Where You Live Decides Your Knee Care: New Report Reveals Stark Gaps

A fresh look at knee pain care — and why it matters now

Millions of Americans see a doctor for knee pain every year. A new report from Motive Medical Intelligence says the care they receive depends heavily on where they live. In some places, patients are getting the kinds of treatments experts recommend. In others, people routinely miss simple, proven steps that doctors say should come first. That matters because those early steps can ease pain, improve function and sometimes prevent more invasive surgery.

The report analyzed patterns of care across the country and found wide swings in how often guideline‑recommended services are used. The differences are not small. In some regions, patients are much less likely to get basic treatments such as supervised exercise programs or recommended imaging checks before surgery. The upshot: two patients with the same knee problem could end up on very different care paths simply because of their ZIP code.

Where the shortfalls are most pronounced

Motive’s analysis highlights clear geographic pockets where recommended knee care is far less common. Rural areas and some smaller metro regions show the largest gaps. Large parts of the South and certain Midwestern communities appear to lag behind coastal and larger urban centers that offer more consistent access to guideline care.

Inside states, the report finds sharp contrasts between metro areas. Wealthier, better connected cities — where specialty clinics, physical therapists and integrated health systems are more common — tend to show higher use of non‑surgical treatments that experts favor. By contrast, smaller towns and some exurban counties often show lower rates of those services and higher reliance on quick fixes like imaging or injections without accompanying physical therapy.

The picture is not uniformly bleak in any single state. Even states that perform well overall still contain pockets where patients receive care that does not match professional guidance. That patchwork pattern means the problem is both regional and local: community‑level resources and local practice habits play a big role.

Which recommended services are being missed

The report focuses on care steps that professional societies and experts typically recommend as first‑line treatments for knee problems. These include structured exercise and physical therapy programs, education about self‑management, weight-management support when appropriate, and careful use of imaging and specialist referral before recommending surgery.

Across many lagging areas, patients are less likely to receive supervised exercise or a course of physical therapy before moving to more invasive options. In some regions imaging like MRI is used early and often, while other places delay imaging until it will change management. The report also notes that referral patterns vary: in advantaged regions, primary care clinicians and physical therapists are more likely to manage knee pain for longer before sending patients to an orthopedist.

What’s driving these differences

The report points to several overlapping reasons for the gaps it documents. Access is central: places with fewer physical therapists, fewer multidisciplinary clinics, and longer travel times to specialists show lower uptake of recommended non‑surgical care. Insurance design and coverage rules also matter — when coverage for supervised exercise or multiple therapy visits is limited, patients and clinicians may skip those steps.

Socioeconomic factors are part of the story too. Areas with higher rates of poverty, lower education levels, and more people working multiple jobs can make it harder for patients to attend regular therapy sessions. Provider supply and local practice culture also shape care. In some communities, clinicians are used to managing knee pain with rapid imaging and procedural treatments; in others, there’s a stronger emphasis on conservative management first.

The report is careful to separate what it documents from what it assumes. Some differences reflect true access barriers. Others may come from local clinical judgment or differing patient preferences. But when entire regions show consistently low use of guideline care, that pattern points to system‑level obstacles rather than isolated choices.

How clinicians, societies and payers are responding

Report authors and professional groups say the solution is not mysterious. They recommend expanding access to supervised exercise programs, making physical therapy easier to reach and pay for, and aligning incentives so that conservative care is prioritized before invasive options. Some health systems are already testing bundled care programs that encourage a structured non‑surgical pathway, while insurers in a few markets are adding coverage for specialized exercise or digital therapy programs.

Payer responses vary. Some commercial plans and accountable care organizations are exploring ways to remove financial barriers to recommended care. Health systems are also looking at workforce shifts — for example, enabling physical therapists to take a larger role in early management, or using telehealth to reach patients in areas with few local therapists. Report authors call for more coordinated efforts so that improvements aren’t limited to pockets of the country.

How the report reached its conclusions — and its limits

Motive Medical Intelligence based its findings on large‑scale patterns of clinical activity drawn from claims and other care‑delivery data. That approach lets researchers compare care across many regions and spot consistent differences. It’s strong for spotting trends and geographic variation at scale.

But the methods have limits. Claims and routine care data don’t always capture clinical details such as severity of symptoms, patient preferences, or informal care patients might receive. The data also can’t fully explain why a particular clinician chose one treatment over another. In short, the report maps what happens, not always why a given decision was made in a specific case. The authors acknowledge these caveats and frame their work as a broad view that points to where deeper local investigation is needed.

Why these gaps matter beyond a sore knee

At first glance, knee care might seem like a narrow issue. But the differences the report uncovers have broader implications for health equity and system performance. When guideline‑recommended, low‑risk treatments are underused in some communities, patients may face avoidable pain, slower recovery and higher likelihood of more invasive — and more expensive — interventions later on.

Fixing these gaps could improve quality of life for many people, reduce unnecessary procedures, and make care spending more efficient. The changes required are practical: expand access to physical therapy, redesign coverage rules to support conservative care, and invest in workforce and telehealth solutions where local supply is thin. The challenge will be turning recommendations into consistent practice so that where you live no longer predicts the care you get for a common, often treatable condition.

Photo: Robert Golebiewski / Pexels

Sources

• prnewswire.com