Knee osteoarthritis treatment at Novo Soft Tissue starts with a full knee exam, not with a device. We check the joint, the muscles and tendons that control it, and the hip and foot that load it, then explain what we find. If treatment fits, the options are focused shockwave, radial shockwave, EMTT, or manual therapy, chosen to match the findings. The goal is less pain and better function. We cannot reverse osteoarthritis or regrow cartilage, and our care works alongside exercise-based rehab and your physician's care, not in place of it.
Background
Why the X-ray Isn't the Whole Story
X-rays can show the structural changes of osteoarthritis and are especially useful when symptoms are atypical, another diagnosis is suspected, or surgery is being considered. Many cases of knee osteoarthritis can also be diagnosed clinically without routine imaging. An X-ray does not show the joint lining, the tendons, the muscles, or how sensitive the knee has become.
That is why X-ray grade and pain often disagree. A 2008 review of population studies found that, among people with X-ray evidence of knee osteoarthritis, the share who had knee pain ranged from 15% to 81%, depending on how each study defined pain and graded the images. Its authors concluded that knee X-rays should not be used in isolation to assess an individual patient. We explain the research in why knee X-rays and pain don't always match.
Examination
What We Examine in a Painful Knee
- Range of motion, swelling, and where along the joint line it hurts
- Quadriceps and hip strength, and how well the quadriceps switches on
- Tendon attachments around the knee, including the patellar tendon and the inner shin just below the joint. Focal pain at the patellar tendon with jumping or running may be patellar tendinopathy rather than arthritis
- How the kneecap moves, and how the joint capsule, quadriceps, and iliotibial band move and feel. Restricted or adhered tissue there is an exam finding that can add stiffness. It is not the cause of osteoarthritis.
- Hip and foot mechanics that change how load reaches the knee
- Locking, giving way, a hot swollen joint, or night pain, which call for a referral
We also review any X-rays or MRI you bring, so the exam findings can be read against the imaging.
Differential diagnosis
Not All Knee Pain Is Osteoarthritis
Arthritis on an X-ray does not prove that the joint is the source of the pain. Several problems can look similar and need to be separated on examination.
- Patellofemoral pain Pain around or behind the kneecap with stairs, squatting or prolonged sitting.
- Patellar tendinopathy Focal pain at the tendon just below the kneecap with jumping or running. See patellar tendinopathy.
- Meniscal tear Joint-line pain with catching, locking or a twisting injury. Degenerative meniscal changes are also common in knees without pain.
- Pes anserine pain Tenderness on the inner shin just below the joint line rather than within the joint.
- Inflammatory arthritis or gout A hot, swollen joint, several painful joints or prolonged morning stiffness points away from typical osteoarthritis.
- Pain referred from the hip Hip joint problems can be felt in the thigh and knee, so the hip is part of the knee exam.
Treatment selection
How Treatment Is Selected
The plan follows the exam. Focused shockwave (ESWT) reaches a specific, deeper target, such as a tendon attachment or a localized painful area near the joint. Radial shockwave spreads across more superficial muscle and tendon. EMTT delivers a magnetic field through a broader volume of joint tissue. Manual therapy addresses restricted soft tissue where it can be reached by hand.
Some knees get one tool, some get a combination, and some get none, with a referral instead. When EMTT and shockwave are used together, the reasoning is in EMTT alone or with shockwave. You can compare all four tools on our services page.
Strength and activity remain central. Exercise-based rehabilitation is a core part of knee osteoarthritis care, and injections and joint replacement help many people. We aim to reduce pain and stiffness enough that you can keep moving and loading the knee, and we coordinate with your physical therapist or physician when you have one.
Imaging & referral
When Knee Pain Needs Imaging or Referral
Knee osteoarthritis is often diagnosed clinically. Imaging or referral may come first when:
- the knee is hot, red and swollen, or you feel unwell or feverish, which needs same-day medical assessment
- you cannot bear weight after a fall or twisting injury
- the knee locks or repeatedly gives way
- pain is severe at night or at rest, or comes with unexplained weight loss
- symptoms are atypical, progress quickly, or joint replacement is being considered
We review any imaging you bring and coordinate with your physician or orthopedic surgeon when referral is the right next step.
Evidence
Does Shockwave Help Knee Osteoarthritis?
Shockwave therapy for knee osteoarthritis has been studied in dozens of randomized trials. A 2019 meta-analysis of 50 trials found less pain and better function than control treatments, and energy level and follow-up length predicted the size of the effect. A 2023 review of 12 trials found benefit over sham, with smaller gains when shockwave was added to exercise therapy. A 2024 umbrella review of eight meta-analyses reported an average pain reduction of about 2 points on a 0–10 scale versus sham. Another 2024 review found shockwave effective against sham but not in severe osteoarthritis.
The limits matter. Protocols vary widely, most follow-up is short, and none of these trials shows cartilage regrowth in people. The evidence supports shockwave as a way to reduce pain and improve function in some knees, not as a cure.
EMTT has less research. A 2026 sham-controlled trial enrolled 126 patients with three diagnoses: knee osteoarthritis (31), rotator cuff enthesopathy (43), and lumbar spondyloarthrosis (52). For the whole cohort, pain at 12 weeks was 2.2 with EMTT versus 4.2 with sham on a 0–10 scale. These are combined results, not knee-only figures. The full review is in shockwave therapy for knee osteoarthritis: what the research shows.
Sources: Liao et al., Clin Rehabil 2019 · Silva et al., Clin Rehabil 2023 · Tang et al., Int J Surg 2024 · Liao et al., J Orthop 2024 · Hollander et al., J Back Musculoskelet Rehabil 2026 · Bedson & Croft, BMC Musculoskelet Disord 2008