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Aim: to compare the effects of acupuncture, physical modality and home based exercise training on symptoms of knee osteoarthritis. Patients: all patients with knee osteoarthritis, according to American college of rheumatology (ACR) criteria, referred to the clinic of physical therapy in Firoozgar hospital, Tehran, Iran. Main inclusion criteria were knee pain lasting for 6 months or longer and age between 40-65 years. Main exclusion criteria were receiving NSAIDs during study and exacerbation of symptoms. Sixty patients with knee osteoarthritis were randomly divided into three groups (A,B and C) .The acupuncture group (A) received only acupuncture at selected acupoint for knee pain; the physical modality group (B) received TENS (transcutaneous Electrical Nerve Stimulation), ultrasound and hot pack at pain areas .The exercise group (C) received isometric exercise of the knee. Each group received treatment 3 sessions per week for 4 weeks. Evaluating measurement tools were Visual Analogue Scale (VAS) for pain intensity and KOOS questionnaire for function.