Background: Knee Osteoarthritis (OA) is a leading cause of disability, with treatment approaches varying widely based on clinical judgment and patient-specific factors. Despite the availability of clinical guidelines, there is inconsistency in treatment preferences among physical therapists, which may influence patient outcomes. Objective: The study aimed to identify the commonly used treatment modalities for Knee OA by physical therapists in Punjab and to evaluate the adherence to clinical guidelines in practice. Methods: A cross-sectional survey was conducted involving 100 physical therapists from various cities in Punjab, who were selected using convenience sampling. Participants were provided with a standardized questionnaire to capture demographic data, clinical experience, and preferred treatment approaches for Knee OA. Data was collected in a one-time setting across government and private clinical environments over a four-month period. Therapists with a minimum of three years of clinical experience were included if they consented to participate. The data was analyzed using SPSS version 25.0. Results: Of the physical therapists surveyed, 54% were male and 46% were female. The majority (56%) worked in private/primary health centers, with lesser representation in general/specialist hospitals (19%), tertiary/teaching hospitals (17%), and secondary/federal medical centers (8%). Diagnostic preferences showed a reliance on Range of Motion assessments, with other methods such as muscle strength and radiographic findings also utilized. Treatment preferences indicated a predominant use of TENS (87 therapists), followed by ultrasound (61 therapists), and education regarding weight control (47 therapists). Less frequently used treatments included acupuncture (2 therapists) and aerobic exercises (4 therapists). Conclusion: The treatment preferences for Knee OA among physical therapists in Punjab do not consistently align with established clinical guidelines, indicating a need for enhanced guideline education and integration. The predominance of private practice settings may influence these preferences, suggesting a potential area for targeted guideline dissemination.