Every major osteoarthritis guideline in the world lists weight management as core care. Ben Steele-Turner's scoping review pulled together 79 records on what physiotherapists do, and the picture is messy. Clinician surveys have 60 to 94 per cent of physios saying they include weight management. Notes audits and patient interviews put it closer to 8 to 22 per cent.
Ben is a physiotherapist and PhD candidate at the University of Portsmouth, and he joins me to talk through why that gap exists and what to do about it. We get into scope of practice and why so many clinicians find the conversation awkward.
We also cover the part I've always struggled with. Osteoarthritis is a whole system condition, inflammatory, metabolic, psychological, and yet the mechanical side is the bit I know how to do. Sets, reps, load, progression.. Ben and I dig into whether the lifestyle side actually outperforms what we're already doing, what someone can be offered for faster relief in the first few weeks, and where taping, footwear, orthoses and injections sit.
Then there's the steroid question. If a knee is angry and inflamed we know what that environment does to cartilage, but the drug that settles it is itself chondrotoxic. Do we steer people away from it or put it on the table and let them decide? And can we really blame someone for wanting the pain gone now, when most of us wouldn't accept "just live with it" for our own injuries either.
Ben finishes with how he selects exercise for someone with knee OA, whether he starts local or zooms out, and the one thing he wants every patient to walk away understanding about their knee.
Papers discussed:
Steele-Turner B, Gonçalves AC, Shepherd AI, Drummond H, Allison K, Bennell KL, Exell TA. Physiotherapist-led weight management for people with osteoarthritis: A scoping review. Osteoarthritis and Cartilage 2026;34:121-138. https://pubmed.ncbi.nlm.nih.gov/41276008/
Moseng T, Vliet Vlieland TPM, Battista S, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024;83:730-740. https://pubmed.ncbi.nlm.nih.gov/38212040/
