Exercise and Self Management


NICE Guidelines


The National Institute for Health and Care Excellence (NICE) has recommended core, evidence-based management approaches that should be undertaken for everyone with osteoarthritis and a suite of approaches that can be used to support patients to undertake core treatment and manage their symptoms.

Core treatment for osteoarthritis includes supported self-management:

First line adjuncts to core treatment approaches include:

  • Drug-based approaches: paracetamol, topical non-steroid anti-inflammatories (NSAIDs), topical capsaicin
  • Non-drug-based approaches: local heat or cold, assistive devices, supports/braces, transcutaneous electrical nerve stimulation, manipulation/stretching (for hip osteoarthritis)

Second line adjuncts to core treatment approaches include:

  • Oral non-steroidal anti-inflammatories (NSAIDs), cyclo-oxygenase-2 (COX-2) inhibitors, opioids

In addition to these recommendations, intra-articular corticosteroid injections can be considered to support use of core treatments and joint arthroplasty can be considered if core management has been offered without adequate benefit.

Review and follow-up of all patients with symptoms of osteoarthritis is recommended, timed according to the needs of the individual patient.

References and Further Reading

NICE Clinical Guideline CG177 Osteoarthritis: Care and management (2014) https://www.nice.org.uk/guidance/cg177

NICE Quality Standard QS87 Osteoarthritis (2015) https://www.nice.org.uk/guidance/qs87