Exercise, Medicine and Icing (EMI) for the Knee: Small Instalments, Big Gains in Early Osteoarthritis

BACKGROUND: Early knee osteoarthritis (OA) is a common cause of pain and functional limitation, often managed conservatively with medications and physiotherapy. The EMI protocol (Exercise, Medicine, and Icing) was developed as a surgeon-led, home-based intervention aimed at improving pain, function, and muscle strength in patients with early knee OA. METHODS: This prospective, parallel-group, randomised controlled trial included 150 patients aged 40-70 years with Kellgren-Lawrence Grade 1-2 knee OA. Participants were randomised to receive either the EMI protocol (exercise, icing, and a standardised 6 week medical regimen including vitamin D, calcium, and magnesium supplementation) or the same medical regimen alone. The primary outcome was change in Visual Analog Scale (VAS) pain score at 6 weeks. Secondary outcomes included Kujala score, quadriceps strength (manual muscle testing), rescue NSAID use, adherence, and adverse events over 1 year. RESULTS: At 1 year follow-up, 138 patients (92%) completed the study. The EMI group demonstrated significantly greater pain reduction (VAS 6.6 ± 1.1-1.9 ± 0.9) compared with Medicine Alone (6.5 ± 1.2-3.4 ± 1.2; p < 0.001). Functional outcomes (Kujala score), quadriceps strength, and reduction in rescue NSAID use were also significantly superior in the EMI group. Adherence to exercise and icing was high, and adverse events were minimal and comparable between groups. CONCLUSION: The EMI protocol was associated with significantly greater improvements in pain, function, and quadriceps strength compared with medical therapy alone in patients with early knee OA. The findings support the incorporation of structured home-based exercise and cryotherapy into conservative management strategies for early knee OA. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01939-3.