physiotherapist advice on pain management on arthritis

Physiotherapy is the NHS-recommended first-line treatment for arthritis. According to NICE guideline NG226, therapeutic exercise should be offered to all people with osteoarthritis before medication is considered. Research shows that exercise therapy can reduce pain by up to 12 points on a 100-point scale and significantly improve physical function – benefits that can last for months with continued practice.

At CK Physiotherapy, we've helped thousands of patients across Hanwell, Ealing, and West London to reduce their arthritis pain, improve their mobility, and reclaim activities they thought were lost. This comprehensive guide explains exactly how physiotherapy works for arthritis, what the latest research shows, and how you can take the first step towards better joint health.

Key Facts at a Glance

Understanding Arthritis: A Growing Health Concern

Arthritis is not a single disease but an umbrella term covering over 100 conditions that cause pain and inflammation in the joints. In the UK, around a third of the population – more than 20 million people – live with a musculoskeletal condition, with arthritis affecting approximately one in six adults. This prevalence is expected to rise to one in five by 2050 as our population ages.

The two most common forms are osteoarthritis and rheumatoid arthritis, each requiring a different approach to treatment:

For a deeper understanding of how we treat osteoarthritis specifically, read our detailed guide on physiotherapy treatment of osteoarthritis patients.

Why NICE Recommends Physiotherapy First

In October 2022, the National Institute for Health and Care Excellence (NICE) published updated guidelines for osteoarthritis management (NG226) that place therapeutic exercise at the centre of treatment. The guideline states clearly:

"The core treatments for the condition are therapeutic exercise and weight management (if appropriate), along with information and support." — NICE Guideline NG226

This recommendation places physiotherapy ahead of medication – a significant shift that reflects the strength of evidence supporting exercise as the most effective intervention for arthritis management. NICE specifically recommends that medication should only be used alongside non-pharmacological treatments and therapeutic exercise, not as a replacement for them.

What the Research Shows

The evidence supporting physiotherapy for arthritis is substantial and continues to grow:

Cochrane Review 2024 (139 trials, 12,468 participants): Land-based exercise significantly reduced pain by 12 points on a 100-point scale immediately after treatment and improved physical function by 10 points. These effects were sustained at 2–6 months follow-up.

New England Journal of Medicine Trial 2020: Physical therapy produced better outcomes at one year than glucocorticoid (steroid) injections for knee osteoarthritis. Patients receiving physiotherapy scored 18.8 points better on function assessments (37.0 vs 55.8 on the WOMAC scale).

Network meta-analysis findings identified that different exercise types offer specific benefits: aerobic exercise is most effective for pain relief, yoga is most effective for stiffness, function, and quality of life, whilst resistance training shows strong overall effectiveness. The good news is that all exercise types are beneficial.

To explore our comprehensive approach to treatment, visit our physiotherapy treatment page.

"Will Exercise Damage My Joints?" – Addressing the Most Common Concern

This is perhaps the question we hear most often from patients with arthritis. Many people worry that moving their joints will accelerate damage or increase pain. The evidence consistently shows the opposite.

"Many people worry that exercise will increase their pain or damage their joints. However, regular exercise that keeps you active, builds up muscle and strengthens the joints usually helps to improve symptoms." — NHS

Your joints are designed to move. Inactivity actually weakens the muscles that support and protect your joints, leading to greater stress on the joint surfaces. Appropriate, guided exercise strengthens these supporting muscles, reducing load on the joint itself and improving shock absorption. At CK Physiotherapy, we create programmes tailored specifically to your condition, ensuring exercises are safe, effective, and gradually progressed as your strength and confidence improve.

How Physiotherapy Helps Different Types of Arthritis

Effective arthritis treatment requires an approach tailored to your specific condition. Our Chartered Physiotherapists assess your individual needs and create a personalised programme based on the type of arthritis you have, your current fitness level, and your goals.

For Osteoarthritis

Our physiotherapy programmes for osteoarthritis typically include:

• Strengthening exercises – Targeting muscles around affected joints (quadriceps for knee OA, hip abductors for hip OA) to provide better support and shock absorption
• Aerobic exercise – Walking, swimming, or cycling for 30–60 minutes daily to improve cardiovascular health and reduce inflammation
• Flexibility and range-of-motion exercises – Gentle stretches to maintain joint mobility and prevent stiffness
• Balance training – Particularly important for lower limb arthritis to reduce fall risk
• Manual therapy – Joint mobilisation and soft tissue techniques, always combined with exercise (as per NICE guidance)
• Heat therapy – Applied before exercise to improve tissue elasticity (typically 20 minutes, 2–3 times daily)

For Rheumatoid Arthritis

Rheumatoid arthritis requires a more nuanced approach that accounts for the fluctuating nature of the condition:

• During flare-ups: Gentle range-of-movement exercises only, avoiding strength training, with cold therapy for acute inflammation
• During remission: Gradual return to full exercise programme including strengthening and aerobic activity
• Joint protection strategies: Techniques to reduce stress on inflamed joints during daily activities
• Cervical spine precautions: Special care for neck exercises due to risk of atlanto-axial subluxation in RA

NICE guideline NG100 for rheumatoid arthritis specifically states that adults with RA should have access to specialist physiotherapy with periodic review to improve general fitness, encourage regular exercise, and learn exercises for enhancing joint flexibility and muscle strength.

For Ankylosing Spondylitis

As the Spondylitis Association states: "In no other type of arthritis is the role of exercise more important." For spinal arthritis, our programmes focus on spinal mobility, posture correction, chest expansion exercises, core strengthening, deep breathing exercises, and Pilates-based approaches (which research shows can improve function scores by up to 77.5%).

Learn more about our approach to mobility issues in our guide on physiotherapy for mobility issues in older people.

What to Expect from Physiotherapy at CK Physio

When you visit CK Physiotherapy for arthritis treatment, you're not receiving a one-size-fits-all programme. Our Chartered Physiotherapists take a holistic, personalised approach that considers your physical condition, lifestyle, and personal goals.

Self-Management Strategies That Work

While professional physiotherapy provides the foundation for arthritis management, what you do between sessions matters enormously. Here are evidence-based strategies that complement your treatment:

Exercise Recommendations

The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity activity per week. For arthritis, Versus Arthritis recommends starting with at least 30 minutes of exercise, five times per week, combining strengthening, stretching, aerobic, and balance exercises. The key is to start gently and build up gradually.

Weight Management

The impact of weight on arthritic joints is significant. Research shows that one pound of weight loss results in four pounds less pressure on your knees with every step you take. For some people, losing 10% of body weight can reduce arthritis pain by up to 50%. This doesn't mean extreme dieting – sustainable, gradual weight loss combined with exercise provides the best outcomes.

The Four Ps of Pacing

The Chartered Society of Physiotherapy recommends the "Four Ps" approach to managing daily activities with arthritis:

1. Problem-solving – Identify which activities cause the most fatigue or pain
2. Planning – Schedule demanding tasks for when your energy is highest
3. Prioritising – Save energy for activities you enjoy most
4. Pacing – Keep active without overdoing it, avoiding the "boom and bust" cycle

Looking After Your Mental Health

Living with chronic pain takes a toll on mental wellbeing. Research from the National Early Inflammatory Arthritis Audit shows that 42% of patients experience anxiety or depression within three months of diagnosis. The rates of depression and anxiety in people with arthritis are 2–10 times higher than the general population. It's important to acknowledge this and seek support if you're struggling – this is a normal response to a challenging condition, not a sign of weakness.

When to Seek Professional Help

Many people wait too long before seeking physiotherapy for arthritis, missing the opportunity for early intervention that can significantly slow disease progression and preserve joint function.

Signs You Should Book an Appointment

• Pain is getting worse rather than better despite self-management
• Pain persists beyond 6–8 weeks
• Pain interferes with daily activities or sleep
• You're finding it harder to move or stay active
• You've been newly diagnosed and want to learn management strategies
• You're looking to delay or avoid surgical intervention

The Benefits of Early Intervention

Research consistently shows that beginning physiotherapy early prevents additional stress from damaging your joints, reduces dependence on pain medications, may delay or help avoid surgery, and preserves joint function for longer. A 2020 trial published in the New England Journal of Medicine found physical therapy to be as effective as – or better than – steroid injections at one year.

A Note on Electrotherapy and TENS for Osteoarthritis

While CK Physiotherapy offers electrotherapy treatments for various conditions, it's important to note that NICE guideline NG226 does not recommend TENS, therapeutic ultrasound, interferential therapy, or laser therapy specifically for osteoarthritis management. This is based on a thorough review of scientific evidence that found insufficient proof of clinical benefit for these modalities in OA treatment.

However, these treatments may still be appropriate for other musculoskeletal conditions or for arthritis types other than OA. Your physiotherapist will discuss the most evidence-based treatment options for your specific situation.

Frequently Asked Questions About Physiotherapy for Arthritis

Ready to Take Control of Your Arthritis?

Our experienced Chartered Physiotherapists in Hanwell and Ealing are ready to help you reduce pain, improve mobility, and get back to doing what you love.

Or call us on 020 8566 4113

References and Further Reading

1. National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management [NICE Guideline NG226]. https://www.nice.org.uk/guidance/ng226
2. Versus Arthritis (2024). The State of Musculoskeletal Health 2024. https://versusarthritis.org/about-arthritis/data-and-statistics/the-state-of-musculoskeletal-health/
3. Cochrane Database of Systematic Reviews (2024). Exercise for knee osteoarthritis. https://www.cochrane.org/CD004376/CENTRALED_exercise-effective-therapy-treat-knee-osteoarthritis
4. Deyle GD, et al. (2020). Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1905877
5. NHS (2024). Osteoarthritis – Treatment. https://www.nhs.uk/conditions/osteoarthritis/treatment/
6. Chartered Society of Physiotherapy. Arthritis – Advice and exercises. https://www.csp.org.uk/conditions/arthritis
7. National Institute for Health and Care Excellence (2018). Rheumatoid arthritis in adults: management [NICE Guideline NG100]. https://www.nice.org.uk/guidance/ng100

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