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MSK Pain – Reduces pain

Reduces pain

Evidence summary

A large body of good quality randomised controlled trial data shows consistent reduction in pain due to osteoarthritis, with benefits reported in strengthening, weight-bearing and aerobic exercise [1–7]. This benefit is comparable with other treatment modalities, including many oral and topical analgesics [6]. Effect size diminishes with time from structured physical activity intervention with no sustained benefit seen >6 months after a 3 month intervention in 5222 participants reported in a good quality meta-analysis of 54 RCTs suggesting physical activity needs to be sustained to maintain effect [2]. Strengthening exercises alone have been shown to have the greatest effect on pain, although a combination of strengthening, aerobic and flexibility exercises is advised due to this combination still adequately improving pain and having a greater effect on function and general health [7]. A systematic review looking at the safety of physical activity interventions in those with knee osteoarthritis found that no studies reported an increase in pain in the physical activity group versus controls [8].

Quality of evidence

High quality

Strength of recommendation



Physical activity can be recommended for the treatment of pain to most people with osteoarthritis in most circumstances and should be undertaken unless there are compelling reasons to do otherwise.


1         Tanaka R, Ozawa J, Kito N, et al.Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil2013;27:1059–71. doi:10.1177/0269215513488898

2         Fransen M, McConnell S, Harmer AR, et al.Exercise for osteoarthritis of the knee: A Cochrane systematic review. Br J Sports Med2015;49:1554–7. doi:10.1136/bjsports-2015-095424

3         Hall J, Swinkels A, Briddon J, et al.Does Aquatic Exercise Relieve Pain in Adults With Neurologic or Musculoskeletal Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil2008;89:873–83. doi:10.1016/j.apmr.2007.09.054

4         O’Keeffe M, Hayes A, McCreesh K, et al.Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Br J Sports Med2017;51:126–32. doi:10.1136/bjsports-2015-095410

5         Anwer S, Alghadir A, Brismée J-M. Effect of Home Exercise Program in Patients With Knee Osteoarthritis. J Geriatr Phys Ther2016;39:38–48. doi:10.1519/JPT.0000000000000045

6         Babatunde OO, Jordan JL, Van Der Windt DA, et al.Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One2017;12:1–30. doi:10.1371/journal.pone.0178621

7         Uthman OA, van der Windt DA, Jordan JL, et al.Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. Bmj2013;347:f5555–f5555. doi:10.1136/bmj.f5555

8         Quicke JG, Foster NE, Thomas MJ, et al.Is long-term physical activity safe for older adults with knee pain?: A systematic review. Osteoarthr Cartil2015;23:1445–56. doi:10.1016/j.joca.2015.05.002