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Knee Therapy: What the Non-Surgical Options Involve

Knee therapy is the conservative ground between accepting a knee problem and having something done to it, and for many knee conditions that ground is where most of the improvement happens. Cartilage wear, ligament strain, meniscal change and kneecap tracking problems commonly respond to graded loading before any invasive option becomes necessary.

The program usually involves less knee work than expected. Hip strength, ankle movement and the way the leg is loaded on stairs all change what the knee absorbs, so the exercises often sit above and below the joint. Progress is measured rather than assumed: range, strength against the other side, and stairs or walking distance.

The non-surgical options are physiotherapy, exercise-based rehabilitation, gentle joint mobilization with gentle chiropractic care, and laser or shockwave therapy when the findings call for them. Which of them a knee therapy plan uses depends on the structure involved, so the plan starts by finding it.

This guide to knee therapy, what the non-surgical options involve and what repeated steroid injections do to a knee, is published by Chiropractic Specialty Center, Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Knee Therapy: Key Takeaways

PointWhat to know
Where knee therapy startsWith the structure producing the symptoms (cartilage, meniscus, ligament, tendon, bursa or joint lining) and with what is overloading it from the hip, the foot or the way the leg is used.
What a program involvesGraded strengthening of the knee and the muscles above and below it, gentle joint mobilization, and laser or shockwave therapy when the findings call for them, with progress measured in range, strength, stairs and walking distance.
ExerciseIn a Cochrane review of 54 trials, land-based exercise reduced knee osteoarthritis pain and improved quality of life, with a moderate effect at the end of treatment and a smaller one two to six months later (Fransen et al., 2015).
Weight and the kneeFor overweight older adults with knee osteoarthritis, an 18-month trial found that diet-induced weight loss combined with exercise eased pain and improved function more than either exercise or diet alone (Messier et al., 2013).
Repeated steroid injectionsIn a two-year trial, injections every three months led to more cartilage loss than saline and no significant difference in knee pain (McAlindon et al., 2017).
Arthroscopy for a worn meniscusFor a degenerative meniscal tear in a knee without osteoarthritis, partial meniscectomy did no better than sham surgery at 12 months (Sihvonen et al., 2013).
ImagingAn X-ray shows bone, joint space and alignment; an MRI shows cartilage, menisci, ligaments and tendons. Either is added when its result will change the plan.
Knee Therapy: Page Guide & Key Sections

Can Knee Therapy Help Avoid Surgery?

For most knee problems, knee therapy is the first step and surgery is weighed later. Cartilage wear, early osteoarthritis, a worn meniscus, ligament strain and tendon pain are usually managed without an operation at the start, and surgery is considered when careful conservative care has not helped enough, the knee keeps getting worse, or the examination shows damage that therapy cannot address.

The research on worn knees supports that order. A Cochrane review of 54 trials found that land-based therapeutic exercise reduced knee pain and improved quality of life for people with knee osteoarthritis (Fransen et al., 2015). The trials of repeated steroid injections and of keyhole surgery for worn knees, described below, give little reason to start with either.

Exercise is also the option that asks the most of the person, because the work is done by the person rather than to the knee. The clinician's part is to make that work specific: identify which structure is producing the symptoms, correct what is overloading it, and set loading that can actually be completed. The warm-up, wall squats and machine work involved are shown in the knee pain causes and exercises video. A knee that is locked or acutely swollen after an injury is examined before any loading is set.

Knee Therapy Before Keyhole Surgery: What the New England Journal of Medicine Reported

Two reports in the New England Journal of Medicine, from one Finnish trial, are the clearest test of whether a common keyhole operation adds anything to the knee therapy that follows it.

One Difference Between the Groups (2013)

The 146 adults in the trial, aged 35 to 65, had a worn medial meniscus, no knee arthritis and pain that had lasted more than three months despite conventional conservative treatment. In the operating room, 70 had the meniscus trimmed and 76 had a sham procedure that only imitated it. Afterward, everyone received the same walking aids and the same graduated exercise program, so the trimming was the only difference between the groups, and at 12 months it had made none (Sihvonen et al., N Engl J Med. 2013;369(26):2515-2524; free PDF from NEJM).

Ten Years On (2026)

At ten years, with 91% of the patients still followed, the trimmed knees scored worse on a meniscus questionnaire, arthritis had progressed on X-ray in 81% of them against 70% of the sham group, and 8 trimmed patients against 3 sham patients had needed a knee replacement or a realignment operation on the shinbone (Kalske et al., N Engl J Med. 2026;394(17):1757-1759; free authors’ copy).

Outside trials, English hospital records show that 13.5% of people who had a meniscus trimmed went on to a knee replacement within 15 years, with the operated knee replaced three times as often as the other knee (Abram et al., 2019). A review of 20 studies of keyhole surgery for arthritic knees found a rate of about 2.5% a year (Winter et al., 2017), and the full review can be downloaded as a PDF.

For anyone choosing between knee therapy and a keyhole operation, these are the results to weigh. In CSC’s view, a proper course of therapy from a provider thoroughly familiar with knee physiotherapy, knee chiropractic care, knee rehabilitation and knee exercise comes first, and an operation is considered only if that care has not helped.

Arranging a Knee Therapy Assessment in KL

Knee pain can come from the joint itself, from the tissues around it, or from the hip, the lower back or the foot, so the first visit sorts these apart. It covers a detailed history; how the knee moves, swells and takes weight; tests of its ligaments and menisci; the strength of the thigh and hip muscles; and the hip, ankle and foot, which change how load reaches the knee. Any X-ray or MRI is read against those findings before care options are discussed. Either Kuala Lumpur center can arrange it:

What Repeated Steroid Injections Do to a Knee

A cortisone injection is often offered as a way to buy time. It is worth knowing what a well-designed two-year trial of that approach found before a third or fourth one is accepted.

In a randomized clinical trial, 140 people with painful knee osteoarthritis and signs of joint-lining inflammation on ultrasound received either triamcinolone or saline into the knee every three months for two years. The steroid group lost significantly more cartilage thickness in the index compartment, a between-group difference of 0.11 mm, and there was no significant difference between the groups in knee pain (McAlindon et al., 2017).

Read plainly: over two years, the injections did not relieve pain more than salt water did, and the knees that received them lost more cartilage. One injection for a flare is a different question from a standing quarterly appointment, and this trial is about the latter.

Reports of harm have gathered as well. A 2019 review in Radiology described four adverse joint findings seen after corticosteroid injections into the hip and knee: faster progression of osteoarthritis, a stress fracture of the bone just beneath the cartilage (subchondral insufficiency fracture), complications of osteonecrosis, and rapid joint destruction with bone loss. How often these occur has not been well studied, and the authors called for urgent research into who is at risk (Kompel et al., 2019).

Knee Therapy Options: Invasive and Non-Invasive Care

Knee care falls into two groups. Invasive care means injections into the joint and surgery. Non-invasive care covers physiotherapy, gentle chiropractic care, exercise rehabilitation, braces and home care, with medication prescribed by a doctor where it is needed. The treatment methods used at CSC are all non-invasive, and how the right option is decided for a particular knee is covered in the guide to knee pain treatment.

Knee Injections

Injections offered for knee osteoarthritis include corticosteroid (cortisone), hyaluronic acid, platelet-rich plasma (PRP) and stem cell preparations. The trial and the review described above concern corticosteroids. Anyone weighing an injection can ask the doctor offering it what the evidence shows for that type of injection and how many are planned.

Knee Surgery

The three main operations are arthroscopy (keyhole surgery), osteotomy, which realigns the bone, and total knee replacement. For a degenerative tear of the medial meniscus in a knee without osteoarthritis, a sham-controlled trial of 146 patients aged 35 to 65 found no significant difference between arthroscopic partial meniscectomy and sham surgery 12 months later, and at ten years the trimmed knees showed signs of more arthritis and more later operations (Sihvonen et al., 2013; Kalske et al., 2026). A 2017 clinical practice guideline in the BMJ made a strong recommendation against arthroscopy in nearly all patients with degenerative knee disease (Siemieniuk et al., 2017).

Osteotomy and knee replacement are discussed for advanced osteoarthritis only when careful conservative care has not helped enough. In CSC’s view, knee replacement is a last resort, generally not before a person is near 70 years of age, and the decision belongs with an orthopedic surgeon, after an examination and imaging.

Video: Knee Pain Causes and Exercises

Knee symptoms often come from how load reaches the knee as much as from the knee itself: the hip, pelvis, ankle and foot all change it, alongside cartilage wear and stress on the menisci. The video below explains how the knee works as a weight-transfer joint, when an X-ray or an MRI may help, and the warm-up, wall squat, thigh and gym exercises used for knee strengthening.

Key moments and an edited transcript of this video are on our Knee Pain Causes and Exercises video page.

Key Moments in the Knee Pain Causes and Exercises Video

  • 00:00 Knee Pain Causes: Why Knee Problems Happen During Walking, Stairs, or Turning in Bed
  • 00:40 Knee Pain and Weight Transfer: How the Hip, Pelvis, Ankle, and Foot Affect the Knee
  • 01:52 Knee Cartilage and Meniscus: Why Shock Absorption Matters
  • 03:05 Knee Degeneration and Alignment: How Uneven Loading Affects the Joint
  • 04:47 Knee Stiffness and Uneven Weight Bearing: Signs That Movement Has Changed
  • 05:40 Knee X-Ray vs MRI: When Alignment, Cartilage, or Meniscus Imaging May Be Needed
  • 06:45 Conservative Knee Care: Why Assessment Should Guide the Next Step
  • 07:55 Knee Warm-Up Exercises: Simple Ankle and Foot Movements Before Strengthening
  • 08:58 Knee Range of Motion and Tubing Exercises for Hip and Thigh Control
  • 10:12 Wall Squats for Knee Pain: Correct Form and Safer Knee Position
  • 11:49 Inner and Outer Thigh Exercises for Knee, Hip, and Lower-Back Control
  • 14:09 Knee Strengthening With Gym Machines: Bike, Elliptical, and Circuit Options
  • 15:40 Quadriceps and Hamstring Exercises: Why Both Sides Matter
  • 16:51 Leg Press, Adductor, and Abductor Machine Tips for Knee Strengthening

How the Knee Works: Bones, Ligaments, Tendons, Cartilage and Bursae

The knee bears the body's weight and lets the leg bend and straighten. It does this through bones, ligaments, tendons and muscles, a layer of cartilage, two menisci and a set of fluid-filled bursae, and a problem in any one of them can produce knee pain. Wear and tear, injury and some general health conditions all play a part.

Bones of the Knee

Front view of a normal knee labeled with the quadriceps muscle and its tendon, the kneecap (patella), thighbone (femur), articular cartilage, anterior cruciate ligament (ACL), meniscus, shinbone (tibia) and fibula

The thighbone (femur) and the shinbone (tibia) carry the body's weight through the knee. The kneecap (patella), the largest sesamoid bone in the body, sits within the quadriceps tendon and improves the thigh muscles' leverage as the knee straightens. The fibula, the slender bone on the outer side of the lower leg, is not part of the knee joint itself, but its head, just below the outer knee, anchors the lateral collateral ligament and the biceps femoris, one of the hamstrings. Because the femur also forms the hip joint, hip problems can be felt in the knee, so the hip is part of a knee assessment.

Ligaments of the Knee

  • Medial collateral ligament (MCL)
  • Lateral collateral ligament (LCL)
  • Anterior cruciate ligament (ACL)
  • Posterior cruciate ligament (PCL)

The medial and lateral collateral ligaments, on the inner and outer sides of the knee, give side-to-side stability. The anterior and posterior cruciate ligaments, inside the joint, control front-to-back movement and help steady the knee as it turns. Many collateral ligament sprains settle with conservative care. A torn cruciate ligament calls for a careful assessment of how stable the knee is and what the person needs it to do before rehabilitation or surgery is chosen; the guides to ACL injury and PCL injury cover each in detail.

Tendons of the Knee

The quadriceps tendon joins the thigh muscles to the top of the kneecap, and the patellar tendon runs from the bottom of the kneecap to the shinbone; because it joins bone to bone, it is also called the patellar ligament. The hamstring tendons cross the back of the knee. Tendon pain, often called tendonitis, usually builds up as an overuse knee injury and is managed with graded strengthening, with laser or shockwave therapy added when the findings call for them.

Knee Cartilage

Articular cartilage is the smooth, firm layer that covers the ends of the thighbone and shinbone and the back of the kneecap, so the joint surfaces glide with little friction. Cartilage has no nerve supply of its own, so wear in it is not felt directly; pain in a worn knee comes from the bone beneath the cartilage, the joint lining and the tissues around the joint. Abnormal loading and injury speed up cartilage wear, which is why knee therapy pays as much attention to how load reaches the knee as to the knee itself.

Menisci of the Knee

Meniscus anatomy: a front view of the knee showing the meniscus between the thighbone and shinbone, and a top view of the shinbone showing the C-shaped lateral and medial menisci

The two menisci, medial and lateral, are C-shaped pads of fibrocartilage between the thighbone and the shinbone. Their upper surfaces are cupped to seat the rounded ends of the thighbone, and together they spread load and help steady the joint. The outer part of each meniscus has a blood supply and the inner part largely does not, which is one reason tears in the outer part are more likely to heal. Degenerative meniscal tears in middle-aged knees are usually managed without surgery first; the trial described above found partial meniscectomy no better than sham surgery for this kind of tear (Sihvonen et al., 2013).

Bursae of the Knee

Front view of the knee showing the suprapatellar, prepatellar, infrapatellar and subsartorial bursae, healthy on the left and, after an injury, an inflamed suprapatellar bursa (bursitis) on the right

A bursa is a small fluid-filled sac that lets skin, tendons and ligaments glide over bone, and several lie around the knee. Those most often involved in knee pain are the prepatellar bursa in front of the kneecap, the infrapatellar bursae below it, the suprapatellar bursa above it, the pes anserine bursa on the inner side just below the joint line, and, behind the knee, the gastrocnemius-semimembranosus bursa, which forms a Baker's cyst when it fills with joint fluid.

Bursitis after a minor knock often settles on its own. Swelling that persists is examined to find what keeps irritating the bursa, such as repeated kneeling, a nearby tendon problem, or, in the case of a Baker's cyst, fluid from inside the knee joint.

How Knee Therapy Is Organized at CSC

A clinician holding a patient's bent knee during a hands-on knee examination

Care starts once the source of the pain has been identified. The muscles, ligaments, menisci and joints of the knee are examined for weakness and faulty movement, the hip, ankle and foot are checked, and an X-ray or MRI is added when its result will change the plan.

Physiotherapists and chiropractors then work together. Where the kneecap, the thighbone on the shinbone or the top of the fibula sits out of alignment, it is corrected with gentle Activator adjustments, never forceful or aggressive manipulation, and graded strengthening of the knee and the muscles above and below it runs alongside, with therapy devices such as laser or shockwave when the findings call for them. Exercise begins at a level the knee can complete and builds from there. Care is not meant to hurt, and any discomfort during a session is reported so the plan can be adjusted.

Knee care at CSC follows one principle: increase what benefits the knee and decrease what harms it. Getting there takes an accurate diagnosis, a proper plan, execution with no flaws or as few as possible, and changes to posture, habits and daily activity, so the knee is loaded in a way it can handle.

When a knee needs an opinion that CSC is not the right place to give, such as a suspected fracture or infection, a knee that stays locked, or instability that rehabilitation is not controlling, CSC says so plainly and the person is referred on. A knee that is hot, red and swollen with fever, a knee that cannot bear weight after an injury, or a swollen, tender calf needs a medical assessment the same day; short of these, most knee symptoms can be assessed calmly, and conservative care can be a reasonable route for as long as it keeps producing results.

Fees are listed on the chiropractic price in Kuala Lumpur and physiotherapy fees in Kuala Lumpur pages.

Every knee guide on this site, grouped by topic:

Frequently Asked Questions About Knee Therapy

Can knee therapy be tried before injections or surgery?

In many knee conditions, yes. A structured non-surgical program is usually the first step for cartilage wear, early osteoarthritis, meniscus changes, ligament strain and tendon pain, and it stays the first step for a degenerative meniscal tear, where a sham-controlled trial found partial meniscectomy no better than sham surgery (Sihvonen et al., 2013). The exceptions are the situations where the examination points to a problem that needs a doctor first, such as a suspected fracture or infection. The plan follows what the examination and any imaging show, and progress is measured so it can change early if the knee is not responding.

What decides how well knee therapy works?

Mainly how accurately the source of the symptoms is identified and how well the plan fits it. Knee pain may come from cartilage wear, a meniscus problem, a ligament strain, a tendon, a bursa, stiffness, muscle weakness or the way the hip and foot load the knee, and each needs different work. After that, it depends on whether the exercises are done consistently and whether the daily habits that keep overloading the knee change too. The person's age, activity level and goals shape the plan as well, which is why two people with the same diagnosis may follow different programs.

Can therapy help knee arthritis?

Exercise has been studied extensively for knee osteoarthritis. A Cochrane review of 54 trials found that land-based exercise reduced knee pain and improved quality of life; the benefit was moderate when treatment ended and smaller, though still present, two to six months later (Fransen et al., 2015). For people who are overweight, an 18-month trial found that diet-induced weight loss combined with exercise eased pain and improved function more than either exercise alone or diet alone (Messier et al., 2013). At CSC, exercise is combined with gentle joint mobilization and, when the findings call for them, laser or shockwave therapy.

When should an MRI or X-ray be considered?

An X-ray shows the bones, the joint space and alignment, so it is used to look at arthritis and at how the knee is lined up. An MRI shows the soft tissues: cartilage, menisci, ligaments and tendons. Imaging is considered when symptoms persist, when the knee is unstable or locks, after a significant injury, or when the source of the problem is unclear from the examination. Its result is read together with the examination rather than on its own, and it is added when it will change the plan.

When is surgery usually considered?

Surgery may be discussed when there is significant structural damage, a knee that keeps giving way despite good rehabilitation, a knee that stays locked, or advanced osteoarthritis that a proper course of conservative care has not helped. For worn knees, a 2017 guideline made a strong recommendation against arthroscopy in nearly all patients with degenerative knee disease (Siemieniuk et al., 2017), and in CSC’s view knee replacement is a last resort, generally not before a person is near 70. That decision belongs with an orthopedic surgeon after an examination and imaging.

Can meniscus or ligament problems improve without surgery?

Often, depending on the type and location of the damage. Degenerative meniscal tears in middle-aged knees are usually managed without surgery first, and tears in the outer part of a meniscus, which has a blood supply, are more likely to heal than tears in the inner part. Many collateral ligament sprains settle with conservative care. A torn cruciate ligament needs a careful assessment of the knee's stability and the person's activities before rehabilitation or surgery is chosen. In each case, targeted strengthening, stability work and movement correction are the core of non-surgical care.

This guide describes knee problems and knee therapy in general. It cannot assess any one person's knee; that takes a history and an examination.

References

  1. Abram SGF, Judge A, Beard DJ, Carr AJ, Price AJ. Long-term rates of knee arthroplasty in a cohort of 834 393 patients with a history of arthroscopic partial meniscectomy. Bone Joint J. 2019;101-B(9):1071-1080.
  2. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1(1):CD004376.
  3. Kalske R, Sihvonen R, Paavola M, et al. Arthroscopic partial meniscectomy for degenerative tear: 10-year outcomes. N Engl J Med. 2026;394(17):1757-1759.
  4. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 2019;293(3):656-663.
  5. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975.
  6. Messier SP, Mihalko SL, Legault C, et al. 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. 2013;310(12):1263-1273.
  7. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017;357:j1982.
  8. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-2524.
  9. Winter AR, Collins JE, Katz JN. The likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic review. BMC Musculoskelet Disord. 2017;18(1):408.

These references describe the knee, knee osteoarthritis, knee surgery and their care in general. None of them evaluates care at Chiropractic Specialty Center.

The Author of Knee Therapy in KL: Before Surgery or Injections

Knee Therapy in KL: Before Surgery or Injections was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.

Last Updated: Knee Therapy: What the Non-Surgical Options Involve

Knee Therapy: What the Non-Surgical Options Involve was last reviewed and updated on October 5, 2026.

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