Knee osteoarthritis rehabilitation: an integrated framework of exercise, nutrition, biomechanics, and physical therapist guidance-a narrative review

Abstract

Knee osteoarthritis (KOA) is a prevalent, debilitating chronic joint disease characterized by pain, stiffness, and functional limitations. Non-pharmacological rehabilitation is a fundamental management strategy. This narrative review synthesizes evidence on an integrated KOA rehabilitation framework, including: exercise therapy (aerobic, resistance, neuromuscular training), which reduces pain and improves function through enhanced muscle activation and joint stability; dietary interventions (weight management and anti-inflammatory diets), which lower mechanical load and systemic inflammation; biomechanical optimization (bracing, gait retraining), aimed at reducing joint stress; and physical therapist-guided strategies (individualized exercises, manual therapy, patient education) addressing pain and functional restoration. While these core components demonstrate synergistic potential and highlight the need for personalized approaches, the review notes suboptimal adherence to guideline-recommended therapies in clinical practice. Additionally, supplementary treatments such as manual therapy and acupuncture, although commonly used, lack strong evidence, characterized by low-quality Randomized controlled trials, insufficient sample sizes, and inconsistent findings. This situation warrants further robust research. Future studies should focus on personalized approaches that utilize machine learning, mobile health tools for real-time gait analysis, and novel biotechnologies to address the remaining challenges. This review aims to provide clinicians and researchers with a practical guide to optimize KOA rehabilitation, enhancing patient care and quality of life.

Keywords: Biomechanics; Exercise; Knee osteoarthritis; Nutrition; Rehabilitation.

Fig. 1

Flow chart for research screening

Fig. 2

Rehabilitation Intervention Strategies Targeting Modifiable Risk Factors in Knee Osteoarthritis

Fig. 3

Diverse Types of Exercise Therapies for KOA

Fig. 4

Intervention Measures from KOA Biomechanics to Gait Retraining for KOA