Assessing Nonsurgical Options for Knee Osteoarthritis

In knee osteoarthritis therapy, transcutaneous electrical nerve stimulation (TENS) is sometimes used to help relieve pain, raising the question of whether combining it with exercise can improve treatment outcomes. In a randomized, sham-controlled trial researchers assessed whether high-frequency TENS provided additional benefits when delivered alongside a structured exercise program.

The findings are published in Physiotherapy Research International . The researchers enrolled 96 people with knee osteoarthritis and randomly assigned them to one of two groups. One group received exercise therapy combined with active high-frequency TENS, and the other received the same exercise program with sham stimulation.

The study was designed to determine whether active electrical stimulation offered meaningful benefits beyond those associated with exercise and the treatment experience itself. The primary outcome was the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Researchers also assessed other aspects of knee-related quality of life, pain intensity, confidence in managing pain, individual functional goals, disability, quadriceps strength, and physical performance.

Outcomes were measured before treatment, immediately after the intervention, and at a 1-month follow-up visit. The results showed no significant additional benefit from active TENS. Immediately after treatment, the adjusted difference between the groups on the KOOS pain scale was 1.05 points, with a 95% CI of −5.19 to 7.29.

At the 1-month follow-up visit, the difference was 0.40 point, with a 95% CI of −5.91 to 6.71. Both estimates were well below the study’s predefined threshold of 10 points for a clinically meaningful difference. The researchers also found no statistically significant differences between the groups in any of the secondary outcomes.

This included measures of physical function, muscle strength, pain-related self-efficacy, and disability. No adverse effects were reported during the study. These findings suggest that adding high-frequency TENS to a structured exercise program does not necessarily improve outcomes for people with knee osteoarthritis.

Although electrical stimulation may be appealing as an additional pain-management option, the trial did not demonstrate that it provides meaningful benefits beyond sham stimulation when both groups receive exercise therapy. This study has important limitations. Follow-up lasted only 1 month after the intervention, so the study cannot establish whether longer-term effects might emerge.

The researchers also did not formally assess the success of participant blinding, and the absence of an exercise-only group means the trial cannot determine how the overall treatment experience compares with exercise alone. For clinical practice, the findings reinforce the importance of exercise-based rehabilitation rather than routinely adding TENS with the expectation of better results.

Treatment decisions should still be individualized, taking patients’ preferences, symptoms, and response to therapy into account. References Dos Santos PG, et al. Physiother Res Int .

2026;31(4):e70351. doi: 10.1002/pri.70351