic assessment may be appropriate when:

• Symptoms remain significant despite appropriate conservative treatment
• Walking is substantially limited
• Stairs are extremely difficult
• Sleep is repeatedly affected
• Work is significantly affected
• Daily activities are becoming difficult
• Quality of life is substantially impaired
• Surgery may reasonably need to be considered

Referral does not automatically mean surgery will occur.

It means obtaining an appropriate specialist assessment.

---

When Should Knee Replacement Be Considered?

Knee replacement can be highly relevant for appropriately selected patients with severe symptomatic knee osteoarthritis.

It should neither be:

Rushed into unnecessarily

nor

Avoided indefinitely when it is appropriate.

Singapore’s current clinical guidance supports surgical referral when persistent symptoms substantially affect function and quality of life despite appropriate management.

The decision should consider:

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

---

“I Want to Avoid Surgery at All Costs”

It is understandable that some patients prefer to avoid surgery.

But the goal should not necessarily be:

Avoid surgery forever.

A better objective may be:

Use appropriate conservative treatment for as long as it provides sufficient function and quality of life.

If conservative treatment is working, continue it.

If it is no longer working and disability is substantial, specialist assessment may be appropriate.

---

A Practical Escalation Pathway

If basic physiotherapy has not been enough, a reasonable pathway may look like:

1. REASSESS

Is the diagnosis correct?

↓

2. REVIEW THE REHABILITATION

Was it active, appropriate and sufficiently progressed?

↓

3. ADDRESS BARRIERS

Pain, weight, weakness, adherence or other medical factors.

↓

4. OPTIMISE MEDICAL MANAGEMENT

Where appropriate.

↓

5. CONSIDER ADJUNCTIVE REHABILITATION

Such as selected shockwave or TECAR-based treatment where clinically appropriate.

↓

6. CONSIDER INJECTION OPTIONS

For appropriate patients after discussion of benefits, limitations and evidence.

↓

7. ADVANCED PAIN MANAGEMENT

For selected persistent cases.

↓

8. ORTHOPAEDIC ASSESSMENT

When significant functional limitation persists.

This is not a rigid ladder.

Individual patients may require different pathways.

---

Why Integrated Doctor + Physiotherapy Care Can Help

When physiotherapy and medical treatment occur completely separately, a patient can sometimes become stuck.

The physiotherapist says:

“You should ask your doctor.”

The doctor says:

“Continue physiotherapy.”

The patient remains uncertain about what happens next.

At The Pain Relief Clinic, our doctors work alongside our:

Experienced, AHPC-Registered Physiotherapists

within the same care pathway.

This allows the treatment cycle to become:

DOCTOR

↓

PHYSIOTHERAPIST

↓

REASSESS

↓

MODIFY OR ESCALATE

rather than continuing one treatment indefinitely.

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Why AHPC Registration Matters

Physiotherapy is regulated in Singapore by the Allied Health Professions Council (AHPC).

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

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

This provides independently verifiable professional registration and supports an appropriately documented clinical pathway.

It can also be relevant when treatment documentation is required for eligible MediSave or insurance claims.

AHPC registration itself does not guarantee claimability.

---

What If My Previous Physiotherapy Was Somewhere Else?

That is not a problem.

You do not necessarily need to start everything again.

Where available, bring information such as:

• Previous X-rays
• MRI reports
• Medication lists
• Physiotherapy reports
• Previous exercise programmes
• Injection records
• Specialist letters

The objective is to understand what has already been tried and what should happen next.

---

Do I Have to Repeat Physiotherapy at The Pain Relief Clinic?

Not automatically.

The purpose of reassessment is to determine the appropriate next step.

That may involve:

• Modifying rehabilitation
• Continuing exercises independently
• Additional physiotherapy
• Medical treatment
• Weight management
• Additional investigation
• Injection treatment
• Advanced pain management
• Specialist referral

The recommendation should depend on the individual patient’s needs.

---

Can MediSave Help With Knee Arthritis Treatment?

Osteoarthritis is included under Singapore’s Chronic Disease Management Programme.

For eligible patients, qualifying outpatient management may include:

• Doctor consultations
• Relevant investigations
• Medication
• Doctor-referred allied-health services such as physiotherapy

At The Pain Relief Clinic, our integrated doctor and AHPC-registered physiotherapy pathway can support eligible CDMP management.

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$650 Knee Arthritis Rehab Programme

For suitable patients who have not yet undergone a structured doctor-led rehabilitation programme, The Pain Relief Clinic offers:

$650 Knee Arthritis Rehab Programme

including:

2 Doctor Consultations

For assessment, treatment planning and review.

2 Physiotherapy Sessions

With our experienced, AHPC-registered physiotherapy team.

Individualised Rehabilitation Programme

For exercise and strengthening.

Lifestyle Counselling

Where appropriate.

Weight-Management Counselling

Where appropriate.

Knee X-Ray

Where clinically indicated.

Medication

Where clinically indicated.

---

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 limit, sufficient MediSave balance, applicable co-payment requirements, clinical indication and eligibility of individual services.

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Frequently Asked Questions

What should I do if physiotherapy hasn’t helped my knee arthritis?

The next step should generally be reassessment.

Review the diagnosis, exercise programme, progression, pain control and other factors that may be preventing improvement.

---

Should I just do more physiotherapy?

Not automatically.

Continued physiotherapy may be appropriate if you are making meaningful progress.

If there has been little improvement, the treatment strategy should be reviewed.

---

Do I need an MRI if physiotherapy doesn’t work?

Not necessarily.

MRI is more useful when another diagnosis is suspected or the additional information is likely to change management.

---

Should I get a steroid injection?

It may be considered for short-term symptom relief in appropriate patients whose symptoms persist despite suitable medication and/or allied-health support.

It is not automatically required simply because physiotherapy has not helped enough.

---

Is hyaluronic acid injection better than steroid?

They are different treatments with different evidence, objectives and considerations.

There is no universal answer suitable for every patient.

---

Can shockwave help knee arthritis?

Shockwave may be considered as an adjunct in selected musculoskeletal situations, but it is not automatically required for every patient with knee osteoarthritis.

---

What about TECAR therapy?

TECAR-based treatment may be used as an adjunct in selected patients, but active exercise and rehabilitation remain important.

---

What is pulsed radiofrequency?

Pulsed radiofrequency is an interventional pain-management option that may be considered for selected patients with persistent chronic pain after appropriate assessment.

It is not routine first-line treatment for knee osteoarthritis.

---

When should I see an orthopaedic surgeon?

Specialist assessment may be appropriate when persistent symptoms significantly affect function and quality of life despite appropriate conservative treatment.

---

Does seeing a surgeon mean I need surgery?

No.

An orthopaedic consultation is an assessment.

Surgery is one possible treatment depending on the patient’s condition.

---

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

Yes.

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

---

If Physiotherapy Isn’t Enough, Don’t Just Repeat It Forever

The important principle is:

PHYSIOTHERAPY

↓

MEASURE THE RESPONSE

↓

REASSESS

↓

IDENTIFY THE BARRIER

↓

MODIFY OR ESCALATE TREATMENT

The objective is not to keep a patient in physiotherapy indefinitely.

Nor is it to jump immediately to surgery.

It is to determine:

What is the next appropriate level of care?

---

From Rehabilitation to Specialist Treatment When Needed

At The Pain Relief Clinic, our knee arthritis pathway can include:

Doctor-Led Assessment

Experienced AHPC-Registered Physiotherapy

Exercise & Strengthening

Lifestyle & Weight Management

Appropriate Medication

Appropriate Imaging

Shockwave or TECAR-Based Adjunctive Treatment in Selected Cases

Corticosteroid Injection Where Appropriate

Viscosupplementation Where Appropriately Considered

Advanced Pain-Management Assessment

Pulsed Radiofrequency for Selected Patients

Visiting Specialist Doctors

Orthopaedic Referral When Necessary

The principle is simple:

Start with the simplest appropriate treatment.

Measure whether it works.

Escalate when necessary.

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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 and visiting specialist doctors within an integrated care pathway.

Last reviewed: 3 October 2026

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Medical, MediSave & Insurance Disclaimer

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

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

Not every treatment described is appropriate for every patient. Adjunctive treatments, injections and interventional pain procedures should only be considered following appropriate clinical assessment.

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.