If your knees have started negotiating with you every time you stand up, you’ve probably heard the menu: physical therapy, laser treatments, shock waves, ultrasound, electrical stimulation, special insoles, pool classes.
Some cost a fortune. Some are billed to Medicare visit after visit.
Now a team of researchers has ranked them. They pooled 139 randomized trials covering 9,644 people with knee osteoarthritis and compared 12 drug-free treatments head to head. The winner wasn’t the most expensive option or the most high-tech.
It was a knee brace.
I’m 71. I know a few things about creaky joints. So let’s look at what the analysis actually found, what it doesn’t prove, and how to get the winning treatment covered.
What the analysis found
The study, published in the journal PLOS One by orthopedic and rehabilitation researchers at the First People’s Hospital of Neijiang in China, used a technique called network meta-analysis. It lets scientists compare treatments that were never tested against each other directly by chaining together trials that share a common comparison.
The 12 contenders:
- knee braces
- lateral-wedge insoles
- exercise
- hydrotherapy (exercise in water)
- kinesiology tape
- TENS electrical stimulation
- interferential current
- shortwave diathermy
- therapeutic ultrasound
- low-intensity laser
- high-intensity laser
- shock wave therapy
Here are the best results, measured on the standard scales doctors use for arthritis:
Pain: Knee braces ranked first, exercise second, high-intensity laser third. Ultrasound finished last.
Function: Braces first, hydrotherapy second, shock wave third. Ultrasound last again.
Stiffness: Braces first, exercise second, hydrotherapy third.
Pain during activity: Braces first. Ultrasound last.
Hydrotherapy took the top spot for pain at rest and for the combined score. But when the researchers rolled every outcome together, the brace had the highest probability of being the best treatment, followed by hydrotherapy and exercise.
Their conclusion: A knee brace “may be the most recommended therapeutic option” for knee osteoarthritis. In a statement, the authors put it more plainly, saying “simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound.”
What it doesn’t prove
Before you throw out your gym membership, here’s some honesty about the limits.
The study was published in June 2025 and has been making the rounds again recently. It’s not a single new trial; it’s a roundup of existing ones.
The authors say many of those trials were small, and they varied in how long treatment lasted. And some had weak randomization or blinding. They only included studies published in English. Rankings like this are probabilities, not verdicts.
It also covered mild-to-moderate arthritis, not bone-on-bone knees. And the analysis lumped together different kinds of braces, from simple sleeves to hinged unloader braces that shift weight off the worn side of the joint.
Still, the finding lines up with what the experts already say. The American College of Rheumatology’s guideline strongly recommends braces for knee arthritis serious enough to affect walking or stability, and it strongly recommends exercise.
The American Academy of Orthopaedic Surgeons says a brace “could be used to improve function, pain and quality of life.”
The same rheumatology guideline strongly recommends against TENS electrical stimulation for knee arthritis, citing a lack of benefit. That one didn’t crack the top three in the ranking either.
Why this matters for anyone over 55
About 33 million American adults have osteoarthritis, according to the Centers for Disease Control and Prevention, and the knee is one of the joints it hits most. More than half of adults 75 and older have been diagnosed with some form of arthritis.
That’s a big market, and the market knows it. Physical therapy built around modalities like ultrasound or electrical stimulation is billed one visit at a time, week after week. Medicare pays 80% after your deductible, but it doesn’t rank the treatments by evidence. It just pays for the visit.
Meanwhile, the option that topped the list is a piece of equipment you wear.
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How to get a brace covered by Medicare
A drugstore knee sleeve costs a few dollars and you can buy one this afternoon. But the braces studied for arthritis are often more substantial, and a custom unloader brace can run several hundred dollars or more.
Here’s the good news: Medicare Part B covers leg braces when a doctor or other provider orders them as medically necessary. You pay 20% of the Medicare-approved amount after meeting the Part B deductible, which is $283 in 2026.
Two rules to follow:
Get the order from your own doctor. Bring up the study. Ask whether a brace fits your case and, if so, which kind is best for you. Fit matters, and a professional should do it.
Use a Medicare-enrolled supplier that accepts assignment. Medicare only pays for durable medical equipment from enrolled suppliers, and a supplier who won’t accept assignment can charge you more than the approved amount. Ask before you buy.
The scam to watch for
There’s a reason braces are on the government’s radar. The Office of Inspector General at the Department of Health and Human Services has a standing fraud alert about companies that call Medicare beneficiaries or run TV ads offering “free” braces.
You give them your Medicare number, a brace you didn’t ask for shows up, and Medicare gets billed for it, sometimes even for several of them.
The rule is simple. If a brace is a good idea, the conversation starts with your doctor, not with a phone call from someone you’ve never met. Hang up, and never share your Medicare number with a stranger. We’ve covered the sneakiest Medicare scams before, and this one’s a regular.
The bottom line
Nobody’s saying a brace replaces exercise. The same analysis put exercise and water workouts right behind it, and the rheumatologists want you moving.
What the numbers say is that the cheapest, lowest-tech options on the menu hold their own against the expensive ones, and the treatment that repeatedly landed at the bottom is one that gets billed a visit at a time.
Before you sign up for another round of anything, ask your doctor one question: Is there evidence this works better than a brace and a walk? If the answer is a shrug, you have your answer.
If you’re also spending money on joint supplements, we’ve looked at which ones have evidence behind them. And if surgery is on the horizon, know that the same knee operation can cost 30 times more depending on where you have it done.
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