Background: Osteoarthritis is a common form of degenerative joint disease characterized by the wear and tear and progressive loss of particular cartilage. It is One of the major causes of physical disability & the most common indication for knee replacement. Knee osteoarthritis is classified as primary and secondary depending upon its cause. The main clinical features are pain, stiffness and restrictions in functional activity. Pilates exercise is a mind-body fitness program. Interferential therapy is combined along Pilates exercise to relieve pain, stimulate muscle, increase the local blood flow and reduce edema. Objective: To investigate the effectiveness of Pilates exercise combined with interferential therapy (IFT) on pain and functional outcomes in individuals with knee osteoarthritis. Methods: A pre–post experimental study was conducted among 40 participants aged 35–65 years diagnosed with knee OA. Participants underwent Pilates exercise combined with interferential therapy four sessions per week for four weeks. Pain intensity and functional status were measured using the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analysis was performed using paired t-test. Results: Significant improvements were observed in VAS scores (Pre: 6.20 ± 0.96; Post: 3.82 ± 1.19) and WOMAC scores (Pre: 59.15 ± 5.58; Post: 27.97 ± 3.64), with p ≤ 0.001. Conclusion: Pilates exercise combined with interferential therapy is an effective physiotherapeutic intervention for reducing pain and improving functional ability in patients with knee osteoarthritis.