Osteoarthritis is the most common joint condition in the world, and it's surrounded by two unhelpful messages. One says there's nothing to be done, just painkillers and patience until a joint replacement. The other, from the supplement and gadget ads, says the right cream, magnet, or injection will regrow your cartilage. Both are wrong. The truth is more useful: there's a clear hierarchy of things that genuinely help osteoarthritis pain, and knowing the order saves you money and disappointment.
What osteoarthritis actually is
Osteoarthritis is the gradual thinning and roughening of the cartilage that caps the ends of bones in a joint, along with changes to the bone and soft tissue around it. It shows up most in knees, hips, hands, and the spine, and it produces a familiar pattern: stiffness after rest that eases with movement, pain that worsens with heavy use, and a joint that grumbles on stairs or first thing in the morning. The key fact for every treatment decision is that it's a structural change. That single truth is what separates the treatments that work from the ones that oversell.
The hierarchy of what helps
Here's the honest order, strongest first.
- Exercise and strengthening. The single most effective thing for most osteoarthritis. Strong muscles around a joint offload it and control it — for a knee, that means the quadriceps; for a hip, the glutes. This is recommended first in every guideline.
- Weight management. For weight-bearing joints, reducing load meaningfully reduces pain and slows progression. Even modest loss helps.
- A plan for flares — activity pacing, sensible use of pain relief when needed, and staying active rather than resting into stiffness.
Everything else — including the devices we offer — sits below these, as support. That's not false modesty; it's what the evidence says, and any clinic that leads with a gadget instead of movement has the order backwards.
Where shockwave fits
This is the more encouraging recent development. For knee osteoarthritis specifically, a run of 2023–2024 systematic reviews and meta-analyses found that extracorporeal shockwave therapy improves pain and physical function compared with control.1,2 That's a stronger and more consistent signal than PEMF has for the same joint, and it's why shockwave has moved from "worth a look" toward "reasonable adjunct" in knee osteoarthritis. The honest caveats still apply: it treats the symptoms and the surrounding tissue, not the cartilage loss itself, and the evidence for hips and other joints is thinner.
Where PEMF fits
PEMF (pulsed electromagnetic field therapy) has more modest evidence in knee osteoarthritis, most reliable for physical function and less certain for pain, from small trials of variable quality.3 It's a low-risk adjunct that can make a joint more comfortable to move. We go into the detail in our guide to PEMF for joint pain. In practice we often pair the two — shockwave for the more forceful effect, PEMF to support recovery — but always underneath the exercise plan, never instead of it.
What no therapy can do
It's worth being blunt, because this is where money gets wasted. Nothing available short of surgery reverses osteoarthritis or grows new cartilage — not shockwave, not PEMF, not supplements, not the injectables marketed with before-and-after cartilage claims. Treatments can reduce pain, improve function, and slow the impact on your life, and that's genuinely valuable. But a claim to reverse arthritis is a claim to be skeptical of.
When it's time to consider surgery
For advanced arthritis that's severely limiting your life despite good non-surgical care — pain that disturbs sleep, a joint that's failing at daily tasks — joint replacement is the definitive treatment, and modern hip and knee replacements have strong, well-documented outcomes. Recognizing when you've reached that threshold, and referring you on rather than stringing out treatments that can't match the problem, is part of what honest care looks like.
When to get assessed promptly
- The joint is hot, red, and swollen, or the pain came on suddenly and severely — this can signal infection or gout, which need urgent, specific care.
- Several joints flare together, especially with morning stiffness lasting over an hour — this can point to an inflammatory arthritis that's treated differently.
- There's fever, unexplained weight loss, or night pain that won't settle.
What to do next
If a knee or hip has been aching and you want a plan that's honest about what helps, a consultation is the place to build one. We'll work out what's actually going on, get you pointed at the strengthening and activity that do the heavy lifting, and be straight about whether shockwave or PEMF is a worthwhile adjunct for your joint — or whether the right next step is imaging or a specialist referral. The goal isn't to sell you a course of anything. It's to get the order of treatment right.