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If knee arthritis makes walking painful, start with a clinician-guided plan that combines tailored exercise, practical mobility support and appropriate pain relief. A cane can improve safety and confidence, while a topical anti-inflammatory gel is the usual first medicine option for knee osteoarthritis. Arrange prompt medical assessment for a hot, swollen knee, rapid deterioration, recent injury or other unusual symptoms.
First, decide whether this is routine arthritis pain or something that needs urgent assessment
Osteoarthritis commonly causes knee pain, stiffness and reduced function. Walking may become harder, and hills or stairs can be particularly demanding. However, not every painful or swollen knee is ordinary osteoarthritis. An article cannot diagnose the cause, so use the pattern of symptoms to decide how quickly to seek help.
Arrange prompt clinical assessment for atypical symptoms
- A hot, markedly swollen or red knee, especially with fever or feeling unwell, can indicate infection or another inflammatory problem.
- Rapidly worsening pain, rapidly increasing deformity or a sudden major loss of function needs assessment rather than a self-directed exercise increase.
- Recent trauma, such as a fall or twist, may have caused an injury in addition to arthritis.
- Prolonged morning joint-related stiffness or symptoms raising concern about another serious condition should be reviewed by a clinician.
These features are among the atypical presentations identified in NICE guidance. Seek urgent local medical advice for a hot, swollen joint or severe, rapidly changing symptoms.
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Build treatment around therapeutic exercise
NICE recommends offering every person with osteoarthritis therapeutic exercise tailored to their needs, including local muscle strengthening and general aerobic fitness. Exercise is not an optional extra: it is a core treatment intended to improve pain, physical function and quality of life.
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What tailored exercise means
A physiotherapist or other suitably trained clinician can adjust the type, amount and progression of movement to your strength, balance, pain and daily goals. A plan might combine strengthening around the thigh and hip with low-impact aerobic activity, but the exact exercises should match your assessment rather than a generic online routine.
Pain can increase when therapeutic exercise begins. That does not automatically mean the exercise is damaging the joint, but severe pain, rapidly increasing pain, substantial swelling or a continuing decline in walking ability is a reason to reduce the load and obtain professional advice. Consistent participation over time is more useful than occasional, exhausting sessions.
When supervised sessions make sense
NICE says supervised exercise sessions may be considered. Supervision is particularly useful if you are unsure how to move safely, have been inactive, lack confidence, or cannot progress without feedback. NHS guidance also describes physiotherapists and occupational therapists as sources of specialist help with mobility and equipment.
Keep everyday movement manageable
- Break longer walks into shorter trips and rest before pain forces you to stop.
- Use flatter routes while you build strength, and plan for stairs or hills rather than treating them as a test of willpower.
- Change position regularly instead of remaining seated or standing for long periods.
- Record which activities trigger pain, how long symptoms last afterwards and what helps. This gives your clinician useful information for adjusting the plan.
Consider weight management when overweight or obese
For people with osteoarthritis who are living with overweight or obesity, NICE says weight loss can reduce pain and improve physical function and quality of life. Any amount of weight loss may help; the guideline says losing 10% of body weight is likely to provide more benefit than losing 5%. This is an additional treatment option, not a universal requirement or a reason to delay care until a particular weight is reached.
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Choose a sustainable approach that supports adequate nutrition and allows you to keep moving. A clinician or dietitian can help set a realistic target, particularly if other health conditions or medicines affect weight.
Use a cane or stick safely when walking is difficult
NICE recommends considering walking aids, including sticks, for people with lower-limb osteoarthritis. A cane can provide a point of support, improve balance and make walking feel more secure. It is not a cure and should not be expected to remove all pain.
Which side should hold the cane?
NHS guidance advises holding a cane on the side opposite the affected leg. If the right knee hurts, hold the cane in the left hand; if the left knee hurts, hold it in the right hand. When both knees hurt, a physiotherapist or occupational therapist can help decide whether a cane, another aid or a different technique is appropriate.
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The handle should allow a comfortable grip, and the height should let you stand upright with a slight bend in the elbow rather than leaning heavily over the stick. A therapist can check height, gait and whether the rubber tip is secure. Practice on a clear, level surface before using the cane outdoors, then learn how to manage kerbs, stairs and uneven ground.
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Evidence for canes is limited. NICE’s evidence review describes one study in which a T-shaped cane, compared with no device, produced a clinically important improvement in pain and health-related quality of life at less than three months. That single study does not establish a guaranteed amount of relief for every person, so judge the aid by safer, more functional walking and seek a fitting review if it makes you lean, trip or hurt elsewhere.
| Option | When it may help | Important limitation |
|---|---|---|
| No walking aid | If you can walk safely with manageable symptoms and good balance. | Continuing without support may increase fear of movement or instability when a device would improve confidence. |
| Cane or stick | For additional balance, confidence and load sharing during walking. | Needs correct side, height and technique; individual benefit varies. |
| Physiotherapy or occupational-therapy assessment | When you are unsure which aid to use, how to fit it or how to negotiate stairs and uneven ground. | Requires an appointment and an individualized assessment. |
Do not buy braces, insoles or supports automatically
NICE does not recommend routinely offering insoles, braces, tape, splints or other supports for knee osteoarthritis. They may be considered when there is joint instability or abnormal biomechanical loading, exercise is ineffective or unsuitable without the device, and the device is likely to improve movement and function.
These products can cause problems such as blisters, pressure damage or altered loading elsewhere. A clinician should identify a specific reason for using one and check that it actually improves walking. An expensive support is not a substitute for an exercise plan or a mobility assessment.
Choose pain relief with a clinician or pharmacist
Topical NSAID: the usual first medicine option
NICE recommends offering a topical non-steroidal anti-inflammatory drug (NSAID) to people with knee osteoarthritis. A topical preparation is applied to the painful area, but it is still a medicine: follow the product instructions and ask a pharmacist or clinician whether it is suitable for you.
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Oral NSAID: consider risks before use
If a topical NSAID is ineffective or unsuitable, an oral NSAID may be considered. The decision should account for gastrointestinal, kidney, liver and cardiovascular toxicity, other medicines and your personal risk factors. NICE recommends gastroprotective treatment, such as a proton-pump inhibitor, while a person with osteoarthritis is taking an NSAID. Use the lowest effective dose for the shortest possible time and do not combine products without professional advice.
Paracetamol and weak opioids are not routine choices
NICE advises against routinely offering paracetamol or weak opioids for osteoarthritis. They may be considered for infrequent, short-term pain relief only when other pharmacological treatments are contraindicated, not tolerated or ineffective. The guideline notes there is no strong evidence of benefit for paracetamol. Medication should support, not replace, exercise and other non-drug care.
| Medicine approach | Place in care | Safety point |
|---|---|---|
| Topical NSAID | NICE-recommended first medicine option for knee osteoarthritis. | Check suitability and use as directed. |
| Oral NSAID | Consider if topical treatment is unsuitable or ineffective. | Review gastrointestinal, kidney, liver and cardiovascular risks; gastroprotection is recommended during use. |
| Paracetamol or weak opioid | Not routine treatment; only infrequent, short-term use in restricted circumstances. | Requires professional advice when other options cannot be used or have failed. |
Know when self-management has not been enough
Arrange a review if pain continues to limit walking, sleep, work, self-care or activities that matter to you despite a properly followed exercise and pain-management plan. Explain the practical impact, not just a pain score: how far you can walk, whether you can use stairs, and whether you need support to leave home.
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Repair common Windows errors and clear accumulated junk for a smoother, more stable PC - no reinstall needed.Free scan · no reinstallNICE says to consider referral for joint-replacement assessment when osteoarthritis symptoms substantially affect quality of life and non-surgical management—such as exercise, weight management or pain relief—is ineffective or unsuitable. Referral should be based on clinical assessment. NICE says people should not be excluded solely because of age, sex or gender, smoking, other medical conditions, or overweight or obesity measured by body-mass index.
A referral for assessment is not a promise that surgery will be required. It is a way to discuss whether the severity of symptoms, examination findings and previous treatment make replacement a reasonable option.
Use digital support cautiously
NICE’s early value assessment, published 22 January 2026, allows eight named digital technologies to be used in the NHS during an evidence-generation period for adults with mild to moderate hip or knee osteoarthritis symptoms, subject to evidence-generation and regulatory conditions. This is not blanket endorsement, does not establish availability in every country or health system, and does not replace a clinical assessment. If you are offered a digital programme, confirm who supervises it, how your progress is reviewed, what happens if symptoms worsen and whether it is available through your local service.
Quick Recap
A practical plan for the next seven days
- Check for warning signs. If the knee is hot and swollen, symptoms are rapidly worsening, there was recent trauma or another atypical feature is present, contact a clinician promptly instead of increasing activity.
- Book appropriate support. Arrange a primary-care, physiotherapy or occupational-therapy review if walking is becoming unsafe, if you need a cane fitted, or if you cannot progress exercise confidently.
- Start with tolerable movement. Follow a tailored strengthening and aerobic plan. Expect possible short-lived discomfort at first, but stop and seek advice for severe or rapidly worsening symptoms.
- Trial mobility support. If advised, use a correctly fitted cane on the side opposite the painful leg and practise on level ground before stairs or uneven surfaces.
- Review medicines safely. Ask a pharmacist or clinician about a topical NSAID and disclose ulcers, kidney or liver disease, cardiovascular disease, pregnancy, allergies and other medicines before considering an oral NSAID.
- Reassess function. After a reasonable period of consistent care, note whether walking distance, stairs, sleep and daily activities are improving. Persistent major limitation warrants a treatment review and possible referral discussion.
Questions to take to your appointment
- Is osteoarthritis the most likely explanation, or do my symptoms need another investigation?
- Which strengthening and aerobic exercises fit my current walking ability?
- Would a cane or another aid improve my balance, and can you check the fit?
- Is a topical NSAID suitable with my medical history and current medicines?
- If non-surgical care is not improving my quality of life, when should we discuss specialist or joint-replacement assessment?
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